T Nation

My HRT Journey


#1

So...my journey began the beginning of January when I got back the test results from my annual physical.

But first, about me:
-age
45 this July 1st

-height
5' 8.5"

-waist
50

-weight
378.5 (23.7 lbs lost since diet began 6 weeks ago with a high of 402.2)

-describe body and facial hair
Sparse. Quarter American Indian...none of the family is very hairy. Decent goatee...too many bald spots for a good beard...thin mustache.

-describe where you carry fat and how changed
I carry it all over at this point, but more heavily around the middle. Started gaining quickly 12 years ago when my wife was pregnant 51 lbs. Slowly ramped up since.

-health conditions, symptoms [history]
Compression fracture of the L2 1983. Worked out heavily to rehabilitate and became a Weider disciple.
Diagnosed with GERD in 95. .
Diagnosed with borderline high BP in 96.(diastolic hovers between 85-90 untreated).

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Mycardis HCT 80/25 for BP. (usually around 140/70)
Zantac 150mg 2-3/day for GERD.
Never any hair loss or prostate drugs.
Androgel 1% 5mg/day for last 2 weeks, was 7.5mg/day for 12 weeks prior, (this has been changed to Test Cyp 200mg/ml .25ml E3.5D starting next week).
Anastrozole 3mg/week divided ED (This has been changed to 1.5mg/week divided 3 times per week by new doctor, and per advise from KSman)

-lab results with ranges
1/7/11, 7:38am draw (pre HRT)
TT 100 (241-827 ng/dL) L - No FT or E2 taken at this time
TSH, 3rd Generation 1.22 (.040-4.50 mIU/L)
T4, Free 1.1 (.8-1.8 ng/dL)
Cholesterol, Total 137 (125-200 mg/dL)
12 hour fasting Glucose 104 (65-99 mg/dL) H note...this is before starting on a diet.
A1c 6.2(<5.7% of total Hgb) H
AST 20 10-40 U/L
ALT 29 9-60 U/L

2/2/11, 7:29am draw
Glucose 114 66-99mg/dL
TSH, 3rd Gen. 1.80 0.40-4.50 mIU/L
T4, Free 1.3 0.8-1.8 ng/DL
ACTH, Plasma 22 7-50 pg/mL
Cortisol, Totl 12.5 mcg/dL
FSH 1.3 1.6-8.0 miU/mL
LH 2.1 1.5-9.3 miu/mL
Prolactin 7.7 2.0-18 ng/mL
TT 113 241-827 ng/dL (after 6 weeks of Androgel 1%, 5mg/day)
E2 54 13-54 pg/mL
PSA, Total 0.8 < OR = 4.0 ng/mL - test performed using Siemens chemiluminescent method
Hemocrit 43.8 38.5-50.0 %
AST 19 10-40 U/L
ALT 25 9-60 U/L
MRI on the Pituitary was ordered at this point and came back negative

4/7/11, 7:21am draw
FSH <.07 1.6-8.0 mIU/mL
E2 42 13-54 pg/mL - began Anastrozol 1mg/week, 11 drops EOD
PSA, Total 1.2 < OR = 4.0 mg/mL - test performed using Siemens chemiluminescent method
TT,(LC/MS/MS)? 120 250-1100 ng/dL - after 6 weeks Androgel 1%, 7.5mg/day
FT 31.1 35.0-155.0 pg/mL

5/11/11, 7:38am draw
TT,(LC/MS/MS) 602 250-1100 ng/dL - after 5 more weeks Androgel 1%, 7.5mg/day (changed application area)
FT 146.3 35.0-155.0 pg/mL
E2 38 13-54 pg/mL - increased Anastrozol to 2mg/week 9 drops ED after results

6/22/11, 7:28am draw
TT,(LC/MS/MS) 604 250-1100 ng/dL - after 5 more weeks Androgel 1%, 7.5mg/day (changed application area)
FT 176.6 35.0-155.0 pg/mL
E2 32 13-54 pg/mL - increased Anastrozol to 3mg/week, 13 drops ED after results

-describe diet [some create substantial damage with starvation diets]
Currently on a diet consisting of 2 meals of Myoplex Shakes, one regular balanced meal, and 2-3 snacks. The usual is a 17oz Myoplex shake for breakfast or lunch http://eas.com/product/myoplex-original-ready-to-drink. If I eat breakfast, it's 2 scrambled eggs, 2 turkey sausage links and possibly a bagel with orange juice. If I eat lunch it's usually some sort of turkey wrap or chef salad with a vinaigrette. Dinner is 2 11oz low carb EA shakes http://eas.com/product/advantedge-carb-control-ready-to-drink. Snacks are some nuts, usually pistachio, carrots, broccoli or occasionally a trail mix with low as possible sugar. I am maintaining 1100-1800 calories a day with occasional splurges on my one meal. Haven't gone above 1900 in the last 6 weeks.

current supplements:
NSI Mega EFA�?�® Omega-3 EPA & DHA -- 2.126 grams per serving http://www.gonsi.com/...ku-835003005017
NSI CoQ10 -- 100 mg x2 per day http://www.gonsi.com/...ku-835003004560
NSI Chromium Picolinate -- 500 mcg x2 per day http://www.gonsi.com/...ku-835003004126
NSI Synergy�?�® NutriSlim Low Carb Dieter's Basic Multi-Vitamin http://www.gonsi.com/...835003001552NSI
Iodoral 12.5mg/day
NatureMade D3 2000iu x2/day (will switch to 5k ui/day once these run out per suggestion from KSman)

Will be looking into some probiotics, Acetyl L-Carnatine and Lipoic Acid based on KSman's recommendations. Also will be changing my multi-vitamin.

-describe training [some ruin there hormones by over training]
Very little training at the moment. Swimming for an hour 3 times a week is about all my back allows right now. As I lose some weight I'll be adding walking, and then running to the mix. Have mo plans to start lifting again until I lose at least 100lbs and figure out a way to pay for it.

-testes ache, ever, with a fever?
Occasional ache in the last few weeks. Doesn't last long...no fever.

-how have morning wood and nocturnal erections changed
Don't have morning wood other than the occasional piss hardon. Don't have nocturnal erections either. Had a period of about 3 weeks when I felt back to normal when I first started androgel, as is usual, but then quickly went back to feeling like shit.

The whole interest in this was sparked by two things. First, I hit 400lbs shortly after my 44th birthday and the low carb diet I was on wasn't doing shit. Second, I had been feeling progressively crappier but was chalking it up to getting older and being grossly obese. Right before my annual physical in January, I heard one of the commercials that have been playing about bio-identical HRT, and when they went down the list of symptoms of low T, I could say yes to about 2/3 of the list. So I asked my primary care doc to throw a TT on the blood work and it came back at 100. From there, we decided to try an Endo since my glucose was borderline as well (prior to finding this site, mind you). He put me on 5mg/day of Androgel and told me that I was making Estrogen from being fat, and that I needed to lose weight (you think?). Not feeling real great about his lack of feedback, I started doing some research, which led me here.

Needless to say, I wasn't too thrilled when I read how much he was likely to suck, which he confirmed my next visit when I brought him a bunch of studies I printed out, that were referenced here, and asked him about Anastrozole. Since he wouldn't put me on it, I bought it myself and went from there...starting at 1mg/week and up to 3mg/week.

Once it was clear that I wasn't getting anywhere, I took KSman's post advice about finding an hrt doc, called the compounding pharmacist, got a recommendation and made an appointment. In the meantime I contacted KSman via PM, and he patiently put up with a week worth of back and forth questions and got me pointed in the right direction. I can't thank him enough.

That appointment was today. He listened to me for 30 minutes about what I wanted, what I expected, and what I had read here. He then prescribed 100mg of Test Cyp per week, 1.5mg of Arimidex in 3 .5mg doses per week, and a cycle of 250iu EOD of HCG to start me off, with a follow up in 6 weeks to review blood tests. He also ordered TSH, fT4 and fT3 which I should have back by the end of the week.

So I decided to stop lurking, put up my thread, and once again publicly thank KSman for all his time and effort in putting up with yet another noob he didn't know from Adam.

And also a thank you in advance for anyone else who chimes in on yet another thread by a noob.


#2

Isn't it wonderful...5 months dicking around with an Endo that wants to put me somewhere within the chart on his Endo script, and I finally get what seems like he will be a good HRT doc...who gives me just what has been suggested here as a start to a good HRT program...and I find out my insurance doesn't cover Test Cyp or HCG.

Just lovely.


#3

Test cyp really isn't that expensive...I got a 10 mL vial (200 mg/mL) for $60 at Costco, and I'm not a member. I think its $5 less if you have a membership. Not sure how expensive hcg is, but can't imagine it being much higher than that. So for $60 I get a 20 week supply of test--not too bad IMO...

CVS wanted to ream me for like $120/bottle...bad deal....

Your diet is shitty and ridiculously low on calories and is probably fucking up your metabolism...you are nearly 4 bills dude, you need way more than 1100 calories a day to maintain whatever muscle you have and not fuck up your thyroid....

Do some searching on this site for sensical nutrition plans....


#4

Cheapest I could find it locally was $94. CVS was $95 for a 10ml bottle...and I wanted it today. The HCG will be ready tomorrow from a compounding pharmacy. It's $75...not sure the amount, but I'm guessing it's an 8 week supply.

The diet is what it is. It's what's doable with my schedule and finances. Daily intake is closer to 1800 most days than 1100.

My metabolism has been fucked for the last decade...this diet didn't start it. This diet is the first one I've been on in quite some time that's actually been working at all. If I eat more than about 2k calories a day, I gain. Two different doctors have approved it, so it's what I'm going with until I break below 300 and can get some of this pressure off of my joints and back.

But...I have looked at some of the nutritional information and will continue to do so. I'm hoping once I get my E and aromatasation under control, I won't find it so difficult to lose weight and will switch to something better.

So I do appreciate the input and will take it into consideration.


#5

Starvation diets lead to bad thyroid problems, and seeing as how your thyroid miraculously is (appearing to be) OK, I would second VT's suggestion. I know you want to feel better now, and drop weight as quickly as possible... but not thinking in terms of long-term goals is probably what got you into your current situation.

I know heavier people drop weight more quickly, but 4lbs/week still seems like a lot to me (OP stated 24lbs in 6 weeks).

What was the refernce range for your cortisol draw? If it was the typical range, where the top is 20ish, you might need some adrenal support. 12.5 isn't the worst on this board but is far from optimal (if I have my reference range right - you want to be near the top of the range at an 8am draw, which I'm assuming is 20)


#6

Test result for TSH, fT3 and fT4 came back today and were normal. They're mailing me the results today so I should have them tomorrow or the next day and I'll post then.

I don't know what to say on the diet. I don't lose if I'm much over 2k per day...and I want 4lbs a week average for the first 100lbs. My only workouts consist of 3 hours a week in a pool doing side stroke, breast stroke and a vigorous treading water for an hour at a time, trying to keep my heart rate up while doing so at 60% of my max heart rate.

Other than that, I pretty much sit on my ass. My job is seated, and I manage a decent sized IT department, so I'm sitting for most of the day 10-12 hours a day...and doing much the same at home. If I don't keep my caloric count fairly low, I don't lose.

I'm currently using a program called Myfitnesspal.com on my phone and at home to keep a diary of what I've been eating and so far, it's been working. Once I drop to below 300lb, the goal will become 2 lbs a week to 200.

We'll continue to monitor Thyroid in the meantime and I'll continue searching this site for ideas on how to change my diet and still meet my goals. I will also try to make sure I don't go below 1600 calories a day from this point forward. We'll see how it goes.

You know, that's the only thing that didn't have a range on the results sheet. In any case, I called Quest and after having to get a supervisor to talk to me, she said the 8am draw range on total is 4.0-22.0. That draw was at 7:29am and I was up at 5:45am to make it to the lab on time before work.

I don't sleep well. I think that's the root of a good many of the things that are a bit off on my numbers...including cortisol. But I'll bring it up to the doc when I see him in 6 weeks.


#7

Oh...one other thing.

Did my first injection of Test Cyp yesterday. All they had was a 28g 100ml syringe, so I'll be picking up some 50ml after I get paid Friday. Filling and use went exactly as described on multiple threads here...slow but steady. Thanks for all the good advice on that from all who've given it.

Picked up the HCG today from a compounding pharmacy the doc sent the script to. 3ml of 5000U/5ml (month supply at 250iu EOD, 3x/week) was $75 for the month's supply. Not happy about that cost. Going to need to press my crap insurance on it. I don't see why I have to get the doc to sign a "medically necessary" form. Not like I'm going to jab myself with a sharp object 3 times a week for something that isn't "medically necessary."

In any case, the stick was a breeze. Didn't feel it go in until the barrel of the syringe touched the skin. Still gives me the willies a bit, but it's getting better.


#8

You don't sleep well and your cortisol is low... two signs of poor adrenal function. This bears more testing (i.e. 4x saliva test) as TRT often won't do much if you don't have your adrenals in line.

I know your thyroid is fine now - I'm saying that starvation diets over a period of time will damage it. It won't show anything from a week or a month of lowish intake. Adrenals, thyroid, and T are all linked and I'd hate to see the one strong link in your chain broken. That's all.


#9

Fair enough.

What's the definition of "starvation" diet? If I maintain at 2k, and gain above that, at what point am I going so low that I'm in starvation mode?


#10

Depends on the person, there is no set kcal mark. 4lbs/week sounds like a crapload to me, I've never heard of much over 2lbs/week... but I don't have much experience being that heavy so I'm just saying be careful and watch your thyroid markers closely.


#11

When I decided on a goal weight per week, I did take several factors into consideration, and did discuss it with both my primary care physician, and my endocrinologist. The latter not only listened to what I had to say, but looked at my food diary for a week as well as the supplements I was taking and the meal replacements I was using. Both approved the diet.

At a 402 lb starting weight and a BMI of 61.1, 4lbs a week is 1% a week of loss. The typical pre-op diet plan for the most common forms of bariatric surgery is 800-1200 calories today with 70-120 grams of protein a day for 4 to 6 weeks.

Post op counts start at about 800-1000 calories for 4-6 weeks while you get ready to eat solid foods, and then tend to be in the 1200-1600 calorie range with minimum daily protein count at 60-70 grams for men after that for the loss of the first 20% of your body weight...which for me would be an 80lb loss.

So that's what I was shooting for without paying $20k-$30k for a procedure my insurance doesn't cover. The shakes alone give me 76 grams of protein a day, and I try to find something high in protein and low in carbs for the other meal I eat, and often in the snacks as well.

Now I admit to not being anything close to a dietician, so I'm more than happy to take suggestions under advisement as I continue to learn, and I do appreciate those suggestions, and I will most certainly be keeping a close eye on my thyroid numbers :slight_smile:


#12

Sounds like you are well-informed and on the right track. Keep us posted.


#13

Is there any reason HCG can't be taken all the time when on HRT? My doc mentioned that you need to go 8 weeks on 4 off.


#14

I can't see a good reason...as long as you are using a sane dose (500-750 iu/week) then there is no risk of leydig desensitization, which is the only rationale I can think of for cycling it...


#15

Yeah...he has me on 750 iu/week.


#16

Just got the latest Thyroid labs.

TSH, 3rd gen 2.01 0.40-4.50 mIU/L
T4, Free 1.2 0.8-1.8 ng/dL
T3, Free 3.1 2.3-4.2 pg/mL


#17

Your thyroid labs are not nearly as bad as I was expecting...could be better, but I've seen way worse here (mine included).

You may want to consider some iodine supplementation and tyrosine for thyroid support, but probably not a big deal if not...

How is the weight loss coming?


#18

Already on iodine. Taking 12.5mg daily of Iodoral for the last couple of weeks.

Weight loss slowed down a bit. Haven't been able to hit the pool the last couple of weeks and been having to go out to dinner several times. Throws off my routine. Up to 27 lb loss.


#19

So. 2 years and a couple of months running now. T levels stabilized about where I want them and where I'm feeling relatively good on .35ml 200mg/ml test cyp 2x per week and .5mg Arimidex 3x per week.

Last labs were:
TT,(LC/MS/MS) 622 250-1100 ng/dL
FT 152.6 35.0-155.0 pg/mL
E2 21 13-54 pg/mL

These were pretty much the same as they've been for the last 9 months. Down about 70lbs from the start of this...slow and stead wins the race. Bought a juicer that I'm going to start using when I can afford to, so that should help.

The problem I've run into now is that I lost my job at the beginning of July. With it went my insurance and ability to pay for insurance. I've spent the last 3 weeks watching my 10ml vial get lower and searching the internet for another source without a script that isn't going to give me an abscess, cost $100 a vial, and actually has what they say in it. I've come to the conclusion that if you didn't get into do using Test/bodybuilding a decade ago and already know everyone and all the sources, then nobody wants to talk to you other than tell you to do some searching, hehe. So my journey is about to go on hiatus until I get working again.

Thanks to all those who've given so much information on how to get started, how to find a doc, and who I read often on these threads, even if I don't post almost ever.