T Nation

New Doc, New Protocol

Yesterday I saw a doc that is actually up to date on TRT and overall health. I feel like I might get somewhere with him.
We talked about my goals and because fertility is important to me (and I just dont like the side effects of Testosterone), he wants me to taper off the Test and increase HCG to 250iu per day.
He looked at my labs and realized that even though everything is in range, very few things are at optimal. When he said that it was music to my ears. It infuriates me that not all docs think this way.

My labs from 8/31/12 were:
TT 536 (280-1100)
BT 371 (131-682)
FT 133 (47-244)
E2 12 (10-60)
Corisol 11 (5-23)
TSH 2.2 (.45-4.67)
T4 1.21 (.71-1.85)
T3 3 (2.4-4.2)
Vit D 37 (30-80)
DHEAS 230 (168-592)

The protocol he put me on: (tapering off Test over next 2 months)
250iu HCG daily
1mg Arimidex per week
DHEA 25mg daily
Armour 1grain daily
Vit D 5000iu daily
Vit B complex daily

Id like to hear any thoughts on you may have on this protocol for me.
HCG monotherapy is another discussion on its own but right now I do have these specific questions:
Is 250iu HCG every day too much? I dont want to risk Leydig desensitization
How does DHEA affect test and estrogen levels? (my reading makes it sound like it complicates things)
Can someone explain why HCG monotherapy causes higher E2 than Test and HCG together?

Thanks guys. I appreciate your wisdom.

Joe

Hi joey.Im john and an ex-competitive bodybuilder and i think you have a very good dr. I take delatestryl-testosterone enanthate,but when i ask for clomid,or hcg most general practicioners don’t even associate these drugs to male health.I used from 18-25 and was off for 10years and got back into training 4years ago.please post again in regards to your progress. thank’s johnny

I am far from an expert but I heard that for long term you don’t want to be over 1000iu per week of HCG. I think you usually use more to jump start production then go to around 1000iu per week to maintain. I think E2 becomes a problem with HCG because it can cause E2 to be produced in your balls, and that E2 produced in your nuts can’t be controlled by an AI.

DHEA is converted to T in the testes, your DHEA-S is a below what some consider adequate.

You can watch to see what happens to E2. For a few, DHEA can increase that.

High dose DHEA can increase E2 sometimes and anastrozole [Arimidex] cannot manage T–>E2 inside the testes.

1mg anastrozole per week may only make sense if you get TT up to 800-900 or greater. I would start with 1/2mg until you sense that T is up. Read about anastrozole over-responders.

Are you using iodized salt and have iodine in your vitamins? You do not want to be using drugs to compensate for an iodine deficiency.

What do you mean side effects of testosterone? You like the side effects of low testosterone. There are no side effects for a proper serum level of T, with managed E2 levels.

Cortisol=11 at an 8 AM lab draw? That would be low.

If your cholesterol is below 180, you need to increase it.

KSman - good point. Having Low T is even worse than side effects of exogenous T.
The side effects I was referring to was testicular atrophy/fertility and some other minor ones like hair loss, oily skin.

You were right about the AI. I think my ideal is about .25mg every 5 days. - I just need to find a better way to divide into smaller doses.

I want to know more about iodine defifciency. - That correlates to adrenal problems right?
Also whats the best supplement to correct iodine deficency. - I remember seeing a link to something on Amazon a while ago?.

Enter “ksman has a thyroid problem” in the search box at the top of the screen.

Fertility is preserved with hCG. Not optimal but sufficient. Nolvadex can be used to improve sperm count if and when needed.

Hair loss: If you have the genes for this, then the only way to slow it down is to have low testosterone. If you had good T levels on your own, then you would still loose hair. If hCG works very well and T improves, you still loose hair. Hair loss drugs are dangerous and can kill libido as that depends on DHT that the drug reduces. Hard to make babies if you are not interested.

Oily skin is a good thing, cope with it. Want dry skin, ask someone who has that problem.

If you have adrenal fatigue from stress, accidents, illness, infections surgery etc, rT3 can increase which blocks your fT3 thyroid hormone. And adrenal fatigue can be a major problem all by itself. Hard to fix, cannot fix with medication alone. Doctors then do not know what to do. Anything they cannot fix with a drug does not exist.

We often see hypogonadism with hypothyroidism and see some case here with those and adrenal fatigue. They all affect each other as well, synergistically bad.

After reading your thyroid post again, I know I have an iodine deficiency. My T4:T3 ratio is 2.5 and my TSH is elevated. I will read more on that and start taking something for it.

Other related symptoms right now: fatigue, hot flash feelings, puffiness ?esp in the face, weight gain, low body temps.
Is it odd that I feel warm/overheated even though my body temps are low?

You mentioned something else I wondered about on my drive home today.
Why is hCG used more commonly than a SERM for testicular function? - especially when SERMs improve the LH and FSH?
Is a SERM restart the equivalent as HCG monotherapy?

A restart, that involves more than a SERM, is an attempt to get a poorly functioning HPTA to work properly. Often does not and the older one is, the less chance of a good outcome.

SERMs are not considered suitable for life long continuous use. hCG is a natural substance and one of its lobes is identical to the active lobe of LH that docks with LH receptors.

Here are some updated labs. I am feeling better and better but still far from normal. Concerned about fertility.
I would appreciate feedback on the progress over the last month and input on what still needs work.
What should I talk to the doc about? I meet with him Thursday.

Thanks

Image

What was your protocol for that lab?
Did you have time to get some iodine onboard?

E2=11.6 suggests reducing anastrozole dose by 30-50%

What are your body temps and how have these changed?

After the 10/15/12 Lab I started this protocol:

Test Cypionate- 33mg MWF = 100mg/week
HCG- 250 iu MWF = 750mg/week (doc prescribed 250 ED but I dont want to risk desensitization)
Arimidex- . 25mg/E5D (yes- every 5 days)
Armour- 1 grain/day
1 Fish oil/day
Vit D- 5000 units per day
DHEA- 25 mg/day
Nutrascriptives Daily Multiple

Last Wednesday I started taking a Multi-Vit that gives me 150mcg Iodine per day. (on the label it says “From Kelp”) I specifically chose that one because it contains the Iodine. Is it sufficient?

I am surprized how low my E2 is. -I take a minimal dose but am still on the low end. - I dont know how to divide it up smaller than a quarter pill without completely crushing it.

Temps today so far:
6:00am 96.9
9:00am 97.8
10:30am 98.1

Dissolve Anastrozole tablet in vodka, 1mg/4ml. Get a dropper bottle. Count drops per ML. Do some math and dispense by the drop. Ratio for normal responders would be 1mg/1ml.

150mcg iodine is a maintenance dose and is inadequate for iodine replenishment [IR]. Adults can store 1 - 1.5 GRAMS of iodine, mostly in the thyroid. You can see that 150 millionths of a gram will not do IR.

RDA 150-180 is all that you will find in vitamins.

I will look into replentishing Iodine with an additional supplement.

Any other thoughts on my other numbers? Does anything look way out of whack?
What should I try to accomplish at my doc appointment tomorrow?

Thanks

For simple iodine deficiency [ID], one watches body temperatures as a indicator that levels are getting adequate. IR [iodine replenishment] stores may need to be greater than that.

With tyroid meds, the dose should both normalize temperatures and depress TSH levels.

If you are iodine deficient, and start thyroid meds, you can see how:
-body temperature may not be a guide to IR status
-if IR resolves your problem while on meds, how do you get of the meds or find out if you really need them or not.

The objective is to avoid a life time of thyroid meds to cover up an iodine deficiency. Doctors seem to be blind about iodine, even though it is so very basic to any degree of understanding. All they can see is their prescription pad. If you do have a true thyroid problem, not ID, then you need to start thyroid meds, and your TSH level and body temperatures are your dosing guide. If your thyroid status has been making you feel poorly, IR or meds can have a major effect.

Adding TRT to a thyroid or ID situation can make some feel worse as the body cannot support the restored metabolic demands that come with TRT.

KSman - your efforts to educate about Iodine deficiency are sinking in.

Last night I started talking in my sleep and was awake and decided to mess with me. This morning she told me about the conversation we had while I was asleep.

Me: Thanks for getting that down for me.
Her: What did I get down for you?
Me: The Iodigitinized salt from the ocean.
Her The what?
Me: The special salt
Her: Okay
Me: Its really important for proper thyroid function.
Her: Whatever you say Joe.
Me: Suprised you didn’t know that

I find this ok interesting as im in the same boat new doc wants me off testosterone. Check the link out.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913032/

Wanna has created his own thread.

Had an appointment with my doc yesterday. We discussed lots of new things. I still am hopeful to get off test injections but my outlook on my situation has changed. I have felt much better since addressing my thyroid and am hoping that by treating it, the other issues may eventually resolve themselves. ie low T

(I think I am secondary ? my LH was 3 before starting TRT. range 3-10)

Doc increased my Armour thyroid to 2x per day. (double what it was)

He wouldnt talk abuot clomid but I am still interested in trying a restart at some point.

He wants me to stop the Test injections and inject 250 hcg every day . I want to give it a try but worry about what will happen to my test levels.

So my big question: If I switch to HCG mono + AI, will my levels tank? Or will the fact that Im not getting exogenous Testosterone allow my LH to kick in and encourage natural production?

Thanks guys. I appreciate any input/advice.

Armour thyroid dose: Monitor your body temperatures and see how that changes and mood/energy changes. Doing this during a T crash does not make any sense. Suggest that you do one thing at a time.

250iu hCG EOD may provide good T levels, but for some that could lead to high E2. In any case, AI dose needs to match T levels and we really do not know where your T will go.

hCG also shuts down LH/FSH! hCG will build up the testes, then you need to switch to a SERM to get LH/FSH started then slowly taper off of the SERM and you need to then cruise on AI to prevent estrogen rebound and shutdown.

You can get nolvadex on your own. Where are you located?