T Nation

OPIAD, Starting TRT this Tuesday

Recently told my pain management doc about a few of my low T symptoms relating to sex, ( however I have almost all except weight gain)

He recommended I try DHEA for two to three weeks (slightly easier to achieve erection but difficult to maintain, still no sex drive etc) then gave me a script testing for Testosterone Free, Direct

LabCorp say Testosterone free, direct by serum dialysis(i believe) is low 5.5 pg/ml, nominal according to them is 8.1-25.1 pg/ml.

Tuesday I am to go to the pain management Dr for them to show me how to do the injections, I was given the option of him prescribing Gel/injections/ one other option I don’t remember, or going to see an endocronoligist. Figured why add another Dr since I don’t have Insurance!

Are there any other tests I should request before starting treatment like FSH, LH or E2?

I was told they would be weekly injections, and I am assuming testosterone cypionate but I don’t know for certain.

I am 6’1" 147lb always was give or take a little, no sex drive, hot flashes, difficulty getting/ even worse maintaining erection, trouble achieving orgasim, decreased pleasure from orgasim, and according to my friend I can be moody at times, occasionally I am anxious, hot flashes, atrophy, skeletal muscle pain, terrible insomnia, lack of motivation, and fatigue. I used to be laid back and not anxious but get edgy at times now a days.

I was in a no fault MVA in 1995 had low back surgery a few years later and prescribed escalating levels of various narcotics,
previously I assumed these were side effects of my current medications 100mg Morphine sulfate I take twice a day, and 1 - 2 30mg oxycodone every 4hrs as needed, ocassionally 1mg Kolonipin for sleep which doesn’t really help. Previously i thought one had to stop or lower the dose to achieve better sexual function

in order to cope for the last 9 months I had been lowering the IR oxy to have sex and/or waiting till the end of the last dose of the oxy just before it was time to take the time release morphine with various but sub optimal results.

I was unaware this could be treated untill I recently mentioned some of my symptoms to the Dr.

in short, SHOULD I REQUEST OTHERS TESTS before starting the TRT, what about HcG + AI in addition to TRT, and should I think about seeing an endocrinologist to get some sort of stabilized treatment plan then go back to the normal Pain management Dr for refills so I dont have to pay two Dr’s?

Any and all help is appreciated I have been reading everything I can about this since last Thr when I found out it was low from the DR and he recommended TRT.

Get all the tests they will give you. In your case you are almost certainly secondary (you may be primary as well) hypogonadal as opiates slow down your endocrine system. You really need a full thyroid panel (TSH, Free T4, Free T3, reverse T3) and a cortisol test. There is a good chance you have adrenal fatigue due to the effects of the chronic pain and the opiates. Testosterone, Free T, E2, DHT, SHBG, LH, FSH, and Vitamin D, are good to have. Getting a full blood work up is a good idea as well. Read the stickies to get a good understanding of what tests to run and why. Getting HCG and an AI as needed would be nice but may be tough to get your doctor to prescribe. From things I’ve read about low T in chronic pain patients on opiods total T is very important as it helps opiods cross the blood/brain barrier, making them more effective and in many cases allowing you to use a lower dose of opiates once on testosterone treatment. Do a search on google for practical pain management and read their articles on hormone treatments for chronic pain patients. Also read the stickies here well and learn.

is it important to try to get those tests before I start HRT, or is it ok if I take them a few days to a few weeks after?

I also just had a blood analysis for the application process of becoming a volunteer fire fighter and maybe some of those are in there I have no Idea though?

I have been reading everything I can find for days now and the only thing that I can find related to both opioids/HRT basically has to do with just standard Testosterone replacement. I may have found one scholarly article that mentioned E2 also but no specific blood panels to run or anything. they generally cover the know mechanics of the Opioid Induced Androgen Deficiency and just prescribe T.

My guess is also the secondary version of the condition you stated, forgive me I forget the full technical name. If I considerably lower the dosing of the opioids I tend to get back to normal, or close anyway, but at that point I am on the verge of withdrawal. I hate these things I always research any medication any Dr. wants to put me on nowadays. It wasn’t that easy back in the day not to mention I was rather young.

Thanks for the reply

[quote]Ptownmike wrote:
Get all the tests they will give you. In your case you are almost certainly secondary (you may be primary as well) hypogonadal as opiates slow down your endocrine system. You really need a full thyroid panel (TSH, Free T4, Free T3, reverse T3) and a cortisol test. There is a good chance you have adrenal fatigue due to the effects of the chronic pain and the opiates. Testosterone, Free T, E2, DHT, SHBG, LH, FSH, and Vitamin D, are good to have. Getting a full blood work up is a good idea as well. Read the stickies to get a good understanding of what tests to run and why. Getting HCG and an AI as needed would be nice but may be tough to get your doctor to prescribe. From things I’ve read about low T in chronic pain patients on opiods total T is very important as it helps opiods cross the blood/brain barrier, making them more effective and in many cases allowing you to use a lower dose of opiates once on testosterone treatment. Do a search on google for practical pain management and read their articles on hormone treatments for chronic pain patients. Also read the stickies here well and learn. [/quote]

I have been on pain meds for about 10 years. Started with Loratab for a couple years then Ultram (supposedly non addictive) for about 6 years, and then Methadone the last 2 years. I noticed after about a year on TRT I was able to cut down from 50mg of Methadone, too 10mg a day. Still would like to get off of it completely.
I was having problems of getting sore from things as simple as moving a 3 step stool around at work with my legs. I would get sore in my calves, groin ect. and didn’t ever want to heal. Since then I haven’t had any problems with that, or other things that I did that would cause same type of problems.
I have noticed that I am not feeling quite as well since I have lowered my dose because Total T, Free T, and E2 were elevated. I’m thinking that I was feeling better then with the higher T levels to counter the high E2 levels. Just a guess, I will be curious to see where I am at now going from 17cc EOD, too 8cc EOD.

[quote]cobra003 wrote:

I have been on pain meds for about 10 years. Started with Loratab for a couple years then Ultram (supposedly non addictive) for about 6 years, and then Methadone the last 2 years. I noticed after about a year on TRT I was able to cut down from 50mg of Methadone, too 10mg a day. Still would like to get off of it completely.
I was having problems of getting sore from things as simple as moving a 3 step stool around at work with my legs. I would get sore in my calves, groin ect. and didn’t ever want to heal. Since then I haven’t had any problems with that, or other things that I did that would cause same type of problems.
I have noticed that I am not feeling quite as well since I have lowered my dose because Total T, Free T, and E2 were elevated. I’m thinking that I was feeling better then with the higher T levels to counter the high E2 levels. Just a guess, I will be curious to see where I am at now going from 17cc EOD, too 8cc EOD.[/quote]

Hey Cobra003,

Do do you go to a pain clinic or get pain meds from a primary care physician, in addition do you use that same Dr to treat the low T problem or do you see an Endo or Urologist?. What test do they normally run and what did they run in the beginning before starting treatment?

I only had Free Testosterone, Direct done 5.5pg/ml. Dr gave me the option of him prescribing weekly injections/gel/patch or seeing a specialist, I chose just to have him do it because I figured it would be more cost affective. Im starting to think I should have more baseline tests done and/or maybe seeing an Endo

Any recommendation on minimal blood work I have to pay out of pocket?

[quote]1Winder wrote:

[quote]cobra003 wrote:

I have been on pain meds for about 10 years. Started with Loratab for a couple years then Ultram (supposedly non addictive) for about 6 years, and then Methadone the last 2 years. I noticed after about a year on TRT I was able to cut down from 50mg of Methadone, too 10mg a day. Still would like to get off of it completely.
I was having problems of getting sore from things as simple as moving a 3 step stool around at work with my legs. I would get sore in my calves, groin ect. and didn’t ever want to heal. Since then I haven’t had any problems with that, or other things that I did that would cause same type of problems.
I have noticed that I am not feeling quite as well since I have lowered my dose because Total T, Free T, and E2 were elevated. I’m thinking that I was feeling better then with the higher T levels to counter the high E2 levels. Just a guess, I will be curious to see where I am at now going from 17cc EOD, too 8cc EOD.[/quote]

Hey Cobra003,

Do do you go to a pain clinic or get pain meds from a primary care physician, in addition do you use that same Dr to treat the low T problem or do you see an Endo or Urologist?. What test do they normally run and what did they run in the beginning before starting treatment?

I only had Free Testosterone, Direct done 5.5pg/ml. Dr gave me the option of him prescribing weekly injections/gel/patch or seeing a specialist, I chose just to have him do it because I figured it would be more cost affective. Im starting to think I should have more baseline tests done and/or maybe seeing an Endo

Any recommendation on minimal blood work I have to pay out of pocket?[/quote]

My PCP prescribes the pain meds and the T. I am going to see my second Endo this week because he doesn’t feel comfortable prescribing HCG. If you just started the injections I would stop them long enough to get a baseline for all labs! You can read the stickies for what is needed. I wish I had good baselines, but the only thing done on me was TT, and TSH before starting TRT. If your PCP is willing to do the labs and prescribe the necessary meds I would stick with him. If not you will have to take your chances on someone else.
Good luck!

The pain dr. is going to prescribe TRT injections, im going there today for them to “show me how to do the injections” he only ran Free T, Direct 5.5 pg/ml. Im going to see If I can have some blood drawn there to get E2 FSH LH and maybe TT before I start or ask his opinion about seeing an endo if he is unfamiliar with the std protocols or TRT +AI + LH?, not sure of that last one.

Pain management Dr is going to do TRT he ran a Test Free, Direct only 5.5 pg/ml. Im going there in a few hours for them “to show me how to do the injections” and I plan to ask if they can draw blood for LH FSH TT E2. Also I want to ask if he is familar with the T+AI+hCG protocol.

I am hoping I can stick with him but may see if I can have an ENDO do the blood and set up a regimine and just have him do the refills but IDK.

ill fill you in later

OK, so it seems as though the Dr has only done this very few if any times before. first he prescribed a 100mg bottle of T- cypionate which they no longer manufacture so I got it changed to 200mg bottle.

The best part is that I am supposed to inject .5cc every two weeks. fortunately I see him in a month and he says we can change the dose or dosing interval. I have set up an appointment with an Endo after I am supposed to see him just in case.

Seems like he is willing to work with me but but clearly he doesn’t know what he is doing. I may forward some scholarly articles to him regarding OPIAD.

I really rather not see the endo unless I have to because the only extra cost I have as of now is the Testosterone cypionate from the pharmacy. they gave me the needles and what not and didn’t even charge me for the visit yesterday.

In any case gentlemen if you would be so kind as to indulge my naiveté and answer a question or two I would be much appreciative. can I expect to feel any different taking 0.5ml of Testosterone Cypionate 200mg/ml, that is 100mg of T Cyp, every two weeks? This seems to be 36% to 50% of the general consensus pertaining to the recommended starting dose for OPIAD.

It has been about two days since my first injection and I notice no differences yet, what can I expect and when? Dr. says some people start to feel better in 2-3 days; In reality when can i expect to perceive any benefit or is it likely that it wont happen for some time or not at all on this dose? I’ll see him in a month and he says we can discuss increasing the amount or shortening the duration between dosing.

The reasoning being he “Didn’t want to rev me up to quick” and he has only done TRT a few times. I wasn’t able to speak with him much, essentially only during passing in the lobby. I sawt a nurse practitioner just to give me needles and show me how to inject.

I oweight about 140 lbs, and am 34 years old. After all the research I have done on OPIAD the general consensus seems to be 75-100mg of T-Cypionate every week or 150-200mg of T-Cypionate every 10 to 12 days and occasionally every 14 days.

my Free T from LabCorp. was 5.5 pg/ml with nominal being 8.7-25.1 pg/ml

I also was taking DHEA for 3 weeks before having the blood test, I stopped a few days before. First 50 mg/day than 100mg/day, i had a slight improvement at the latter dose split into two times a day. what are the opinions about continue the DHEA, and should it be at 50mg or 100mg a day at least in the short term?

1Winder.hello my friend.I can relate,i an also injured and take an suboxone for pain.I was on percocet prior.The pain clinic i attend also gives people testosterone injections,as opiates categorically reduce a person’s bio-available testosterone.That is a reason why people on methadone arwe sometimes overweight.Best of health with your future. john

Read the protocol for injections sticky… and do not post any of your personal questions there.