T Nation

Pellets to Injections with Doctor Change


First time poster. Just recently found this forum. Wish I would have found it earlier. Here is a brief history followed by blood work. Still working on getting my morning temperatures. Just read through thyroid basics and know that is needed. I will add temps soon.

Started Pellets about two years ago. Felt ok at times followed by a relapse of symptoms. Never consistent. Sex drive has never been an issue, but I did notice fluctuations in drive while on pellets. Energy was always a problem. After noticing my estrogen levels drop to “5” ( range 7.6-42 ), and my doctor saying that was PERFECT, I knew I had an issue. I decided to seek another doctor. Before I continue, I will say that when I first started pellets my estrogen level was 54 ( same reference range ) total T was 410. For two years with pellets, I was never prescribed HCG. I would get both Testosterone and an AI inserted together once every 4 months.

Found another MD about 5 weeks ago. When I met this new MD, I was due for more pellets ( had been about 4 months since last round of pellets were inserted when blood work was taken ). So keep in mind that this blood work was taken while the pellets were still doing something in my opinion.

-Age - 36
-height - 5’11"
-waist - 45
-weight - 265
-describe body and facial hair - Started balding in early 20’s. Thick facial hair. Hairy chest. Hair on legs and arms.

-describe where you carry fat and how changed - Carry fat primarily in gut and chest

-health conditions, symptoms [history] - Low energy. Started about 5 years ago. Sense of apathy. Rather just stay in a lot and do very little. Low motivation. Difficulty losing weight with good diet and working out. Acid reflux and indigestion. Noticed it getting worse with weight gain. Brain fog.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - Use of Rogaine for about 4 years ( in early 20’s ). Percocet for 6 months ( couple of years ago ) for pain management due to broken bone suffered in car accident. Erection quality currently is poor. Maybe 75% fullness. Sex drive is good though.

-describe diet - Been a low carbohydrate dieter for years. Mostly natural food. Also have done numerous low calorie diets in between when I was frustrated that low carb was NOT working. Thought at the time I needed to “eat less and move more”. Bad decision. Eating less work… and then gained it back. Multiple times.

-describe training - Training has been on and off for the past 5 years. Never over training. Usually lifting weights 3-4 times a week if I had the energy to do so. Longest duration of dedicated weight training was probably 3 months before getting exhausted and stopping.
-testes ache, ever, with a fever? - Never noticed any aches with fever, but I do notice occasional aches

-how have morning wood and nocturnal erections changed - Usually wake with morning wood while on TRT ( with pellets )

So here is a quick outline putting pieces together.

  1. Doctor (A) used pellets and AI for two years. Also was prescribed 30 mg of Hydrocortisone for “Adrenal repair”. After two years of pellets the only noticeable change has been higher sex drive. Low energy, apathy, difficulty losing weight with a normal low carb diet and exercise still not working. Also, reflux has gotten worse. I suspect due to my weight. I also suspicion food intolerance of some kind. I eat plenty of Cholesterol and my recent labs show it very low and I really think their is an absorption issue.

Blood work was drawn when switching to new doctor 4-5 weeks ago. This blood work was taking when close to needing more pellets. ( Blood work above )

  1. Doctor (B) has put me on the following protocol that I just started last week. I have NOT received my HCG yet, that is coming by mail via compounding pharmacy and should be here Monday or Tuesday of this coming week.

  2. Test Cypionate - 200 mg/ml 3/4cc week

  3. Arimadex - 1/2 of 1 MG pill twice a week

  4. 1000 IU of HCG once a week

  5. 30MG hydrocortisone to be weaned off of in one year by gradually lowering does

  6. 500MG Metformin x2 Daily to bring down insulin

Also the following supplements have been suggested
5,000 IU vitamin D daily
Fish oil daily
Multi Vitamin
Probiotic x2 Daily
Vitamin C and Magnesium
CoQ10 - I have chosen to take Ubiquinol

What I hope to repair…

Energy. Energy has been shit for years

Weight loss - Even with diet and exercise I have a very difficult time losing weight

Mental awareness - Remove brain fog. Hard to explain, but I feel it. Some days im “ON”… and feel great… followed by more days of being “off” and out of my mind.

Reflux - Figure out what is causing this damn reflux… and if it’s just weight, then hopefully losing the weight will help

Cholesterol - Increase my cholesterol to 180

I have follow up labs in 10 weeks. Any comments or suggestions I would love to hear. Will follow up with temps and I also have questions about the sticky in regards to multiple weekly injections. Thanks

Morning Temp. Upon Waking today was 97.1 and 97.3 - Back to back tests first thing in morning before eating, chewing, talking etc.

Your homocysteine indicates that there is some endothelial dysfunction in your arteries. Your prediabetic state would do that and history of low T and high E2. You have insulin resistance. Your fasting glucose is decent. But glucose might be getting high after meals. This lab work: http://en.wikipedia.org/wiki/Glycated_hemoglobin is useful to eval your overall blood sugar control.

Homocysteine is very specific to inflammation of the arteries. CRP is a not, it is a general inflammatory marker and things like gum disease would increase CRP.

Lots of fish oil and add high potency B-complex multi-vits with iodine listed at 150mcg or more.

1000iu hCG one a week is wrong, better at 250iu EOD as per the protocol for injections sticky.

Thyroid issues can make weight loss a problem. If you are iodine deficient, that is good news in a way as you can can fix that and feel better and restore some vitality and metabolic rate.

Your IGF-1 is not high.

For your condition, 150mg/wk T may make sense, but you may need 1.5mg anastrozole/Arimidex. Read the protocol for injections. You can inject T twice a week and take anastrozole at the time of injections. You can do hCG twice a week, but that is stretching the half-life. If you are going to do hCG EOD, you may find that taking all three drug EOD at the same time is an easier routine to live with.

Don’t get dehydrated for your fasting labs.

Testing LH or FSH while shutdown on TRT is folly.

Reflux/GERD: Can be from a hiatal hernia complicated by intraabdominal fat. This bends the esophagus where is connects to the stomach and that makes the lower esophagal sphincter incompetent. Only good diagnosis is with a general anaesthesia and endoscopic exam. Surgery is a bitch and can easily have a bad outcome. Weight loss and antacids are the best route.

[quote]KSman wrote:
Your homocysteine indicates that there is some endothelial dysfunction in your arteries. Your prediabetic state would do that and history of low T and high E2. You have insulin resistance. Your fasting glucose is decent. But glucose might be getting high after meals. This lab work: http://en.wikipedia.org/wiki/Glycated_hemoglobin is useful to eval your overall blood sugar control.

Homocysteine is very specific to inflammation of the arteries. CRP is a not, it is a general inflammatory marker and things like gum disease would increase CRP.

Lots of fish oil and add high potency B-complex multi-vits with iodine listed at 150mcg or more.

1000iu hCG one a week is wrong, better at 250iu EOD as per the protocol for injections sticky.

Thyroid issues can make weight loss a problem. If you are iodine deficient, that is good news in a way as you can can fix that and feel better and restore some vitality and metabolic rate.

Your IGF-1 is not high.

For your condition, 150mg/wk T may make sense, but you may need 1.5mg anastrozole/Arimidex. Read the protocol for injections. You can inject T twice a week and take anastrozole at the time of injections. You can do hCG twice a week, but that is stretching the half-life. If you are going to do hCG EOD, you may find that taking all three drug EOD at the same time is an easier routine to live with.

Don’t get dehydrated for your fasting labs.

Testing LH or FSH while shutdown on TRT is folly.

Reflux/GERD: Can be from a hiatal hernia complicated by intraabdominal fat. This bends the esophagus where is connects to the stomach and that makes the lower esophagal sphincter incompetent. Only good diagnosis is with a general anaesthesia and endoscopic exam. Surgery is a bitch and can easily have a bad outcome. Weight loss and antacids are the best route.

[/quote]

  1. Thanks for the reply. I have never had a cavity, but I’ve had issues this passed year with sensitive gums/bleeding after brushing. I’m going to make a dental appointment and make that a priority. Other than getting insulin under control, losing weight, and better dental health, what else can help improve my arterial inflammation? I just started taking a High quality fish Oil ( Nordic Natural liquid ) and just purchased Kelp with 350 mcg Iodine. I also started a high quality Multi Vitamin. The link you provided suggest trans fats as a contributer to this issue, I eliminated those years ago. My diet is fairly clean ( Low carb, non processed foods).

  2. I am planning to do a 3 day dosing, would this be fine for Monday/Wed/Friday intervals…
    50mg/test cyp
    250 IU HCG ( Or would I do 330 IU )?
    .5 anastrozole

  3. Also, my MD suggested I take 75MG of DHEA… is this needed? Or will my levels go up from adding in HCG?

  4. Lastly, when I get my labs run again… assuming I do the three day dosing schedule M/W/F… what would be the best day/time to get labs taken? Day of dosing? Before or after dosing? Or on a day that I don’t take anything? I really appreciate the info.

Going to re-read these links. Thank you.

For arterial health you can take a vitamin K complex k2, mk7, mk4.
Hawthorn Berry extract, turmeric, and a bunch of flavonoids and antioxidants. Cardio helps too. Improve your dietary omega 6 to 3 ratio. Krill oil is good as well. Cooking with organic hemp oil adds more omega 3.

250 iu EOD.

Levels could go up with HCG 25mg should be alright test a while later and then modify dose accordingly.

If you dose EOD do it the day after injections.

Morning Temperatures today were 96.6, and 97.1 - I used two different thermometers at the same time, both battery operated type. Makes me wonder about the accuracy of these cheap thermometers.

See if the thermometers will hit 98.6 with someone else. If you need iodine replenishment, 350mcg will not get the job done.

You need DHEA, try 50mg and see how your DHEA-S and E2 reacts. Some freely convert DHEA–>E2.

Thanks for the reply. I just went and purchased a new thermo last night. Morning temperature 97.3 taken immediately after waking. Couple of questions in regards to iodine…

  1. The more I think of it, I am fairly convinced I have iodine deficiency. My digestion issues could be both a combination of excess weight and low iodine. After reading more on the subject, low iodine can cause a lack of stomach acid and this in turn can slow down digestion and cause similar symptoms as reflux. Many times after eating ( even very small portions ) I am belching and feel “stacked”, like the food isn’t getting digested. What’s the smallest amount of Iodine I could try to see if it helps?

  2. EDIT- I picked up “Liquid Kelp” at my local health food store. 1 Drop is 800 mcg ( From Kelp, Potassium Iodide ) would this work for iodine replenishment? Could I start off with say 10 drops ( 8MG ) and see how that goes? It doesnt say to put it under the tongue so i am guessing I just mix is with water and drink?

  3. I do a lot of vegetable juicing ( on and off for YEARS ) mixed with a low carb diet. I take in large amounts of raw spinach which has been mentioned as a goitrogen. Also, large amounts of cauliflower. Now that I really think about it… I can’t really say where I have gotten any real source of iodine in my diet for the past 10 years, but I can list many things that I have eaten that probably interfere with iodine uptake.

  4. Cold hands/fingers/feet… always feeling cold ( when others say it isn’t ), and not feeling alert until hours into the day or even evening. This might be another symptom?

  5. Does Iodine have any interactions with other vitamins/minerals and or drugs that I should look out for? Is there any other supplement that I need to take with iodine to make it absorb better? I thought I read that someplace, but now I can’t seem to find it.

[quote]KSman wrote:
See if the thermometers will hit 98.6 with someone else. If you need iodine replenishment, 350mcg will not get the job done.

You need DHEA, try 50mg and see how your DHEA-S and E2 reacts. Some freely convert DHEA–>E2.

[/quote]

How would taking DHEA and hydrocortisone work? Previous doc had my on 30MG of hydrocortisone, and when I took my DHEA yesterday, I felt exhausted and “stupid”, which is a similar feeling I get when I miss my hydrocortisone dose. I took the 50 MG tab of DHEA, but I am still taking hydrocortisone… new doctor wants me to wean off of it over the course of one year.

I’ve been supplementing with Iodide from Kelp ( 8,000 mcg ) for the past couple days. I have a question in regards to iodine that I didn’t find the answer to in the stickies. As far as I can tell, my thyroid labs look quite decent. Though I have MULTIPLE symptoms of low thyroid.

I have probably been deficient for years… honestly I can’t remember any decent source of Iodine in my diet… my entire life. I’ve been a sea salt user for at least 15 years. I don’t eat any bread on a regular basis, though iodine in bread was removed probably long before I started avoiding processed carbs.

My question is, if I was severely iodine deficient, wouldn’t my labs show some indication of this?

How do you feel now after a couple weeks of supplementing Iodine? I’ve heard stories of other guys who had perfect TSH on their labs, but Iodine helped? Thinking of trying it myself.

The only difference I feel so far ( and it’s a HUGE difference ) is my body temperature. I do NOT feel cold like I used to. I have bumped my iodine intake up to 20mg/day… and two days ago I forget to take my morning dose and I had cold hands and feet all day at work. I am gradually building up to 50mg and will stay there for two weeks.

[quote]hakrjak wrote:
How do you feel now after a couple weeks of supplementing Iodine? I’ve heard stories of other guys who had perfect TSH on their labs, but Iodine helped? Thinking of trying it myself.[/quote]

Interesting progress. Your strong response is exceptional. Any improvement in clarity of mind? You sound enthusiastic. Is that new?

[quote]KSman wrote:
Interesting progress. Your strong response is exceptional. Any improvement in clarity of mind? You sound enthusiastic. Is that new?[/quote]

Definitely having more “on” days than “off” days. Mental clarity is improving. Body temperature is moving up ( 97.4 today ). I am taking 45mg of Iodine from Kelp every day now.

I am dosing as follows
Mon/Wed/Fri 50mg Test Cypionate ( 150mg Total/week as per doctor prescription )
Mon/Wed/Fri 250 IU of HCG
Mon/Tues/Thurs/Fri with .25 mg of ANASTROZOLE ( 1 mg week total )

My diet is not changing. Labido is High. Erection quality is still not great.

questions…

  1. I feel like I am gaining weight. Paints feel tighter. What can be causing this?
  2. Any suggestion for Diet for weight loss? I eat low carb with mostly natural foods. Plenty of meat /good fats. Though my calories are around the 1800 day range. Kinda feeling helpless in this aspect. I need this weight off. Should I be doing cardio or weights only?

I’m taking the following supplements and medication in addition to the TRT protocol

Meds:
Hydrocortisone 10mg 3x day
Metformin 500mg 2x day

Supplements
Anti Oxidant free radical formula by Solgar
Calcium/Magnesium and Zinc blend
L-Carnitine 500 mg
Vitamina K-2
Ultra D-3 5,000 IU
DHEA 50 mg
Reservatrol Antioxidant
CLA 1000 mg
Vitamin C 5,000 mg
Jarrows Pro Biotic
Nordic Natural Fish Oil
Iodine From Kelp 45 mg