T Nation

Post Cancer Treatment. Labs Updated 7/18 ( Sky high E2 result )

Update 7/18 : New TRT Test level labs with ludicrous E2 result in last post .

32 years old. Was diagnosed with rectal cancer in January of 2013. At the time, life was normal. Felt great, plenty of libido lots of energy and no problems to speak of.

Before surgery I did 6 weeks of chemo and radiation. Since the tumor was really low it was almost impossible to shield my testicles from the radiation field. I was made aware that they would probably be affected in some way but the severity was uncertain.

In this 6 weeks I went from normal ( wanting sex, rock hard on command, plenty of get up and go ) to pretty much a lethargic state where I probably couldn’t get it up if you gathered the top 10 hottest women alive and locked me in a room with them.

There just isn’t any interest at all. When I look at a women it’s pretty much the same reaction I have mentally when I look at a dude. Absolutely nothing happens. Sometimes I can “will” myself to be interested but it’s nigh impossible.

Cialis has bridged the gap with my girlfriend (barely) but being 32 without BPH it’s impossible to get it covered (even though another health crisis caused it) and I can’t afford $500 a month out of pocket. Aetna just looks at my age and is like “nah, can’t do it”.

I have no energy AT ALL. I pretty much wake up exhausted and have spells throughout the day where I am so fatigued that I literally feel like I popped a triple dose of pain meds.

I finally broke down and told my oncologist to add a T check to my monthly labs ( he obliged ) and it came back with a TT of 220 and an FT of 55.

On their scale the 220 was 30 points below the very bottom of the range and the 55 on the FT was barely within normal. The test was done at 9am so realistically my daily average T is running something along the lines of 160 or so.

Labs : ( Current as of 7/18/14 )

Lipid Panel :

CHOLESTEROL, TOTAL 148 125-200 mg/dL
HDL CHOLESTEROL 45 > OR = 40 mg/dL
TRIGLYCERIDES 195 H <150 mg/dL
LDL CHOLESTEROL 64 <130 mg/dL (calc)
CHOL/HDLC RATIO 3.3 < OR = 5.0 (calc)
NON HDL CHOLESTEROL 103 mg/dL

Comprehensive Metabolic :

GLUCOSE 114 H 65-99 mg/dL
UREA NITROGEN (BUN) 13 7-25 mg/dL
CREATININE 0.91 0.60-1.35 mg/dL
eGFR NON-AFR. AMERICAN 111 > OR = 60 mL/min/l.73m2
eGFR AFRICAN AMERICAN 129 > OR 60 mL/min/l.73m2
SODIUM 139 135-146 mmol/L
POTASSIUM 3.8 3.5-5.3 mmOl/L
CHLORIDE 105 98-110 mmol/L
POTASSIUM 3.8 3.5-5.3 mmOl/L
CARBON DIOXIDE 22 19-30 mmOl/L
CALCIUM 9.4 8.6-10.3 mg/dL
PROTEIN, TOTAL 6.9 6.1-8.1 g/dL
ALBUMIN 4.5 3.6-5.1 g/dL
GLOBULIN 2.4 1.9-3.7 g/dL (calc)
ALBUMIN/GL-OBULIN RATIO 1.9 1.0-2.5 (calc)
BILIRUBIN, TOTAL 0.4 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 68 40-115
AST 20 10-40
ALT 27 9-46
TSH 0.69 0.40-4.50 mIU/L

CBC :

WHITE BLOOD CELL COUNT 5.5 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.37 4.20-5.80 Million/uL
HEMOGLOBIN 14.8 13.2-17.1 g/dL
HEMATOCRIT 44.2 38.5-50.0 %
MCV 82.5 80.0-100.0 fL
MCH 27.5 27.0-33.0 pg
MCHC 33.4 32.0-36.0 g/dL
RDW 14.6 ll.0~15.0 %
PLATELET COUNT 163 140-400 Thousand/uL
ABSOLUTE NEUTROPHILS 3927 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 1117 850-3900 cells/uL
ABSOLUTE MONOCYTES 297 200-950 cells/uL
ABSOLUTE EOSINOPHILS 154 15-500 cells/uL
ABSOLUTE BASOPHILS 11 0-200 cells/UL
NEUTROPHILS 7l.4 %
LYMPHOCYTES 2O.3 %
MONOCYTES 5.4
EOSINOPHILS 2.8
BASOPHILS O.2

Testosterone, FR & Total : Pre-TRT (awaiting updated results)

TESTOSTERONE, TOTAL, LC/MS/MS 220 L 250-1100 ng/dL
FREE TESTOSTERONE 55.1 35.0~155.0 pg/mL

QUESTASSURED 25-OH VIT D :

Vitamin D, 25-OH, Total 16 30-100 ng/mL
Vitamin D, 25-OH, D3 16 Not Established
Vitamin D, 25-OH, D2 <4 Not Established

Current Recap :
5/21/14 Started TRT (200mg/2weeks = 2x50mg/week) Starting T ( 220T / 55F )
6/14/14 Results peaked.
7/07/14 Results bottom out @ around where they started.
7/13/14 Ordered Female Hormone Panel to check E2, awaiting those results and new TRT Testosterone levels.
7/18/14 First TRT followup labs. T=1045
7/18/14 Female Hormone Panel = E2 level of 104.5! Starting adex when it arrives.

Damn… Your story makes me feel fortunate though I’m having my share of crap. I wish you the best brother. You will be stronger for dealing with this.

Keep at it with the Doctor’s.

Saw my oncologist this morning. He admitted that I probably knew more about TRT than he did but he agreed that mine was exceptionally low for my age.

He said that personally it was beyond his medical expertise so he offered to refer me to a uro that he knows on a personal basis and that he said would be more than inclined to get me on a TRT regimen.

I already confirmed that it’s next to impossible to get transdermal stuff covered with Aetna and even with coverage it’s still about 5x as expensive as injections while being less controlled of a dose and also the headache of having to be careful with cross contaminating other people.

When I see the uro if he doesn’t balk and ends up willing to get me started would it be reasonable to request injections? With insurance it’s only like $20 for a 90 day supply…

You certainly want to be on injections, most that are familiar with TRT are aware of the benefits of it over the creams. He may suggest pellets, but tell him you want to do injections at home. You sound like a clear case to me, hopefully the uro is in agreement. A lot of this is finding a doc who is knowledgeable - if this next one isn’t, keep moving.

Also, while you are here, read all the stickies at the top. Lots of good information to be had.

You might want to be a little cautious about asking to inject at home right away. Many doctors are averse to it because they’ve had experiences with people abusing it. The doctor I am going to made a point of telling me right away on my first visit that he will not prescribe for self-injection (I hadn’t even asked about it).

Then just this week, a few months later, he actually -suggested- that I self-inject at home, and he has prescribed the meds for me to be able to do so. Frankly if he hadn’t, I was about to make a change and find a way to do it anyway. But the point is that some doctors want to get to know and trust you before allowing self-injection, and asking for it in the first five minutes doesn’t make them feel warm and fuzzy about it.

I got lucky and asked a hot PA while my doctor was doing surgery. She stepped out to ask, found out the was to busy and made the call herself to let me self administer. I don’t think the Doctor would have ever gone for it though…

If your Doctor only does shots every two weeks, which seems common. Play it cool for the first few shots. After three or so tell the doctor that you would like to split the same dose into weekly shots because you are having symptoms return consistently on day nine or ten, which will be true. I told the PA that “I hadn’t mentioned it because I thought that is might be my body adjusting but that after three shots with symptoms returning, I was pretty sure I needed to up the frequency.” Next I said “it would be really nice if I could just take care of this myself in five minutes instead of wasting their time and mine every single week.” Bingo!

Some time ago I came across an old thread that had what I thought was a great suggestion. When it’s time to go for it be sure to tell them all about how your wife or sister is an RN and has agreed to do the injections at your house once per week.

I’m a new guy so take it for what it’s worth but I actually had this experience.

I got my appointment with the uro scheduled but it’s not until the first week of May. In the meantime I’m going to spend my free time getting educated so he can’t juke the issue like i’m an idiot when I go see him.

My situation though is a little unique in that I probably have a truncated finite amount of time. I’m 32, have the LS genetic mutation and have already had cancer. It would only be realistic to expect a recurrence after which my 5 year survival rate will plummet into the single digits. Not really being pessimistic just a realist so I’m not surprised when it happens.

With that said, I would like to not spend a year I could have felt normal trying to fix this by trying eleventy things that don’t work and all that jazz. Just going to cut straight to the punchline or self administer if he doesn’t want to play ball.

I went to a “men’s clinic” first. They got me started on TRT. After 6 months or so, I asked my family doc is she would take over my treatment. All she asked for was my records to verify the symptoms and dosage. After that she wrote my script and sent me on my way.
Once you get your script, how you inject and how often is up to you.

Little update.

My Urologist started me on 200mg every 2 weeks so naturally I will inject half of that every week in 2 50mg injections per week.

I have never been on anything injection based so I don’t really know how to come about getting any needles/syringes. Obviously the prescribed ones are only enough for the schedule he put me on and I need 4 times as many as he gave me to do 2 injections a week.

Can you just walk into a pharmacy and buy that stuff or am i going to have to find a shady online retailer?

It depends on the laws in your state. However, even if legal to buy OTC the best prices can be found online.

I am pretty new to the game but find using the instructions provided in the injection stick to be great. Use a 29g 1/2 insulin pin. Takes a minute to draw but its no big deal. I go right into my delt, but others will go into love handle/ab fat.

-Jim

Good luck. Very unique situation. Are you sure the radiation did irreparable damage to your testes, or could this be the body still recovering from all the chemo, and temporary damage that did to the brain, etc? Has your oncologist seen this before?

Both my oncologist and my radiation therapy doctor ( whatever they are called ) think it was actual direct physical damage to the testicles from focused direct beam radiation.

The tumor I had was ultra low pretty much right on the anal verge so it would have been near impossible to hit the tumor without radiating the testes as well. I was made aware of this beforehand so it wasn’t a shock.

I don’t have the labs my Uro pulled but he said that in addition to my testosterone results being low, I had “other signs of testicular failure”. Whatever that means.

More or less what all of my specialists are saying is that my testes were as far as functionality goes, killed by direct beam radiation and that I shouldn’t expect them to do any of the things they are suppose to do ever again.

Radiation scrambles the DNA strand so that cellular mechanisms can cause a controlled cell death called apoptosis. Mutations of the gene P53 can make a cancer cell resistant to radiation. Radiating cells that regenerate means those cells will be replaced but radiating cells that aren’t replaced causes cell dysfunction. When DNA is changed, so are all the proteins that are created from it. Leydig and sertoli cells (Testosterone and sperm) probably don’t regenerate while supporting cells of the testes do.

Other signs of testicular failure likely refers to elevated LH and FSH with subsequent low T values.

Update :

Have been on 100mg a week ( 50mg twice a week ) for a few weeks now. Things I have noticed.

  • Have gained 9 pounds since starting. This might be anecdotal since my weight fluctuates a lot. I have noted that my pants are looser around my waist despite the weight gain so I can assume it’s water weight being held somewhere else in the body.

If it is water weight caused by an E2 issue, I’m not sure what to do as my Doc won’t even add an E2 to my labs and then probably wouldn’t prescribe an AI anyway.

  • Have noticed a marked increase in the efficacy of “as needed” Cialis doses which were hit or miss before with very little confidence in them working. Erections are harder, more reliable and easier to obtain although I still cannot say with confidence that I could get a functional erection without medicinal aid.

  • Morning wood 3-5 days out of the week after going almost a year post treatment with maybe 1 or 2 that I can’t even remember even while taking Cialis.

  • Marked increase in sense of well being

  • Greater overall feeling of strength.

  • Decrease in the lethargic fog I was feeling from pretty much all day every day to sometimes not at all and getting better by the day.

  • Objective but slow progression in the feeling of sleep being restorative. Not really waking up tired anymore like I was.

The only really bad thing is a pretty powerful sense of insomnia. Like I could go to sleep if I tried probably but I have to get absolutely exhausted to make myself try. Half the time It’s 6am after getting off work at midnight and I still have no desire at all to sleep.

Have gone without any sleep at all a few times and at worst still felt better than I did before TRT with a full 8 hours so the insomnia is easy to swallow for now.

Now for the questions.

If I can’t convince my doc to add E2 to my labs next month when I go back, how can I get that done myself and for what presumably ungodly amount of money?

Insurance covers Anastrozole and it’s like $6 for 90 days but Im not really convinced I could get any of my docs to write a scrip so I might be stuck trying to find it myself.

On the topic of HCG. What would I need to do to start working on getting someone convinced to prescribe some? I know I can get it without their help but going by the few “sources” I looked at, It’s not really something I could afford.

Congrats dude, sounds like you’re on the right path.

If you’re doc won’t work with you on Labs, I’d find a new Doc. There are more and more TRT docs out there every year now, as this industry is exploding. You should have no trouble finding one in a major city nearby. If you have to travel to see one, it’s worth the money if he’s a good doc. I drive over 70 miles to see mine every 6 months.

get your E2 tested yourself at privatemdlabs.com then search out a research company for the anastrozole. Or an overseas pharmacy.

I want to order the Estradiol test right?

Was sort of confused since they offer several Estrogen related panels.

Rather weird update:

I have noticed a pretty dramatic increase in the size of my penis while flaccid. Probably slightly less than twice as big as before. I was always slightly above average size when hard but was always smaller than you would think while flaccid. I guess this follows the whole “grower and not a shower” phrase.

Anyway. I’m assuming its circulation related possibly? Would anything in Test Cyp or the reaction to having it injected make a change like this occur? It’s at all times by the way. Not just before or after arousal.

Also,

I have a followup tomorrow where I am going to beg him to check my E2 when they do labs. If for whatever reason, he simply won’t add it to the order, I’m going to order it myself as soon as I get home but I want to make sure I order the right panel. There are like 8 of them listed on there. Would a simple Estradiol suffice?

E2=estradiol

Post all of your labs.
cholesterol, might be low
CBC, ALT, AST
TSH
DHEA-S

Have you read the stickies?