Reassurance of TRT, at a Low Ebb

Pharma / TRT Testosterone Replacement
21

what about the ranges for your most recent tests including cortisol + what time of day was the blood drawn?

a lot of people seem to have problems absorbing transdermal. resolving thyroid issues or possible aldosterone issues may increase absorption.

yes, zinc can help some. good nutritional balance is important and most people don’t get what they need through processed foods. DIM has helped some people as well, but as a herbal supplement people’s reactions are hit and miss.

possibly helpful vitamins:
a good multi-vitamin
6,000 - 10,000iu Vitamin D3 (should be almost mandatory) (D3 only - not D2 or non-labeled D)
zinc 25mg
fish oil (or other source of essential fatty acids)
Niacin (if your CHOL balance is not ideal)
iodine (up to 12.5mg daily - if you have body temp issues)

Crisler has some good information and seems to be one of the better ones out there, but no doctor knows everything, and none are as vested in your quality of life as you are so it is best to do your own research so that you can have an educated conversation with the doctor and so that you can truly partner with your doctor on your treatment plan.

22

The post TRT “optimum ranges” (or at least the doctors idea of optimum ranges) are the same as pre-TRT apparently. The cortisol range given was between 140 - 700, so I’m right in the middle of it.

Thank you for the list of vitamins and the confirmation that zinc may well be of use to me. Thankfully zinc is available over the counter here and doesn’t require a prescription. So if Zinc acts as an anti-estrogen, what is the advantage of injecting HCG instead? Is HCG basically just a much stronger AI, whereas zinc is helpful but doesn’t lower E2 levels that significantly on its own?

It would be a lot more helpful if I knew my Total T levels of course, but do you think my endo is guilty of dishonesty in his claim that my side effects likely stem from my body simply not being used to this amount of testosterone? He may point to the jump in free T levels (4 to 10.2) as justification for this, but aren’t these figures a tad misleading? (I have heard that T levels are often restored to within range within a couple of days, and mine are still well below after over a month on treatment, so this isn’t the rapid increase that it might appear). What do you think?

Conversely, just to play devil’s advocate, have my free T levels raised enough to quash the idea that much of it has been converted into estradiol, or, as I previously mused, is my jump in T not as massive as the endo would like me to believe?

Wow, that’s a lot of questions! Sorry PureChance, but I’d really appreciate it if you could do your best to answer these head-scratchers.

Finally, one thing I noticed upon carrying out yet more internet research is that my LH levels (that were conducted prior to beginning treatment) are well below the normal range. Could this be significant in any way?

Thank you very much!

23

hCG is not an AI…reread that portion of the stickies.

24

HCG has nothing to do with AI.

low LH = secondary hypogonadism

HCG mimics LH stimulating the testicles to make Testosterone (and pregnenolone I think).

ideal 8am cortisol is normally in the top 75% of the range. on a 4-20 scale the ideal is 15-20. being right in the middle for an 8am blood draw = too low.

your doctor unfortunately sound like an idiot (which is pretty common).

what is the range for testosterone?

brainfog could be due to too much Estradiol aromatising from too much T… or it could be because your T production shut down when you started on external T, and the external T is not enough… or it could be because your extra T is demanding more cortisol and your adrenals can’t keep up which can contribute to problems with your thyroid… or it could be your external T (without HCG) is shutting down your natural pregnenolone production. any of which could cause brainfog and countless other symptoms.

25

Why isn’t anyone picking up on this:
Prolactin - 88 miu/L ??

Or is the conversion of miu/L different from normal where 88 is actually within range?

26

Please post what protocols were for the lab testes, edit that post.

You seem to have hypothyroidism, contributing to your problems. Also need fT3. In this case, you may not be able to absorb transdermals and these may actually lower T levels for some.

Do you use iodized salt? Iodine in your vitamins?
Check body temp when you wake and a few times during the day, records. Post results here after a few days.

What was the range for the useless E2 test? E2 can be very low for some when FT is very low. What matters now is where TRT takes E2.

No ranges for total testosterone?

27

[quote]PureChance wrote:
what is the range for testosterone?

brainfog could be due to too much Estradiol aromatising from too much T… or it could be because your T production shut down when you started on external T, and the external T is not enough… or it could be because your extra T is demanding more cortisol and your adrenals can’t keep up which can contribute to problems with your thyroid… or it could be your external T (without HCG) is shutting down your natural pregnenolone production. any of which could cause brainfog and countless other symptoms.[/quote]

I am fully aware of the difference between HCG and Aridimex guys, that was just a one-off mistake (put it down to the information overload of the past few weeks!). Sorry about that.

The range given for total T was 230 - 1000 (although I know that a man of my age should be in the higher echelons of this area).

So, regarding the brainfog, I guess I need to get my total T level back before we can narrow down the potential causes. Would you say that the rise in my free testosterone indicates that T shutdown and/or high E2 isn’t the problem, or can free T show reasonable improvement while total T remains well below range due to either of the above?

Also, wouldn’t my SHBG have gone up if my estradiol levels had risen? (instead it has gone down slightly, from 56 before treatment to 50 now).

My most recent test results seem to rule out the chance of thyroid problems.

Could LOW E2 actually be the problem? I have read that many of the symptoms are the same, while two recognisable symptoms of mine seem to be associated more with levels being too low (frequent urination at night since beginning TRT, although I have had this in the past as well, quite a while ago) and restless sleep (rather than just difficulty getting to sleep).

The other symptom is coldness. I often feel shivery, particularly after waking up, so I will keep track of my temperature over the next few days. Would I be correct in saying this is more in line with low E2?

Thank you once again.

28

Couple more things I forgot to mention - When the endo said the other day that the injections would release testosterone slowly into the bloodstream, and therefore maintain steady levels for the long interim period, it seems he was telling the truth after all, as I believe the product I will be using is called Nebido, which has built its reputation solely on that boast. Let’s hope it isn’t simply too good to be true. If anyone has any information on Nebido then that would be great.

The other issue I meant to raise is that since beginning treatment I have experienced headaches almost every day.

29

OK, time for a major update. After halfing my dose of Testogel to 2.5mg per day for a trial period, I have come off it all together as my symptoms (severe insomnia and, seperately, a debilitating ‘brain fog’) were proving to be too much to handle.

The next course of action prescribed by my endo is that after a week off from any form of TRT, I will be given a 250mg shot of Sustanon as a “trial” to see whether my body’s aversion is to the testosterone itself or the method of delivery.

The idea is that, should I experience a really excellent first few days on the Sustanon because of the rapid increase in T Levels, then this would tell us whether I can move on to Nebido as my long term injection of choice (which provides a much more stable release of T than any other type available).

My question to you guys is this, and I am really hopeful that the answer will be a positive one:

Is there any chance that what the endo is saying is right, in terms of some people having really adverse affects to one type of T delivery, but getting on really well with another?

Bare in mind that I’m not talking in terms of some patients absorbing too much or too little of the gel, but whether some may have an awful time on the gel DESPITE impressive lab results, but then find that injections work great for them.

Basically can the differing METHODS of delivery have much of an influence on a patients well-being, regardless of figures? Obviously I’m posing this question as I’m extremely worried that the Sustaton will be just as damaging as the gel to my physical and emotional state.

30

you seem to be focusing 100% on your testosterone levels when there is so much more involved in the process. All of your systems need to be balanced if you want to feel better.

TSH of 1.5 is not ideal and could be contributing to brain fog. I would recommend additional Thyroid tests free t4, free t3, reverse t3, 8am cortisol, and ferritin.

you need to confirm your cortisol levels with the test above.

you really need to get the right estradiol test to see what your estrogen levels really look like. <56 is not the right test range. Gels are known to cause additional estradiol in some people (I think).

All T-ester injections fade over time regardless of how long lasting they are. All require more frequent dosing then recommended by the doctors.

31

Prolactin - 88 miu/L

miu ? pmol ? ng

When we do not get ranges, are we lazy?

Prolactin levels in men are typically less than 15ng/mL

So do not know if: Hyperprolactinaemia - Wikipedia

so lets do the work:

“prolactin concentrations expressed in mIU/L can be converted to µg/L by dividing by 21.2”

88 mIU / 21.2 = 4.15 ug/L = 4.15 ng/ml

Prolactin is lower than what we see for most guys here. 7-9 is typical when good, some are close to the upper limit.

32

KSman, we get it. You are knowledgeable in this forum. This does not entitle you to walk around here with your nose in the air. All we are trying to do is help the guy out. There really is no need for your condescending tone.

33

Thanks guys. How’s it going with the TRT by the way B WS6? Feel free to PM me at any time if you want to talk about any treatment related issues, as it seems like our situations are comparable in many ways.

After a week of no Testogel application, the ‘fog’ still hasn’t lifted yet. I felt that my congnitive function had improved somewhat only a day or so after quitting, but since then it has remained in a similar state, without any further regression of the symptom.

I am pretty worried now that the Testogel has done some permanent damage to my brain, but surely this cannot be the case? I haven’t heard any other users of the gel complain of this symptom, and an MRI scan was conducted before I began treatment to confirm that there was no tumour lodged in my brain.

I know that in some cases TRT can lead to polycthemia (excess red blood cell production and subsequent ‘thickening’ of the blood). Could this be the cause of my ‘fog’? Perhaps the thickening of the blood led to a slower delivery of oxygen to my brain?

Also of note is that my head has felt very ‘heavy’ and pressurised since coming off the gel.

34

Hey what’s up. I was on a T+HcG+AI protocol but stopped it after a week. Prior to beginning TRT I had another baseline blood test done to with some other things I wanted to check for like Vitamin D, which I was low in and now I am supplementing with 4,000IU’s. One of the things that I hadn’t checked out before was Estradiol. My lab value came in at 62 which is pretty high due to being overweight. I read a few studies that showed a positive correlation on AI use and T levels. Those placed on AI’s more than doubled their testosterone. That’s the route I am taking now. I’m jus’ taking the AI, no Testosterone or HcG in conjunction with a diet/exercise program to shed some pounds. Let’s see how this works out for me.

No, the Testogel didn’t permanently damage your brain. I have anxiety and sometimes I let irrational fears get the better of me. I did great with cognitive behavioral therapy which taught me how to break that fear cycle. I’m not implying this upon you but want you to realize this is a irrational fear based on no concrete evidence. Look at the bigger picture and come to a more reasonable conclusion. Maybe the Testogel increased estrogen levels higher than normal which is playing tricks on you?

It’s true that TRT can lead to polycthemia but that is after long-term use I believe. You haven’t been on it for that long for that too begin to affect you.

35

Forgot to ask, are you overweight?

36

That’s quite a unique route to take, just taking the AI without any testosterone or HCG in conjunction. I’ll be really interested to hear how you get on, best of luck with that.

It’s funny you should mention CBT, as just before learning of my testosterone deficiency I was seriously considering taking the plunge into that form of therapy in order to cope with my depression (it was recommended to me by a University counsellor). I feel it may still be worth looking into at some point, but I’ll see how far the TRT can get me first.

I know I’m just being paranoid about the Testogel, but the reason I’m so concerned is simply because I haven’t read about ANY cases of ‘brain fog’ arising as a result of the use of the gel. It would be nice if I could at least have a rough idea of how long it will take for my cognitive function to get back to normal (at least relative normal, as it was hardly great before treatment, one of the reasons I begin TRT in the first place was to sharpen up my mind!). Kind of perverse how things have worked out then!

It would be nice if my problems were all down to a rise in E2, but the fact that my SHBG went down from 56 to 50 seems to negate the validity of this theory unfortunately. It’s baffling that my labs all seem to show good results yet the gel made me feel absolutely awful, a feeling which has not subsided since ceasing the daily application.

I’m constantly throwing out theories to try and explain the situation, and the only logical explanation I can come up with is that I also had adrenal fatigue prior to the testosterone replacement therapy, which the Testogel then went and exacerbated. The wearing out of adrenal glands was worsened and subsequently the fog become more pronounced. If anyone could vouch for this theory that would be great!

I am not overweight, in fact I am pretty underweight (despite having a large stomach due to the congregation of fat all developing in one area).

Take care and keep me posted on how things develop for you.

37

[quote]Jimbo4 wrote:
That’s quite a unique route to take, just taking the AI without any testosterone or HCG in conjunction. I’ll be really interested to hear how you get on, best of luck with that.

It’s funny you should mention CBT, as just before learning of my testosterone deficiency I was seriously considering taking the plunge into that form of therapy in order to cope with my depression (it was recommended to me by a University counsellor). I feel it may still be worth looking into at some point, but I’ll see how far the TRT can get me first.

I know I’m just being paranoid about the Testogel, but the reason I’m so concerned is simply because I haven’t read about ANY cases of ‘brain fog’ arising as a result of the use of the gel. It would be nice if I could at least have a rough idea of how long it will take for my cognitive function to get back to normal (at least relative normal, as it was hardly great before treatment, one of the reasons I begin TRT in the first place was to sharpen up my mind!). Kind of perverse how things have worked out then!

It would be nice if my problems were all down to a rise in E2, but the fact that my SHBG went down from 56 to 50 seems to negate the validity of this theory unfortunately. It’s baffling that my labs all seem to show good results yet the gel made me feel absolutely awful, a feeling which has not subsided since ceasing the daily application.

I’m constantly throwing out theories to try and explain the situation, and the only logical explanation I can come up with is that I also had adrenal fatigue prior to the testosterone replacement therapy, which the Testogel then went and exacerbated. The wearing out of adrenal glands was worsened and subsequently the fog become more pronounced. If anyone could vouch for this theory that would be great!

I am not overweight, in fact I am pretty underweight (despite having a large stomach due to the congregation of fat all developing in one area).

Take care and keep me posted on how things develop for you.[/quote]

From what I’ve read my friend the central concentrated fat is THE reason for increased Aromatase activity.

From personal experience (I’m a night shift worker and in a constant battle to keep Cortisol under control) and literature Cortisol is one of the key culprits in hold and adding to central fat stores.

A couple ideas to combat that ASIDE from sleep (because of you issues):

  1. Glycine 10g x3 throughout the day. Make sure one dose is 15min pre-bed.

  2. Phosphytadilserine (If funds agree) 400mg mid day, 400mg 15 min pre-bed

  3. Magnesium 500-1000mg pre-bed And maybe even some GABA - 500mg Pre-bed.

That should help a little, and help you relax and stay asleep as well. I’ve got a feeling a lot of this is a result of the poor sleeping habits pre-trt.

Question: Do you study before bed?

38

[quote]Jimbo4 wrote:
It would be nice if my problems were all down to a rise in E2, but the fact that my SHBG went down from 56 to 50 seems to negate the validity of this theory unfortunately.[/quote]

I think it’s the other way around. In my case, I have high E2 and a low SHBG count.

39

Thank you for the tips Darkane, I really appreciate it. I don’t study before bed, no, I usually wind down the day by watching a couple of hours of TV. Are you suggesting that the brain fog and poor sleep may in fact have been caused by high cortisol levels, or at least fluctuating levels throughout the day given that my midday test didn’t show particularly excessive cortisol production? Maybe my cortisol production isn’t following the standard circadian rhythm?

Interesting what you say about E2/SHBG correlation there B WS6. I still think that E2 being the cause is unlikely, given that my TT after a few weeks on Testogel had gone up from 70 to 340, and the fact that my fog hasn’t cleared since abandoning the gel 11 days ago. I certainly haven’t ruled the possibility out though.

Also, to go off on a slight tangent, are there any posters here who are also registered with the ‘all things male forum’ (Dr. John). I only ask because I tried registering there too (as the more opinions I can get the better) but my activation email never arrived, leaving me in a state of not being able to complete my registration.

I’d really love to hear from either Dr. John or an extremely knowledgable member there who goes by the username of ‘chillin’, so if anyone who posts there would be kind enough to alert an admin to the fact that my registration has not been finalised, just give me a PM to ask for my email address to pass along to said admin.

Alternatively, if you could contact ‘chillin’ to ask him to take a look at this thread, then that would be just as useful.

Thank you very much.

40

Another important point worth raising - While on the gel, I was experiencing headaches pretty much every day. These were mostly ‘normal’ feeling headaches but sometimes ‘vice like’ headaches where there wasn’t really any pain involved but my head felt extremely pressurised and heavy.

In the ten days since stopping the Testogel application I have still been experiencing daily headaches, but they have mainly been the latter type (the ‘vice like’ sensation). We haven’t had many bright days in my area recently but when I did go out in full sunshine the pressure seemed to become more intense.