T Nation

Starting Over and Need Advice


#1

I guess I should start at the beginning; so, this may be a bit long. About 14 years ago I developed a very rare growth on my vocal chords that (after a few years) required incredibly frequent surgeries (every 3 weeks) just so I could breathe. After 3 years (and nearly 25 surgeries), the Doc I was seeing recommended I consider experimental treatments.

Shortly after treatment I began to notice issues with libido. Since this was an experimental treatment there were no known side effects. I saw my General Physician about the libido and he indicated my testosterone level was low...but not too low "live with it". After several years of a continually decreasing libido I started seeing another GP.

Again, I received the same reaction. About 2 years later, I began having issues with joint pain, hair loss on my legs, lethargy, and a ton of other things...not to mention a rather upset wife. I begged my doctor to send me to an Endocrinologist. The Endo indicated I had the testosterone levels of a 90-year old man (at the age of 37) and began trying to find a way to boost it.

During the testing, he determined that the experimental treatment I had elected above ultimately affected part of my pituitary gland; specifically, Luteinizing Hormone levels are not anywhere where they should be.

Under the care of at least 2 GPs, 1 Endo, 4 Urologists, and an OBGYN I have been placed on a number of different treatments and a number of different doses. What appears to have worked the best is 100mg Testosterone Cyponate injections 2x weekly. I have been on this for over a year now and have had labs run 3 times now with testosterone levels between at 8.86, 23.44, and 13.97 ng/ml (8.86 was taken the morning before an injection, the 23.44 was taken the day of an injection, and the 13.97 was taken the day after an injection).

My throat issue that had been in remission for almost 8 years has started flaring up. The throat doctor believes it to be linked to an increase in estradiol in my system. Estradiol has been shown to increase the outbreaks. I have relayed this information to my urologist who has started to look at my estradiol levels. The first two results were 92 and 114.1 ng/ml.

After seeing these, the urologist put me on an Anastrozole (0.5 mg/day). My most recent labs showed my estradiol levels are now 0 (which I understand is too low). However, the urologist believes this is just fine and doesn't want to change my Anastrozole.

Finally, through all of this, I honestly don't notice a difference in my libido, my mood, my energy levels, nothing (well, I do notice a bit more daily pain). Over the last 2 years I have bounced from:
8.6 ng/ml testosterone and 92 ng/ml estradiol
23.44 ng/ml testosterone and 114.1 ng/ml estradiol
13.97 ng/ml testosterone and 0 ng/ml estradiol

I don't notice ANY changes at all. Some friends have told me that this may be due to a decrease of GnRH and that I should talk to my urologist about hCG injections. My urologist has pointedly said he does not believe in them and that he will NOT prescribe them. That if I insist on this I should find another doctor. I have seen 7 different ones so far. How do I find one that will help? I feel like I am starting all over here. What do I look for???


#2

Google low estrogen in men


#3

You are taking too much anastrozole. Labs need ranges to be understood.


This is standard advice maintained here:
http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/please_help_me_refine_standard_advice

There is a huge amount of knowledge in the stickies. Please study these. Start with the advice for new guys sticky.
http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/prototype_advice_for_new_guys
There is a lot to read there, so read carefully. There are suggestions for things that are root causes of low testosterone [T]. Low T is a symptom, not a root cause itself. But low T itself is a root cause of many of the symptoms one experiences. Note that other things cause the same spectrum of symptoms, so do not have T tunnel vision. Many docs are guilty of that and they only treat the symptom [low T] and do not attempt to find the real problem. If you go to a clinic that specializes in low T, you will get T tunnel vision for sure.

Post info about yourself as suggested in the above sticky. We need labs, almost all of your labs, not just hormones. We also need the lab ranges.

We see a very high number of thyroid issues in the population of guys that show up here. So there is a strong focus on that. Most people are iodine deficient to some degree. Your history of iodine intake from iodized salt and vitamins that list iodine is important. If you become iodine deficient, the RDA [recommended daily allowance] is inadequate for recovery of iodine stores. Please see the thyroid basics sticky for more information.
http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/thryroid_basics
You do not want to suffer from subclinical hypothyroidism or get Rx thyroid meds to treat iodine deficiency.

If you are injecting T or contemplating that, read the protocol for injections sticky.
http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/trt_protocol_for_injections

There are stickies for finding a TRT doc, estradiol [E2] and lab work.

Do not place your history or treatment details in the stickies! That belongs in your thread. Keep all of your posts in your thread so we can have a clear picture of your situation and needs.


#4

In your case/thread opening post:
-age
40

-height
6'2"

-waist
36"

-weight
225#

-describe body and facial hair
Quickly grow a beard and well covered on chest/arms/legs...unfortunately, starting on my back too

-describe where you carry fat and how changed
Generally carry it on my hips and belly. Never really changed much over the years

-health conditions, symptoms [history]
This is difficult and lengthy. RRP (throat condition) in 2000. Experimental treatment for this in 2004. Vasectomy 2004. Dr believes treatment for RRP resulted in pituitary damage resulting in low Testosterone. Ruptured testicles 2010 resulting in epididyectomy in late 2010. Begin testosterone replacement May 2010. Replacement methods have been 50mg/day cream, 100mg/wk cyponate injections, 30mg/day Axiron, and most recently 100mg 2x/wk cyponate injections. Also diagnosed with Celiac Disease in October 2011. After starting replacement therapy, noticed additional testicular aches. According to the urologist, the doctor that performed the epididyectomy missed some tissue and pain would be a part of my life. He recommended some neural blocks (worked for a bit). And is now recommending an orchiectomy. I have mentioned to him that my testicle size has been getting smaller.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Test Cyp 100mg 2x/wk, Anastrozole 0.5mg/day, Multi-vitamin, Probiotic, Digestive Enzymes. Anastrozole is new (just started in August). I agree, it is too much. But, the Dr is insisting that it is not. Part of why I am depressed...looks like I need to try and find yet another doctor.

-lab results with ranges
I have had YEARS of lab data generated. I could input it all here but it will take forever. What specific parameters are you looking for? I know that my family doctor and the endocrinologist looked at thyroid numbers very closely. Both were adamant that thyroid was not my issue. Both indicated that the issue resided in my pituitary. The endo is fairly certain that the issue is the result of the experimental treatment I underwent for my throat condition.

-describe diet [some create substantial damage with starvation diets]
Normal diet. Believe me, I don't starve myself. I am on a no gluten and no soy diet (for the celiac disease) and have been since October 2011.

-describe training [some ruin there hormones by over training]
I am hoping to get back to the point of being able to train. Right now, just some walking...

-testes ache, ever, with a fever?
Yes, ache. See above. Urologist believes it to be result of tissue left after the epididyectomy. However, I believe it to be the result of atrophy. Dr will not prescribe HCG. Again, looks like I will have to find another new Dr. Figures, about when I get them to listen to one thing another rears it's head. I have been dealing with this for YEARS...

-how have morning wood and nocturnal erections changed
No real changes here. Always had morning wood. No noticed nocturnal changes noted. Libido still low.

I have been injecting for a bit over a year. 27gauge 3/4" needle in the thigh. I inject 100mg on Wednesday mornings and 100 mg on Sunday morning.