T Nation

To Replace or Not to Replace


#1

Hi everyone I'm new here, been reading around as to not post a question thats been done already. My situation is a little different than average, and I just don't know if replacement is the right thing. Any suggestions would be a great help

I'm a 32 year old disabled vet who has been active in lifting and sports my whole life. After being injured I was put on narcodic pain medication and had been taking it for the last 5-6 years. I finally looked in the mirror and realized what I'd become, I gained about fifty pounds during this time and was the all time laziest on these meds. To summarize they really messed me up.

I quit the medication and went through hell doing it, during this time the va did blood work on me. 30 days off all meds and I'm extremely tired, I know this is still a side effect of withdrawal. I found a dr to give me a b12 shot hoping that it would give me some needed energy to get out there and start working out again, which i had been doing during the 30 days getting off. He suspected my testosterone was low and told me that narcotic pain meds suppress testosterone.

I showed him my labs and my levels were 387, which is said was the low side of normal and that i should be around 800-1000, and offered me a shot, he said he doesn't like to prescribe gels and I took the shot, I came back the following week for shot 2. Hes a nice guy and doesn't charge for an office visit just 30 a shot for the week. I asked him about estrogen levels rising over time and said i should have to worry about that because thats mostly from gels having to be on all day long. I still have read otherwise.

So here I am working out 5 days a week again dropped about 15 pounds. Have not really felt any effects from the shots still have to take a pre workout drink just to get up and going. My main fear is that I finally quit something that was super addictive with my meds and now it looks like I'm starting on something else that I will need to take and will build a tolerance too, this freaks me out. Do you guys know much about testosterone levels coming back after years of suppression from meds. I like the idea of getting the help form the t shots but I would rather do it on my own if my body can start making it on its own. If I quit will the two weeks of shots really drop my levels more? Any advice, or opinions on this would be cool.
thanks.


#2

If I were you, I would get off the shots and get the necessary blood panels done to figure out what is going on. There are a whole host of possibilities that blood testing will shed some light on.

If your LH/FSH is low, I would recommend an attempt at a SERM restart to see if that gets you going again.

I do not know how well this works in the context of depression from narcotics....but I would definitely think it is a possibility.


#3

I have complete blood work just done about a month ago, I'll check to see if this is low. I don't know too much but the lab is about ten pages long.

looking through my labs, they only tested testosterone as far as hormone levels go. Va won't do lab work again for some time a couple months from now.

all i have is prolactin = 9.49
and test. 387

I'm suppose to go get this weeks shot tomorrow, it seems like most people i talk to have biased opinions, mainly because they have used it in the past buying it from some guy at the gym, about half the people i know are supportive the others say its bad news at my age. None of them are experts or have been on it long enough though


#4

Without more labs it will be hard to tell what's going on with you and hard to advise you on your options.

If you're on testosterone and you get labs done the data will be skewed. Synthetic T suppresses production of LH and FSH, two very important factors in getting a diagnosis. This is why VT suggested getting off the T, getting the labs done, and going from there. You need to see if there is an underlying issue that is causing your low T (thyroid, pituitary, etc.) as this issue should be addressed before getting on testosterone. If you have old labs they might help out depending on what you have. Anything you can post would be good.

About the pain meds: I have no idea and I've been trying to find information on that too. Between 5 surgeries and several injuries, I've been on more than my fair share and have wondered how this affected my testosterone levels. I can't know for sure since I also had testicular cancer, so that doesn't help narrow down what the pain meds did anyway.

Don't worry about getting "tolerant" to TRT, it won't happen. I know what it's like with tolerance to pain meds: At first one tab works fine, then a month later you need two, then a couple months later you need five. TRT doesn't work like that: You will likely be on the same dose for life, once you get your levels dialed in. Addiction and tolerance freak me out too, so I can see where you're coming from.

Since you can't get labs through the VA for a while, you may want to get them done on your own. This is one of the test packages we recommend guys get (even though it says female panel - the female panel has the better estrogen test in it): www.privatemdlabs.com/lp/Female_Hormone_Testing.php

You can also order other tests from there (the ones recommended in the Stickies on the front-page of this forum), and it's a lot cheaper than getting it done at a lab without insurance. Make sure that if you are going to come off the shots for the time being you talk with your doctor about the safest way of doing so. You shouldn't just quit cold-turkey with no supporting medication to help you reboot your system or you could run into some issues.

Hopefully this answers some of your questions, or points you in some direction. Keep us posted on how things are going.


#5

Thanks so much for posting, I have labs somewhere in my files from before going on pain meds, I was in really good shape at the time, so i'll look for those. I'm suppose to see the doctor tomorrow so I'll address my concerns. Hes a decent educated guy, but hes a doctor in everything. I've never seen a guy be able to do so much from nutrition, to lasik eye surgery, glasses/contacts, hgh and t replacement among other things. I know he will tell me how they can benefit me but I have to look at it from a money perspective even though its not a fortune and he isn't charging for visits, he spends close to an hour with me talking about life or how I'm feeling for 30 dollars. I'm torn and don't trust doctors. Anyway thanks again and I will post if I find the old labs.


#6

here was a link about pain meds and testosterone I was reading earlier that kind of explains what happens although not too detailed.

http://www.healthiertalk.com/dr-dach-low-testosterone-pain-pills-1533


#7

Hopefully you'll get this sorted out sooner than later. Finding a doctor who is good at what he does and is also a pleasure to meet with is hard to find. Usually you get one or the other. The best thing you can do is know the ins-and-outs of what is going on with your health so you can have a wee-informed discussion with your doc and "plead your case" so to speak.

I read that article. If what it says is true, that, "Low testosterone is caused by opioid drug inhibition of LH (Leutininizing Hormone), a pituitary hormone involved in testosterone production, as well direct inhibition of testosterone itself" then I don't fit the bill. My LH was slightly above range when I found out I had low T, so unless I only had the "direct inhibition" part, I don't have opioid-induced low T. It looks like, according to the article, that opioid-induced low T is temporary since they say:

"The reality is that hormone supplementation and nutritional supplementation for the long term opiate pain pill user is only a temporary bandaid. To fully restore health, the opiate addiction must be addressed and the patient must ultimately get off the pain pills."

So yeah, as you said it's not too detailed and, although it has numbers after some sentences as if to reference something, those references don't appear anywhere. I'm always suspicious of papers that don't cite sources. Still an interesting read though.

And forgive me for asking this, but it's been killing me. What's eating you?


#8

Here are some good articles about T replacement and hormones with chronic pain patients.

http://www.practicalpainmanagement.com/treatments/hormone-therapy/hormone-treatments-chronic-intractable-pain

http://www.practicalpainmanagement.com/treatments/hormone-therapy/hormone-replacements-treatments-chronic-pain-update-2010

http://www.practicalpainmanagement.com/treatments/hormone-therapy/testosterone-replacement-chronic-pain-patients

The bottom line is if you can deal with the pain without the opiates do it. However, some people can't function due to their pain without opiates so they must take them. According to those articles the severe pain wrecks your endocrine system as well, causing low t, adrenal fatigue, and low thyroid among other things. So most people that are legitimately on opiate treatment for pain are horribly suppressed in many hormones due to both their pain and the treatment. The author of the articles advocates boosting hormones not only for the tissue building/repairing benefits (along with libido, energy, ect.), but they also argue that low Test makes opiates much less effective as they can't cross the blood/brain barrier. That would help explain why you need to take more and more pills to get the same relief as time goes on. I got on TRT recently as well as treating my thyroid and trying to bolster my adrenals and I've been able to greatly cut back on my pain medicines and I feel better than I have since I blew out my back.


#9

Yeah as far as taking pills I will never take anything again other than non narcotic meds. I felt tricked afterward and didn't know much before I was prescribed meds, doctor started me out on methadone and oxycodone, I researched methadone and told him no way am i taking that. Then he prescribed me morphine instead at pretty high doses, then later oxycontin because i could get it through a patient assistance program. Tolerance went up quickly and there was never really any high from taking it as some people I know tell me, but I had to take more and more not due to the pain but six hours without or so I would start feeling like I had the flu. I did this for close to six years. I recently got married about six months ago and can pretty much count the times I had sex or even wanted too, I know she pissed but was being patient, I was fatter than I ever was and was somehow complacent with this lifestyle. I decided I had enough of the side effects and quit. Anyway it was miserable and I was never informed what withdrawal would really be like, pretty terrible how out of whack it makes your system to quit because of this experience the pills are done forever, and the funny part is that my pain levels are better without the meds although I still hurt I can say I don't hurt as much. I don't ever want to feel trapped in that kind of situation again, taking something to feel better, and that was pretty much my dilemma here. My pain doctor never mentioned anything about testosterone dropping or shutting down, but when I read the symptoms of low t I have about all the symptoms.

Thanks to everyone so far for posting the links and advice, I'm really glad that you've posted. I'll go talk to my doctor tomorrow since hes open for discussion and seems to generally care whats going on, the last two days I've been dead tired more so than normal I don't know if my last shot has been wearing off since I just started this but I'm tired of being tired and torn between my fears of being addicted again, and letting those fears possibly get in the way of something that can genuinely help me get back on my feet, and thats whats been eating me.


#10

Hang in there man. I know there are some doctors that just throw hardcore opiates at you without letting you know what you are getting into. Next thing you know your taking huge doses of pills that can completely change you and enslave you. It's good to see you have your mind set to never use them again. I'm sure you'll be able to get your hormones sorted out too. I'm still working on mine, and it took a few months of hell to get the ball rolling in the right direction, but with my research and a lot of work to find a good doctor I'm finally getting dialed in on a good protocol to get my whole system balanced. Keep reading this site, you will learn a lot.

Luckily my pain doctor tries to do everything possible to minimize the drugs, and at this point I still take 1-3 5mg percocets a day depending on pain. If i have a good day i won't take any and i have no withdrawal effects that I notice. After my surgery I was on 60mg morphine, 120 mg of Percocet, and 30 mg of Valium everyday. Rather than keep me in the hospital an extra couple days to let me get better they just gave me a max dose of percocets with some Valium and morphine chasers to get me out of there. I lost about 20 lbs of muscle in a 2 month period and felt like utter shit being that doped up and non functional. It was hard to cut back at that point too as I was just in a shit cycle of extreme pain from the nerve damage and being doped up. Luckily I got through that without being put on high dose morphine or methadone. My goal is to get my pain down low enough to not need any opiods and I think I'm close to getting there at this point. Once you get in a rythym with your mind, lifestyle, eating, and exercise with a boost from your hormones its amazing how much less you hurt and how little shit that used to bother you just doesn't matter.


#11

Also, you might want to ask your doctor about trying HCG. On that pain website they mention how all of the hormones that HCG stimulates, as well as the HCG itself seem to help with pain. In me my E2 as well as my T was low. My horrible stiff back pain that would wake me up every night is way better now after adding HCG to my protocol. Maybe my joints hurt so bad because my E2 was low and the HCG bumped my E2 just enough to help my joints feel much better?

Since you are likely secondary hypo due to the opiates there is a good chance hCG can raise your testosterone significantly as well as keep your balls working. If you can get your test high enough with just HCG then you wouldn't be on the Test Cyp at least. Obviously a SERM restart would be worth a try though I've read many people not being able to maintain their levels after being off of the SERM for a couple months. It seems you really need to have your diet, adrenals, and thyroid in order for a SERM restart to have a decent shot at working.

Either way you have a lot of options, and with a competent doctor guiding you and picking peoples brains on this website I don't think you have to worry about TRT becoming a bad thing in your life. It's a constant struggle but my worst day now is still 10 times better than before I got on TRT. The increased energy, drive, strength, and better mood are things that you and your wife will both really enjoy. It is a constant struggle but in my opinion well worth it.


#12

I don't remember the movie being that intense!

All joking aside, keep us posted and I hope all goes well.