help me feel normal again

[Aki]

The short and long of it:

Male, 32 years of age, currently in India. I am going for my second consultation tomorrow afternoon with an endocrinologist with the following numbers (he wrote the tests):

Prolactin: 15.8 ng/mL (reference range: 3.70 - 17.90)
Testosterone, Total: 209 ng/dl (reference range: 132 - 813)
Glucose Random 94.0 mg/dL (reference range: 70.0 - 140.0)
Calcium: 8.5 mg/dL (reference range: 8.5 - 10.1)
Phosphorus: 3.4 mg/dL (reference range: 2.5 - 4.9)
Total TSH: 2.84 µIU/mL (reference range: 0.27 - 4.20)

What do the knowledgeable members think of these results? If my doctor seems unwilling to prescribe testosterone therapy for me, how do I make my case?

I have been feeling like crap for a *long* time now. I haven't used steroids before but I think if that's going to fix things (as opposed to antidepressants that I've been taking, and have only made things worse) thats what I'm going to do.

Luckily I happen to be in India at the moment, and apparently steroids can easily be acquired here, if it comes to that.

Don't know if there's any essential info I've left out - wasn't sure whether rambling on about my "history" would help, so I decided not to - but if there is, please ask.

Aki

 

[BigFella]

Hi Aki

You sound just like me, except that you're half my age. I started a thread "61 year old wanting to start TRT". There's some stuff in there which is rather similar - jump in; I won't think you're hijacking it.

Re total T: 209 (132-813): the problem is that no-one knows what your normal was when you were feeling 100%. It might have been 600, so right now you might be running at a third of your normal levels.

Re rambling about your history - I had the same problem. I figured I'd put it in - there's always a "down" button if it bores people.

Re antidepressants: I'm on Prozac, and it takes the edge off things - but it takes the edge off the highs as well. But when I'm on it I don't think about killing myself, so it works.

Re endocrinologists: Ring and find out whether they know anything about testosterone replacement therapy (TRT) before you spend your money. My experience is they don't. They know about thyroids, and female Hormone Replacement Therapy (HRT), but forget TRT.

 

[Aki]

Hi BigFella,

Thanks for the reply. Despite our age difference - and after reading your thread - I empathize with what you're going through. I too, a few short years ago, was a very virile young man - although it feels like it was eons ago! (Since - as I detail below - I have started treatment already, I'll skip writing about myself - not the least because the thought of spending my currently limited mental strength and focus on such an endeavour itself feels very taxing.

Fortunately as it turned out, my endocrinologist seems to be knowledgeable in these matters: he took one look at my test results and went "your testosterone is way too low".

He wrote a CT scan for me (I suppose it was to check for the possibility of a pituatary tumor) but thankfully the results came back normal.

He's written down three shots of "sustanon 250" for me, spaced three weeks apart; I had my first shot after my appointment yesterday. He's also prescribed two 25 mg capsules of "dehydroepiandrosterone" per day.

Since buying sustanon (and, as I understand, steroids) in this country seems to be no problem at all, I was considering researching the whole issue of steroid/testosterone supplementation with the idea that I might be able to figure out a plan to exceed the doses prescribed for me - with the hopes of accelerating the process of "reclaiming lost youth and vigor", as it were - but I figure I should let my T-levels become normal first instead of going overboard with it, what with the associated side effects at all. (And again, the idea of having to do all that research itself seems exhausting.)

The doctor said I should start feeling noticeable improvements in my well-being in around a month's time.

I'll try to keep this thread updated, with the hope that it might help others. Hopefully you'll keep us posted in your thread too.

Aki

 

[BigFella]

Ali

Sounds like you found an Endo who knows enough to be dangerous. It's great that he prescribed T for you, but I think that 95% of the people on this forum will freak at the once per three weeks regime. Your T levels will peak and crash, you will aromatise T into Estrogen, your nuts will shut down. Whereas if you self-injected twice a week the chance of these negative side effects would be far lower.

Caveat: no personal experience yet; this is solely the conclusion I have reached after a lot of research.

In case you think your Endo is dumb: he probably didn't think of the possibility of your self injecting, and prescribed a schedule which would mean you had to visit him least.

Comments from people more experienced than me please!

 

[BigFella]

Aki

Sounds like you found an Endo who knows enough to be dangerous. It's great that he prescribed T for you, but I think that 95% of the people on this forum will freak at the once per three weeks regime. Your T levels will peak and crash, you will aromatise T into Estrogen, your nuts will shut down. Whereas if you self-injected twice a week the chance of these negative side effects would be far lower.

Caveat: no personal experience yet; this is solely the conclusion I have reached after a lot of research. And I know nothing about DHEA.

In case you think your Endo is dumb: he probably didn't think of the possibility of your self injecting, and prescribed a schedule which would mean you had to visit him least.

Comments from people more experienced than me please!

 

[LittleJohnny]

Aki...sustanon 250 is a mixture of 4 different esters of testosterone, each with a different active life. There isn't much experience with sustanon here since most of us use cypionate or propionate, which both have only one ester. So we know the length of time our test shot is effective. The best I can tell, the recommended injection rate for sustanon is about every 10-14 days. I didn't spend a lot of time researching this, so don't take my word for it.


By the way, if you can get testosterone easily and legally in India, you're better off than most. Good luck.

 

[Aki]

Damn, I knew it seemed to good to be true (LOL)... Anyway, even if everything isn't as fine and dandy as I thought it was, at least I found out one day after my first shot in a country where drugs are accessible;seems like I won't be able to get past doing the required research for myself! (Perhaps that's a good thing.)

The endo did say to me, "don't take it any more frequently than this", which gave the impression that he knows what he was talking about wrt dosage.

I'm thinking of posting about this as a separate thread, with a more explanatory title... what do you think?

I'll probably also post in a few more forums, including a general health forum or two (i.e. non-steroid centric forums) to cover as many perspectives as possible.

 

[Aki]

Aki...sustanon 250 is a mixture of 4 different esters of testosterone, each with a different active life. There isn't much experience with sustanon here since most of us use cypionate or propionate, which both have only one ester. So we know the length of time our test shot is effective. The best I can tell, the recommended injection rate for sustanon is about every 10-14 days. I didn't spend a lot of time researching this, so don't take my word for it.

By the way, if you can get testosterone easily and legally in India, you're better off than most. Good luck.

LittleJohnny,

Thanks for the response. Yeah, I read that about sustanon already. I'm thinking if I can look up the half-lives of its various components, I might be able to make a graph of the testosterone concentration in blood with time. [Of course with such a simple model, and without more knowledge of the body's response to the testosterone influx, I might be making gross simplications].

My doc has studied at one of the more prestigious postgrad medical institutes in India and is quite well-regarded, so I can't disregard his opinion lightly. At the same time, I have been bitten before by ignorance (my own, and of those who ought to know better) so I'm going to try to do my homework as much as possible.

Re the legality, strictly speaking I'm not sure how it works here, but I do know that "stuff" can be acquired (with impunity).

 

[BigFella]

Hi Aki

"Yeah, I read that about sustanon already. I'm thinking if I can look up the half-lives of its various components, I might be able to make a graph of the testosterone concentration in blood with time."

I just did that with a low-T befuddled mind. I came up with a result that said your T levels are going to vary by a factor of about 8 over three weeks. (Simple Excel spreadsheet. And the graph looked really ugly on the right hand side.)

That sounded pretty horrible to me, and I didn't believe my mind the way it is working at the moment, so I got on the interwebz and found that other people have done the work before me, and they came up with a factor of 10 variation (!).

I'm not sure of Ology's policy of posting links to other sites, so I won't, but a roid calculator is pretty easy to find.

I'm not going to believe my spreadsheet without confirmation, but it says to me that if you inject the same combination of esters weekly instead of three-weekly your levels won't vary by more than a factor of two.

(I could be wrong - I am frequently. Where I am doubtful in my calculations is in the timing of the effective uptake of the different esters.)

So I don't think there's anything wrong with Sustanon 250 for you; I'd just inject a quarter of it four times more often. That said, I'm going to stay simple and just use Test Cyp EOD or twice weekly. I think. And I really am looking forward to having my brain workling again.

 

[Aki]

I just did that with a low-T befuddled mind. I came up with a result that said your T levels are going to vary by a factor of about 8 over three weeks. (Simple Excel spreadsheet. And the graph looked really ugly on the right hand side.)

BigFella,

Mind if I "see your work" (i.e. the excel chart you made)? And also, I just realised I might have been making a wrong assumption about what the half life of a testosterone compound actually represents, so could you explain that (if you don't mind)?

I am becoming more inclined to the idea of one injection 7-10 days, but I need to learn much more before I'll feel confident about going against the doc's advice.
The most I'm afraid of is having my body respond by bringing about female secondary characteristics - as a man, growing breasts sounds a lot worse than low testosterone. (Although according to you, that's more likely to happen under my doctor's prescribed regimen.) Shrunken testicles, hair loss, etc. aren't too far behind either.

I'm thinking a compromise might be taking Sustanon 100 mg (assuming these are available) more frequently? That would decrease the fluctuation in between shots, I think.

Some of the things I'd like to be able to answer:

1) How do my high prolactin levels factor in? Or is that a red herring?

2) If I'm going to be self-monitoring my hormone levels, how often should that be? (And obviously how results should be interpreted)

3) What other drugs might I need access to, assuming I need to regulate other hormone levels etc.


I've asked my sister (who's a doctor, but different speciality) to ask some of the endos in her hospital about my numbers and the prescribed treatment. Hopefully I'll hear back from her tomorrow or the day after.

 

[BigFella]

Hi Aki (I tried to PM you but I guess I don't qualify yet)

Right now I'm staying up all night, treating myself like shit so I can guarantee a low score in my blood test in about eight hours. I am exhausted and feel terrible, so I'm thinking the number might be good. Why am I doing this? Because in Australia the docs aren't allowed to prescribe Hormone Replacement Therapy (HRT) unless you have two readings below 250 (on the US measuring system) or 8.0 (on the Aussie system). My last was 5.9; I need one more low number, so staying up all night is a small price to pay.

I don't know how to attach a spreadsheet but my private email (has been removed - I can now PM) - I at least know how to send stuff from that, so if you email me I'll send it.

I'm fairly embarrassed by the spreadsheet as I'm quite happy with my Excel skills, but my brain is just not working so I had to do a stack of it manually. It is NOT a thing of beauty. But it gives you the idea.

Email me and I'll send the link to the roid calculator - I'm not sure of the protocol on Steroidology, but I know I haven't seen many external links so I'm guessing it's against the rules.

FYI Cashout has a lot of info in some of his posts (like I said, I have researched this a lot) on uptake rates and half lives which would make a spreadsheet much more accurate. I didn't go much further as the results were so bleeding obvious - inject frequently! I didn't take into consideration the different absorption rates of different esters, but I think they are similar. The half lives vary, the absorption rates don't nearly as much. If you can picture a graph, the upslope (absorption rate) is about five times as steep as the decay rate.

Please remember you're ahead of me here - I've been using transdermals for four months, but haven't injected yet. We are learning from each other.

 

[BigFella]

Sorry, realised there were a couple more questions. As I mentioned in the previous post Cashout speaks pure gold. Go through all his posts and you'll probably find your answers. (You other guys are good too - I just feel as though I found the mother lode with Cash.)

"And also, I just realised I might have been making a wrong assumption about what the half life of a testosterone compound actually represents, so could you explain that "

Plain old testosterone is soluble in water and can be rubbed in as a cream - but it has a half life of hours. (The number is open to debate.) Assume it is six hours. Rub 10mg in then there's zero in your blood at the instant of application, then it ramps up pretty quickly as it is absorbed, then in six hours you'll have 5mg still in your blood, in another six hours it will be down to 2.5mg. In 24 hours when it's time for your next application it's down to 0.625mg. So it fluctuates more than ten times in 24 hours, and it may be the rapid/extreme fluctuation which causes the feedback loops to get screwed up - my nuts shut down, so I have no androgenous production any more, so I'm getting all my T from the cream, and I can't get enough. And I started to aromatize even at this incredibly low level - and grow tits, which I think don't suit me.

So to keep T levels fairly constant you have to apply twice daily - and it is really hard to get enough in anyway. Two heavy applications per day for me just get me into the bottom of the "acceptable" range. (Plenty of scientific papers to show this.)

So esters are added to the T molecule to slow the absorption of the T. Basically the ester prevents the absorption of the T into the blood by blocking that part of the molecule that attaches to another bit (brain fog sets in right now . . . ). In order for the T to be absorbed de-esterification has to happen - the esters get hydrolyzed and then the T can be absorbed. And that happens at different rates for different esters.

Therefore much fiddling has been done with adding different esters to different parts of the T molecule to play with the rates of absorption. The testosterone is identical - once the ester is removed by the esterase enzymes you're left with exactly the same testosterone that is in Test Cyp, Test Enanthate, Sustanon, whatever. It is just able to be absorbed over a longer period.(Theoretically, anyway!)

Two esters that are commonly added are enanthate and propionate - hence the names of the resultant esterified compound.

Re Sustanon 100: Wikipedia says that it was discontinued in 2009. In any case you don't need to use that - all you need to do is to quarter the Sustanon 250 dose and inject four times more often and you've solved the fluctuation problem, which will probably means that you won't aromatize (or will do it far, far less) and it is less likely that your nuts will shut down. Check out Cashout's thread where he recently came off long term Hormone Replacement Therapy (HRT) just to make sure he could. He says he's still firing bullets.

And if you do decide to inject frequently then you may as well use something as simple as Test Cyp. The combination of esters was designed to keep the levels flat, and it doesn't really succeed well. (That's my thinking anyway.)

I have no knowledge of prolactin at all.

Re other stuff:

I am not planning anything because I'm focusing hard on keeping my levels stable - twice a week or every other day small injections. But many people recommend Human Chorionic Gonadotropin (HCG) to keep the nuts functioning and I'm planning to get a scrip for that just in case. I reckon you should get a supply of an Aromatase inhibitor (AI) - Aromotase Inhibitor. Your sister can help there - it's made for post-breast cancer women to keep their estrogen in check, so whereas they might need two tablets per day you might need a quarter of a tablet twice a week.

 

[Aki]

BigFella,

Thanks for taking the time to write all that. I think I'm nearly won over to the idea of injecting more frequently.

For some reason, I'm unable to log into my gmail account right now (been stuck on loading... for a long time) but I've already found "the roid calculator" that I think you're referring to, and its been quite convenient to play around with, so I guess I can do without the excel worksheet you've made. Thanks for the effort in trying to send it though.

SO if I were to quarter the 250 ml dose and inject one part every few days, how would I preserve the remaining contents of the ampule? I'm guessing it would need to be refrigerated?

Good luck with having a "bad" test.

 

[Aki]

BTW I took the first injection in my deltoids (was given a choice between deltoids and glutes, and deltoids definitely seemed more dignified to me - although for some reason one and a half day later the injection site is still sore). But seems some people are saying that it's less effective compared to glutes. And the roid calculator suggests that half lives of the compounds is approximately doubled when administered in the deltoids compared to glutes. Any thoughts on that?

 

[Aki]

I'll check at the chemist's for the Aromatase inhibitor (AI) and Human Chorionic Gonadotropin (HCG) thing you mentioned. My sister lives in a different country so she wouldn't be able to help me with that. I believe she's an excellent doctor but endo isn't her specialty, so she'd probably be worried if I said I was going to "self medicate".

 

[Frustrated1]

Look at the "test app" post. It shows 2 weeks w test e. the rate of change is always moving. So higher dose = faster decline. That shows 330 total t after 14 days. So if you went another week, it would be under 330. But would it really matter? You would feel like shit before then.

I've seen mixed information between delta and glutes. But both are very close to each other, like within 2%.

The bruising or soreness is probably caused by them injecting it too fast. It's suspended in an oil, and it's much thicker than most injectables. What gauge needle did they use?

 

[Aki]

Frustrated1

Looks like a cool app... I'm going to throw together a little Mathematica script (dunno if you're familiar with the software) to generate similar graph using exponential decay equations after plugging in half life values (I'm assuming that's how you're doing it too?). Don't know how absorption is modeled though.

One question: what's the relationship between dosage and t-values in the blood?

Yeah I know the schedule prescribed by my doc seems to suck... I've asked my sister who's a doctor to check with the endos at her hospital, and to specifically inquire about the huge fluctuation in t-values between two shots.

I'm not sure how good I was supposed to be feeling 2 1/2 days after my first shot... I do think I'm feeling better than before, but so far it's nothing extraordinary.

Re the injection site, it's still sore but less than yesterday. Don't really know what gauge needle was used.

 

[Frustrated1]

Yea I've used mathmatica... I think before windows existed. And a little since then.

I used averages that were based off of a study. That was a 200mg dose of E. One thing that I had to guess at a little was the rest of the numbers. But they came out to within a couple of percent.

But don't forget that you will absorb about 99% of peak after 24 hrs of absorption, and peak at 2.3 days. Actual half life worked backwards of test E was about 5.55, the books have it as 5.25. Anyways that was my fault in the first pics. You don't peak nearly as high as I first thought because of the absorption. Hope this all makes sense.

There is a ton more that makes the app pretty sweet. I haven't worked on it in a bit though.

FYI 2.5 days is nothing. And there is no big hit of when it kicks in. Generally it takes a few months for your body to adjust.

 

[Frustrated1]

You'll know for sure when you stand in line waiting for lunch right next to a big dude, and think to yourself about him... "you aint shit". LOL

 

[Aki]

Using the very simple model that a testosterone compound is used up according to the exponential decay model, and making the simplifying assumption that once injected is immediately absorbed, I've arrived at the following formula for the amount of injected substance (i.e. any particular ester) remaining in the blood right before you take your next shot, assuming you've been following the same regimen long enough to have reached equilibrium:

Q(dose, cycle, th) = dose / (1 - exp(-cycle/th))

where cycle is the duration between two shots, th is the half life of the compound in question (and dose is the dosage, obviously)

For a 250 mg dose Sertanon with composition
testosterone decanoate 100mg
testosterone isocaproate 60mg
testosterone phenylpropionate 60mg
testosterone propionate 30 mg

having half lives of 7, 4, 3 and 2 days respectively and injected every 21 days, this formula gives a value of 255 mg, i.e. right before your next shot, you'd have 255 mg of accumulated sustanon in your blood. Interestingly, even if you take a shot every 14 days or 7 days, this amount isn't much higher (268 mg and 328 mg respectively) but you'll reach steady state sooner (haven't worked out the numbers for that though).

Even if I haven't made a silly mistake somewhere, I don't know if this model isn't too simplistic to be worth jacksh*t.

And I still don't know what these numbers translate to, in terms of actual testosterone concentration in the blood.