Need Advice..

[reefstar]

Hi everyone,

As you can tell I'm new here, but this battle has been very long (seems like too long). Pretty much last November everything came to a head for me. 44 yrs old 6ft 180lbs. Life was going great, and married to a wonderful wife (17 yrs) w two kids.
Then bang it hit like a ton of boulders, paranoia, anxiety, fear, lack of confidence etc, massive emotions, and horrible sleep. I have never had ANY issues like this before. I've been very confident, happy, active, etc, etc. After doing some research and alot of reading I decided to see my Dr in January and asked him to test my T levels. He prescribed me cetelopram (anti depressant (which I am not taking any more)) and drew blood. My T level came back at 294, to which the dr said was in "normal" levels. I wasn't happy with that answer so I changed Dr's and finally saw the new Dr in February. He checked my results and told me my levels were indeed low and started me on Androgel 1% at 1 pump per day.
Techniaclly he actually prescribed me 1 pump Axiron daily and when I went to pick it up, the Phamacist said that they did not have the Axiron, so they called the Dr and he changed it to 1 pump of 1% androgel daily. (which in my opinion was the first mis calculation by the Dr) After 5 1/2 weeks and another blood test my levels went to 314 and the Dr increased me to 2 pumps of 1%.
Finally after some persistance a couple of weeks later I got him to let me take three pumps of Androgel. My last Blood test with him was on April 25 and My level went to 369. I told the Dr at the time that I had started using 4 pumps (since I discovered that 4 pumps was the minimum recommended starting dose, I figured I was safe). Although the Dr was slightly upset I went to four and was feeling moderately better, he agreed and then changed my medication from Androgel 1% to the 1.62% and told me to take two pumps. (correct me if I'm wrong but isn't 2 pumps of 1.62 less than 4 pumps of 1%?). He felt I was pretty close to 400, so there was no reason to increase my dosage further.
Finally I called him a few days later and insisted that he send me to a Urologist, to which he finally agreed. In the mean time while I was waiting to see the urologist I went ahead and started using 2 pumps of 1.62% and 2 pumps of 1%, and that is the best I have felt since November. (not as good as I want to but much better)
I finally saw the Urologist on May 9th, and I told him the the dosage I was taking (2+2), and he switched me to 100mg Test cyp shots every 10 days. Pretty much a day after the shot I felt very anxious for the next two days. (blood tests 1 day after shot (May 10) showed levels jumped to 808) The next 3 days I feel pretty good, and then the following 5 days i feel the rapid decline. So on those days i took 2 pumps of 1% and felt pretty good. (when i say pretty good, I mean i feel managable, not at all where i want to feel)
On the 18 I gave my self the second shot, and my reaction has pretty much been the same as the first shot. Anxiety, semi normal, then a long crash. Although at this time I haven't used any androgel.

So here's my questions.
1) is it normal to have an anxiety rush for a couple of days after the shot? Should I split my dosage to every 5 days? (my dr will probably not agree though) My next shot is on the 29th.
2) my biggest issue is anxiety, emotions, and confidence. I'm concerned that the T is being converted to estrodal but my dr refuses to do the blood test. (is there something i can do to help? I've been taking DIM daily 200mg but it doesn't seem to be the magic bullet)
3) I've had very shakey hands and legs. I try to work out a few times a week. Is this normal with low t and will it go away.
4) Should I use androgel to level out the last few days of the shot to help. If so how much. I've used a half life calculator and it seems to me that on day 5 after the shot, the avaiable T will drop below the 62.5 g that I was taking with the 2+2 pumps.
5) what ever i do, I don't want to skew the next blood test on June 30. I want the numbers to come back not artificaially elivated out side of the shots.

Sorry this post it so long, But this sucks. I'm glad i found this forum. Frankly, I'm really suprised there aren't "support groups" for guys and families with low T like AA or somethig like that.

Thanks for any and all help. I'll do my best to answer any questions.

C

 

[gdevine]

First let me say that a sudden onset of symptoms like you describe is not age related androgen deficiency. Were you tested for other pathologies that can cause Hypogonadism?

The Physician's you are seeing know little about Hormone Replacement Therapy (HRT) for men. You can see this by the dosing protocol they have you on.

An every 10 day injection schedule is too long. You should be every 7 days or twice weekly being optimal; this would go a long way to eliminate your hormonal swing and the emotional up and down you feel as you metabolize the testosterone you are using.

Mixing IM with TD is not good at all and you really shouldn't be self medicating, you could make matters a lot worse.

Do you have your latest blood work and if so can you post it here complete with ranges?

1) is it normal to have an anxiety rush for a couple of days after the shot? Should I split my dosage to every 5 days? (my dr will probably not agree though) My next shot is on the 29th.
Some men who start out on IM the first few weeks will feel that "rush" as you describe it. It's generally a result of the body adjusting to the increase in Testosterone serum levels and coming back to homeostasis...in other words some men will feel worse before getting better. It won't last long and will only get better.

2) my biggest issue is anxiety, emotions, and confidence. I'm concerned that the T is being converted to estrodal but my dr refuses to do the blood test. (is there something i can do to help? I've been taking DIM daily 200mg but it doesn't seem to be the magic bullet)
If your Doctor won't test your estrogen levels than you have the wrong Doctor. You need to get an E2 Sensitive assay done to assess your serum levels. Most untrained Doc's don't know that E follows T.

3) I've had very shakey hands and legs. I try to work out a few times a week. Is this normal with low t and will it go away.
Could be anything. Need complete blood work.

4) Should I use androgel to level out the last few days of the shot to help. If so how much. I've used a half life calculator and it seems to me that on day 5 after the shot, the avaiable T will drop below the 62.5 g that I was taking with the 2+2 pumps.
Don't mix TD with IM; there is not effective way to keep control of your serum levels.

5) what ever i do, I don't want to skew the next blood test on June 30. I want the numbers to come back not artificaially elivated out side of the shots.
Stay on the protocol that your Doctor put you on.

Two things:
1) You need to find out why your low androgen levels were a sudden onset. There are some serious pathologies that can cause that to happen and you need to tested for those.
2) Your Doctor is not trained in Hormone Replacement Therapy (HRT) in men and you are not getting the correct care. Find a Physician who is well trained in anti aging medicine and get the right care.

 

[reefstar]

Gdevine,

Thanks for the response. the post was getting pretty long, so I didn't go into all the details. Although to me it felt like the onset was sudden, my wife said she noticed a change in me since Feb/Mar 2012. And i can say my energy levels just felt low, but i just related that to being 44. Then it all came on like a rush. (for me winter is the slow season for my business, so the added stress of that, may have been the straw that broke the camels back or just made it clear).

Unfortunately I can't draw my own blood and do tests, all I've been able to do is ask, and listen to them tell me no. At this point, I have asked for the E levels, and the Dr (Urologist) said "He doesnt think it's necessary at this time". The ONLY test I have is the T total. 294 to 314 to 369 to 808. they said if they felt it necessary they will test it after the 8 week revisit.

So what I can do is add TD (which you say is not a good idea) My idea was to do that for the next couple of IM doses (just to help level the end cycle swings a little), but definitely not during the last dose or two. But I'll take your advice seriously. What are the probelms with adding TD to IM. Is it just a level issue or is there a cross medication problem in doing that?

The other thing I can do is half dose every 5 days rather than a full dose every 10 days. The half life calculator I have shows that it will keep my levels much closer to that Mid week "normal" I feel. Will/could that help eleviate the first days rush, and help me stay more level?

So if, my estrogen levels are high and I cannot get my DR to do the test, is there something I can do to test it myself. Like I said i am taking 200mg of DIM, and I can't say that it is working. Is there a way to theoritically "test" it without a blood test.

Also am I on the right track when I said the Dr made Calculation errors when switching me from Axiron to Androgel 1% to Androgel 1.62%? Alos, what is the relation from 62.5g of Androgel to 100mg of Test cyp.

Sorry for all of the questions, All of this process seems like 2 steps forward 1 step back.

Thanks again for any input
C

 

[riprockwell]

Looks like you got good advice. Here a couple of pointers. If your doctor doesn't want to test your estrogen, then test it yourself. You can go to Private MD - Buy Lab Tests Online and order a "Hormone Panel for Females." Don't worry because when you go to checkout and pay on the site, it gives you an option to check what gender you are. I am pretty sure your estrogen is high from what you are saying. An effective testosterone replacement therapy (TRT) protocol includes injectable test, Aromatase inhibitor (AI) (Aromatase Inhibitor) and Human Chorionic Gonadotropin (HCG) for some guys. Test aromatizes to estrogen and gels/creams are notorious for that. By the way, when you order that blood work on that site, they email you a sheet to take to the nearest LabCorp in your area. You will draw blood and they will email your results to you in 24-48 hours. Lastly, if your doctor is being such an ass, I would look at another testosterone replacement therapy (TRT) clinic like the sponsor on this site called IMT (IncreaseMyT.com). They know proper hormone therapy and can get you dialed in. I personally inject every 7 days and I feel fine. Some guys need twice a week injections to feel the best. As for your estrogen reading, I generally like mine between 20-30.

 

[gdevine]

Gdevine,

I like your handle, I live is South FLA and keep a 95g live reef tank so don't know if it's relevant or not

Thanks for the response. the post was getting pretty long, so I didn't go into all the details. Although to me it felt like the onset was sudden, my wife said she noticed a change in me since Feb/Mar 2012. And i can say my energy levels just felt low, but i just related that to being 44. Then it all came on like a rush. (for me winter is the slow season for my business, so the added stress of that, may have been the straw that broke the camels back or just made it clear).
Men lose anywhere from 1 to 3% on average of androgen production annually. So even with the timeline noted above "came on like a rush" I'd still rank it as sudden onset. One of the big culprits is Hypothyroidism; it has many of the same symptoms of Low Testosterone and if not corrected it will cause secondary hypogonadism in men. It's why having a well trained testosterone replacement therapy (TRT) Physician is so critical as they would have done a complete Thyroid workup in addition to looking at things like prolactin to rule out tumors and cortisol to rule out adrenal issues. The list goes on...

Unfortunately I can't draw my own blood and do tests, all I've been able to do is ask, and listen to them tell me no. At this point, I have asked for the E levels, and the Dr (Urologist) said "He doesnt think it's necessary at this time". The ONLY test I have is the T total. 294 to 314 to 369 to 808. they said if they felt it necessary they will test it after the 8 week revisit.
Go here and email it to your Doctor; than I want you to read it...better yet, study it. http://www.allthingsmale.com/word_docs/TRT.doc If your Doctor refuses to read it and understand it...find another Doctor as he is not helping you.

So what I can do is add TD (which you say is not a good idea) My idea was to do that for the next couple of IM doses (just to help level the end cycle swings a little), but definitely not during the last dose or two. But I'll take your advice seriously. What are the probelms with adding TD to IM. Is it just a level issue or is there a cross medication problem in doing that?

The other thing I can do is half dose every 5 days rather than a full dose every 10 days. The half life calculator I have shows that it will keep my levels much closer to that Mid week "normal" I feel. Will/could that help eleviate the first days rush, and help me stay more level?
Go with the every 5 day half dose schedule. Never mix testosterone administration therapies, it can really throw your serum levels off wildly and impact things like E2 which you don't want. Just not a good idea...ever.

So if, my estrogen levels are high and I cannot get my DR to do the test, is there something I can do to test it myself. Like I said i am taking 200mg of DIM, and I can't say that it is working. Is there a way to theoritically "test" it without a blood test.
Here is a list of some of the symptoms of high E2 (you don't have to
experience all of the symptoms to know that you have high E2):
* Depression
* Trouble reaching an orgasm
* No erections while sleeping (i.e. "night wood" or "morning wood")
* Anxiety
* Panic Attacks
* Prostate problems
* Gyneomastia
* Water Retention
* Dizziness/Vertigo
* Increased Blood Pressure
* Decreased Libido
* ED
* When penis is limp, it doesn't hang low (it seems to try to crawl back up)
* Asthma like issues (due to increased water retention around the lungs)
* Trouble sleeping at night - waking up multiple times per night
* Lack of Libido
* Crying while watching TV shows/movies
* Easier to get angry (think PMS)
* Insulin Resistance (getting tired after eating a meal - if left
untreated, it can lead to Type II Diabetes)
* Larger stomach
* Redness on the face and/or chest
* Feeling hotter than everybody else
* Thinner skin/bleeding easier

Also am I on the right track when I said the Dr made Calculation errors when switching me from Axiron to Androgel 1% to Androgel 1.62%?
Yes.

Alos, what is the relation from 62.5g of Androgel to 100mg of Test cyp.

Sorry for all of the questions, All of this process seems like 2 steps forward 1 step back.

Thanks again for any input
C

Bold.

 

[reefstar]

Riprockwell,

Thanks for the reply. The Private MD also shows a Hormone Panel for Males.

It shows:

- Lipid Profile
-Complete Blood Count w/ Differential
-Estradiol, Sensitive
-Insulin Growth Factor (IGF-1)
-Comprehensive Metabolic Panel
-Testosterone (Free) , Serum (Equilibrium Ultrafiltration) With Total Testosterone
-Prostate-Specific Antigen (PSA)
-Thyroid Profile

The Female panel includes:

Estradiol, Serum
Luteinizing Hormone (LH)
Follicle-Stimulating Hormone (FSH)
Testosterone, Serum
Complete Blood Count (CBC)
Comprehensive Metabolic Profile

Do I just need to order the female one and check that I'm a male and that test comes with what I need? Sorry if the questions seem uneducated. Fortunately there is a test center about 15 miles from me. I think I may do it. So at least I have the info, and can show it to my Dr. (if he will accept it)

Does IMT take medical insurance? Or how does it work? Would IMT take the labs from Private MD or would they need their own tests?

Thanks Again

 

[reefstar]

Gdevine,

Thanks again, Yes reefstar is because I used to build reef aquariums. I actually have a 75 gal myself, But I have no drive to do anything with it right now...

Heres what i have

* Depression (thats what the dr is convinced I need treatment for)
* Anxiety
* Panic Attacks
* Dizziness/Vertigo
* When penis is limp, it doesn't hang low (it seems to try to crawl back up) ++not if I totally understand but I'll leave it
* Trouble sleeping at night - waking up multiple times per night ++ big time
* Crying while watching TV shows/movies ++ yes and when stressed
* Redness on the face and/or chest
* Feeling hotter than everybody else
Also night sweats, I'll soak my pillow regularly.

Thansk again, I think I'll try splitting my dosage and see what happens.

C

 

[gdevine]

Gdevine,

Thanks again, Yes reefstar is because I used to build reef aquariums. I actually have a 75 gal myself, But I have no drive to do anything with it right now...

Heres what i have

* Depression (thats what the dr is convinced I need treatment for)
* Anxiety
* Panic Attacks
* Dizziness/Vertigo
* When penis is limp, it doesn't hang low (it seems to try to crawl back up) ++not if I totally understand but I'll leave it
* Trouble sleeping at night - waking up multiple times per night ++ big time
* Crying while watching TV shows/movies ++ yes and when stressed
* Redness on the face and/or chest
* Feeling hotter than everybody else
Also night sweats, I'll soak my pillow regularly.

Thansk again, I think I'll try splitting my dosage and see what happens.

C

You need to find a physician who understands adrenals in men. Not easy, but most American Academy of Anti-Aging Medicine - The World Leader in Anti-Aging, Regenerative, Metabolic and Functional Medicine Education, Conferences and Exhibitions. Doc's will know how to diagnosis you.

Your symptoms are not that difficult to understand with experience.

Many simple things like elevated E2 to adrenal fatigue can cause these symptoms.

You just need to find the right Doctor and get the right diagnosis; if you walked into your GP with these symptoms they'd just throw an AD and PDE5i at you and tell you to go home and things will get better...

BUNK!

Find a good anti aging Doc near you they will know how to get you right!

 

[reefstar]

Thanks everyone,

So here's my latest update. I found what seems do be a better Dr. (he specializes in anti aging and HRT) and he seemed to finally understand everything I was asking. He changed my dosage to 100mg test cyp every 7 days and added 1/2 mg anastrozole twice a week. Now I have a couple more questions.

According to what I have read it takes 48hrs for Test cyp to peak once you take the injection, so when is the best time to take the Anastrozole. When I take the shot, or 48 hrs later? Also does 1/2 mg 2 times per week sound right. I read alot of guys take 1/4 every other day. What is better? It seems the 1/2 mg kinda makes me feel weird (but I may be imagining it).

Seems like everything I am feeling now I associate to my Testosterone because I have been dealing with it for so long. The other day my head was all coudy and my son said, "take a sinutab". Didn't accure to me that it could have been a stuffed head. Duh.

Also the DR took about 9 blood tests, and I'm still waiting on the results of the Estrogen levels, but he went ahead and put me on the Anastrozole due to the symptoms I have. I'm still fighting with heavy emotion (crying and sensitivity), poor sleep, and anxiety.

Any advice is appreciated.

Thanks again
Cary

 

[Megatron28]

Thanks everyone,

So here's my latest update. I found what seems do be a better Dr. (he specializes in anti aging and HRT) and he seemed to finally understand everything I was asking. He changed my dosage to 100mg test cyp every 7 days and added 1/2 mg anastrozole twice a week. Now I have a couple more questions.

According to what I have read it takes 48hrs for Test cyp to peak once you take the injection, so when is the best time to take the Anastrozole. When I take the shot, or 48 hrs later? Also does 1/2 mg 2 times per week sound right. I read alot of guys take 1/4 every other day. What is better? It seems the 1/2 mg kinda makes me feel weird (but I may be imagining it).

Seems like everything I am feeling now I associate to my Testosterone because I have been dealing with it for so long. The other day my head was all coudy and my son said, "take a sinutab". Didn't accure to me that it could have been a stuffed head. Duh.

Also the DR took about 9 blood tests, and I'm still waiting on the results of the Estrogen levels, but he went ahead and put me on the Anastrozole due to the symptoms I have. I'm still fighting with heavy emotion (crying and sensitivity), poor sleep, and anxiety.

Any advice is appreciated.

Thanks again
Cary

.50mg twice a week is a lot for the test dose you are taking. Arimidex (anastrozole) is pretty powerful stuff. I would try the .25mg twice a week and get another blood test in about 4 weeks to see how it is working. Crashing your estradiol really sucks so try to avoid that.

I advocate for keeping things simple. For me, that means taking the arimidex at the same time as the injection. It is easier for me to remember since I inject twice a week. If you want to delay it, I would take it the day after the injection rather than waiting two full days.

Better yet, if I were you -- knowing you have estradiol problems -- I would split your 100mg of test into two injections every 3.5 days. So for example, 50mg Saturday morning and 50mg Tuesday evening. That's more pinning, but I would be willing to bet that you would NOT need arimidex doing that. And avoiding another drug is worth the extra pinning in my mind.

Post your lab results when you get them and maybe we can all help you more.

 

[reefstar]

Thanks for the reply,

Here are the results I have gotten back so far:
-total testosterone came back at 660 ng/dl, (48 hrs after shot)
-the remaining pituitary labs are normal,
-vitamin D is low (30).
Still waiting on estradiol levels (hopefully tomorrow)

Thanks

Cary

 

[bigben34]

Thanks for the reply,

Here are the results I have gotten back so far:
-total testosterone came back at 660 ng/dl, (48 hrs after shot)
-the remaining pituitary labs are normal,
-vitamin D is low (30).
Still waiting on estradiol levels (hopefully tomorrow)

Thanks

Cary

How do you feel at those levels?

 

[tiredguy]

an instant red flag i saw was the terribly low starting dosages (one squirt Axiron, one squirt Androgel) - those are WAY to low. apparently the docs don't know much about what they are doing and were setting you up for failure for that period, wasting time and money.

 

[reefstar]

How do you feel at those levels?

Man that is a good question. It's been soooo long since I have felt "good", that I don't really remember how "good" feels. That may sound lame, but it's what I'm realizing. My best guess is that i feel about 70%. Generally I feel good about 48 hours after the shot for a couple of days, then I feel tired the next 2 days, and run down on day 5.

But I can't tell for sure if that is because of the test running low, or because of poor sleep, etc. This is such a tail chaser.

Thanks

Cary

 

[reefstar]

an instant red flag i saw was the terribly low starting dosages (one squirt Axiron, one squirt Androgel) - those are WAY to low. apparently the docs don't know much about what they are doing and were setting you up for failure for that period, wasting time and money.

Yah, plus what makes it difficult is your supposed to be able to trust your Dr. My GP wanted to push me on to anti depression drugs and that's why he kept my Androgel dosing so low (all he had to do was read the side of the bottle). So now, on my medical history it says "General Anxiety Disorder". So everytime I see a Dr, they are gonna see, GAD, and assume that it has been an on going issue with me. Which it hasn't, Ever.

Thanks for everyones help. Plus comments like yours really help, make me feel like I'm not crazy.

Cary

 

[reefstar]

.50mg twice a week is a lot for the test dose you are taking. Arimidex (anastrozole) is pretty powerful stuff. I would try the .25mg twice a week and get another blood test in about 4 weeks to see how it is working. Crashing your estradiol really sucks so try to avoid that.

I advocate for keeping things simple. For me, that means taking the arimidex at the same time as the injection. It is easier for me to remember since I inject twice a week. If you want to delay it, I would take it the day after the injection rather than waiting two full days.

Better yet, if I were you -- knowing you have estradiol problems -- I would split your 100mg of test into two injections every 3.5 days. So for example, 50mg Saturday morning and 50mg Tuesday evening. That's more pinning, but I would be willing to bet that you would NOT need arimidex doing that. And avoiding another drug is worth the extra pinning in my mind.

Post your lab results when you get them and maybe we can all help you more.

OK,

I just got all of the test lab results emailed to me here is what I got: I'm not sure what everything means so, I'll just post what I see

Test total = 605 ng/dL
t3 Free = 3.8 pg/mL
t4 Free = 1.2 ng/dL
Then there are some LH and FSH numbers with a bunch of Tanner stages (should I post them?)

Prolactin = 6.4 ng/mL
Thyroid Peroxidase = < 0.3 IU/mL

Estradiol Ultrasensitive = 40 pg/mL

Thanks for any help

Cary

 

[Megatron28]

OK,

I just got all of the test lab results emailed to me here is what I got: I'm not sure what everything means so, I'll just post what I see

Test total = 605 ng/dL
t3 Free = 3.8 pg/mL
t4 Free = 1.2 ng/dL
Then there are some LH and FSH numbers with a bunch of Tanner stages (should I post them?)

Prolactin = 6.4 ng/mL
Thyroid Peroxidase = < 0.3 IU/mL

Estradiol Ultrasensitive = 40 pg/mL

Thanks for any help

Cary

Can you post the reference ranges too? Each lab is different and I don't have al the ranges memorized.

If it was me, I would want to be higher than ~600 2 days after my injection which should be a peak measurement. Next time check your trough to see where you are bottoming out at. I think you need to bump up your dose. You should be near 1000-1200 at your peak. If you are going to go to all this testosterone replacement therapy (TRT) hassle, make it worth your while and put yourself at the top of the range.

 

[reefstar]

Can you post the reference ranges too? Each lab is different and I don't have al the ranges memorized.

If it was me, I would want to be higher than ~600 2 days after my injection which should be a peak measurement. Next time check your trough to see where you are bottoming out at. I think you need to bump up your dose. You should be near 1000-1200 at your peak. If you are going to go to all this testosterone replacement therapy (TRT) hassle, make it worth your while and put yourself at the top of the range.

Sorry,

Here they are:

test total = 605 ng/dL *** 291-739 (739 seems low)
t3 Free = 3.8 pg/mL *** 2.3 - 4.2
t4 Free = 1.2 ng/dL *** 0.7 - 1.5
Then there are some LH and FSH numbers with a bunch of Tanner stages (should I post them?)

Prolactin = 6.4 ng/mL *** 1.6 - 18.8
Thyroid Peroxidase = < 0.3 IU/mL *** 0.0 - 9.0

Estradiol Ultrasensitive = 40 pg/mL *** < or = 29

The tests were taken at PAML

Thanks again.

cary