New Lab Results...Very troubling

[willnorthwest]

I did lose the Aromatase inhibitor (AI). I think the arimidex crashed my e2. I havent taken adex in over 2 weeks, hopefully I wont have to use it again. I dont think my fatigue is from poor nutrition, because I do try to eat healthy. As far as being sleep deprived, now that could definitely be a factor. But I dot try to get enough sleep, usually 8-9 hours. I think that my job definitely keeps me tired. I work as the director for a high volume dodge store. I work 10-12 hour days, 6 days a week. So lots of stress with quotas and other pressure, and of course the hours are horrid

 

[totalburnout]

I did lose the Aromatase inhibitor (AI). I think the arimidex crashed my e2. I havent taken adex in over 2 weeks, hopefully I wont have to use it again. I dont think my fatigue is from poor nutrition, because I do try to eat healthy. As far as being sleep deprived, now that could definitely be a factor. But I dot try to get enough sleep, usually 8-9 hours. I think that my job definitely keeps me tired. I work as the director for a high volume dodge store. I work 10-12 hour days, 6 days a week. So lots of stress with quotas and other pressure, and of course the hours are horrid

Sounds like a cortisol test would be good for you.

As far as nutrition - everyone's version of 'eating healthy' is different. Are you aware that things like grains, milk, eggs, nuts, night shades are all common allergins that cause inflammation (stress) within your body? It's possible to have your calories in check and be eating 'health food' while still negatively impacting your body. We're all different, some of us can handle those foods without much inflammation.

Also, I know we seem to have been successful in getting your E2 in check by cutting the adex - but don't necessarily swear it off completely. Its not an evil - its just that adex can be some nasty stuff if taken in higher doses. You'll still want to watch E2 and possibly add back your Aromatase inhibitor (AI) in a small dose, if your E2 starts to climb.

 

[willnorthwest]

totalburnout....i went ahead and had a few tests done this morning, hopefully results will be ready tommorrow. I checked for prolactin, cortisol serum, dhea, vitamin b12, and vitamin d. Ive felt pretty run down for about 10 years now. What's weird is that when I first started testosterone replacement therapy (TRT), I felt absolutely great for about 2months, and then all the positive affects diminished back to my pre-trt state. Im actually hoping that one of these tests come back abnormal so I can address the problem. I wouldnt be surprised if it is the Cortisol.

had my thyroid checked about a month ago. the results were:
TSH .960 range .450 - 4.500
Thryoxine(T4) 8.1 range 4.5 - 12.0
Triiodothryonine (T3) 113 range 71 - 180

Is my TSH too low? I know it's in range, but........

 

[totalburnout]

I suspect many of us have gone through the same issue you have.

You see disgruntled posters talk all the time about how testosterone replacement therapy (TRT) "didn't work for them" or only worked for a period of time. I firmly believe that those people had negative experiences because they haven't gotten their protocols dialed in and/or T wasn't the underlying problem from the start. Its actually humorous some posters that have gone through pellets, different gels, sub q, IM, and a zillion different things and say that "TRT doesn't work". Well, no. You're adding an exogenous hormone to your body - unless your body rejects that compound - THEN IT WORKS. Even if it works, that doesn't mean it will solve all of a patient's symptoms, if they weren't solely related to T to begin with.

I'll end this post with saying I can empathize. I had my up's and down's. Felt great and then fell off the wagon. Started with gel, went to injections. Dose started too low and sent me crashing. Took too much adex, sent me crashing. Boosted the dose. Felt good. More is better, right? Boosted the dose more, got acne and mood issues. Took bigger dose Aromatase inhibitor (AI) to combat that. Crashed E2. When I finally went with a less is more approach and became consistent, things all started feeling better.

 

[totalburnout]

Really really like this poster and this thread.

A Primer for those considering HRT

 

[willnorthwest]

okay guys....new labs, new problems! As I suspected, Cortisol is very high, and DHEA is very low. What the hell do I do now!

Cortisol 23.2 range 2.3 - 19.4 FLAGGED HIGH

DHEA-Sulfate 161.4 range 160 - 449

Prolactin 15.0 range 4.0 - 15.2

Vitamin D 33.5 range 30 - 100

Vitamin B12 417 range 211 - 946

Cortisol flagged high and DHEA almost flagged low! As most of you know, I have felt fatigued for a very long time now. Does the high Cortisol and resultant low DHEA-S prove that Im having Adrenal issues?

 

[halfwit]

okay guys....new labs, new problems! As I suspected, Cortisol is very high, and DHEA is very low. What the hell do I do now!

Cortisol 23.2 range 2.3 - 19.4 FLAGGED HIGH

DHEA-Sulfate 161.4 range 160 - 449

Prolactin 15.0 range 4.0 - 15.2

Vitamin D 33.5 range 30 - 100

Vitamin B12 417 range 211 - 946

Cortisol flagged high and DHEA almost flagged high! As most of you know, I have felt fatigued for a very long time now. Does the high Cortisol and resultant low DHEA-S prove that Im having Adrenal issues?

You also have elevated prolactin (in range, but high end) and are close to being vitamin D deficient. This is where I think you take it to an endocrinologist to be honest. Yes, you very well could be suffering from adrenal fatigue (careful with saying this to a doc as it's not an official diagnosis) as well as some sort of absorption issue. You very well may have found the root-cause of your hypogonadism by the way, I would be sure to bring this with you when you go to see the doc. I'm curious if you are diagnosed with Cushing's Syndrome, as you certainly fit the symptoms and have blood work that correlates with that.

I am both happy and sad for you as nobody likes to see problems, BUT you now may be onto something here that could potentially bring you back to how you should feel. Please let us know how it goes!

 

[willnorthwest]

I went and saw an endo last week. He spent 5 minutes with me and told me he couldnt/wouldnt help me because I'm with IMT and I use hcG and Aromatase inhibitor (AI), which he stated has no purpose in testosterone replacement. He did offer to check my prolactin before I left, but at that point I was so disgusted by his arrogance that I just told him I would check it on my own and left. So needless to say, me and the ol endo didnt get much accomplished.
Looking at these lab reports, it seems like I need to lower my cortisol output and raise my DHEA. Does anyone think that supplementing with transdermal DHEA and pregnenalone could help me restore my adrenal balance? Also, maybe I should take a vitamin d supplement. Thoughts?

 

[Megatron28]

I went and saw an endo last week. He spent 5 minutes with me and told me he couldnt/wouldnt help me because I'm with IMT and I use hcG and Aromatase inhibitor (AI), which he stated has no purpose in testosterone replacement. He did offer to check my prolactin before I left, but at that point I was so disgusted by his arrogance that I just told him I would check it on my own and left. So needless to say, me and the ol endo didnt get much accomplished.
Looking at these lab reports, it seems like I need to lower my cortisol output and raise my DHEA. Does anyone think that supplementing with transdermal DHEA and pregnenalone could help me restore my adrenal balance? Also, maybe I should take a vitamin d supplement. Thoughts?

Halfwit gave you some good advice -- you should heed all of it. Try to find a new endo. Get recommendations from people who live near you for a good endo. And don't forget to also focus on prolactin and vitamin D. They are important too.

 

[totalburnout]

Halfwit gave you some good advice -- you should heed all of it. Try to find a new endo. Get recommendations from people who live near you for a good endo. And don't forget to also focus on prolactin and vitamin D. They are important too.

Agreed.

They both said exactly what I would have said and pointed out that both prolactin and vit D appear to be issues in addition to the issues you state.

DHEA is a spray or a pill. Most people start at 25mg
Vit D is a pill. Most often used by people interested in improving quality of life is 5000iu gel caps/pills. Some doctors/people will front load vit D if they're deficient.
Prolactin you hit the nail on the head.

Those will help treat the SYMPTOMS but talking to a well informed endo will help you get to the root cause of the problem.

As for cortisol, what do you identify as the biggest stress factors in your life? Remember poor sleep, poor diet, inflammatory diet, work stress, family stress, etc are all generally major stressors in people's lives. Maybe the answer does or doesn't lie completely in examining those things but maybe you can lessen the cortisol issues by making some changes.

Sorry these solutions don't easily fix the problem but hopefully they give you direction and help you get some relief!

 

[willnorthwest]

okay so I went out and bought some micronized dhea as well as some pregnenolone. I took 20mg dhea and 50mg pregnenolone today. I also went out and bought some vitamin d at 1000iu per tablet which is 275% of the daily recommended dose. Im gonna supplement with the dhea and preg to see if i can get my dhea levels back to a much higher range, and hopefully reduce the cortisol output as well. From the research Ive done online, it seems that dhea and pregnenolone can help restore energy and reduce cortisol output. hopefully the vitamin d supplement will raise my lowish vitamin d levels too.
totalburnout....as far as the inflammation is concerned, I did just recently finish a round of anti-biotics for an infection in my stomach. my gastroentologist found indicans in my urine, which suggested a gastro infection. hopefully the antibiotics worked and killed the infection. well see

In the meantime i am looking for a new endo. since i have to have a referral from my gp, i set an appt with them for july 11th. that is the earliest they can see me. ill experiment with the dhea, preg, and vitamin d in the meantime.

interesting articles on the matter:
http://www.drlam.com/articles/adrenal_fatigue_and_hormone.asp
http://articles.mercola.com/sites/articles/archive/2000/08/27/adrenals.aspx

 

[Megatron28]

okay so I went out and bought some micronized dhea as well as some pregnenolone. I took 20mg dhea and 50mg pregnenolone today. I also went out and bought some vitamin d at 1000iu per tablet which is 275% of the daily recommended dose. Im gonna supplement with the dhea and preg to see if i can get my dhea levels back to a much higher range, and hopefully reduce the cortisol output as well. From the research Ive done online, it seems that dhea and pregnenolone can help restore energy and reduce cortisol output. hopefully the vitamin d supplement will raise my lowish vitamin d levels too.
totalburnout....as far as the inflammation is concerned, I did just recently finish a round of anti-biotics for an infection in my stomach. my gastroentologist found indicans in my urine, which suggested a gastro infection. hopefully the antibiotics worked and killed the infection. well see

In the meantime i am looking for a new endo. since i have to have a referral from my gp, i set an appt with them for july 11th. that is the earliest they can see me. ill experiment with the dhea, preg, and vitamin d in the meantime.

interesting articles on the matter:
Adrenal Fatigue and Hormone Therapy - DrLam® - Body. Mind. Nutrition®
Understanding Adrenal Function - DHEA, Cortisol, Pregnenolone

1000 iu's per day of Vitamin D will not be enough. You should take between 5000-10000 per day. And for the next week or two, you could take about 30,000 per day to bump you up quicker. You get diminishing returns as you take more vitamin D. That is to say, increasing your vitamin by the first 10 points comes more easily than getting the next 10 point increase.

 

[totalburnout]

You probably can get the referral from the GP over the phone depending on the doctor and your insurance.

 

[willnorthwest]

mega....that sounds like a hell of alot of vit d! not saying that you are wrong of course, but damn that sounds like a huge amount!!!!! can you take too much vit d, or is excess vit d excreted in the urine?

totalburn.... i will try calling my gp.

 

[totalburnout]

mega....that sounds like a hell of alot of vit d! not saying that you are wrong of course, but damn that sounds like a huge amount!!!!! can you take too much vit d, or is excess vit d excreted in the urine?

totalburn.... i will try calling my gp.

When you supplement with vitamin D, you can take too much. When your body is naturally producing vitamin D from being in the sub, there's a mechanism that prevents your body from creating an over abundance of vit d.

With that said, what mega said is the general practice. I don't have more of your labs and info but if it were me, I'd be front loading the vit D for a few weeks of between 20,000-30,000iu/day. There was a point I took 60,000iu/daily to get my levels up before moving to 5000iu per day. The 1000iu tabs you bought wont even make a dent.

 

[Megatron28]

Before I started testosterone replacement therapy (TRT) my doc checked my vitamin D and it was really low. I don't remember the exact numbers, but I was probably around 20. He put me on 30,000 iu's per day for a week and then 1'000 iu's/day after that. I got retested about 4 months later and I was around 28. He suggested going to 2,000 iu's/day which surely would get me just into range. Keep in mind this was in the middle of the winter in a Northern snowy climate where I live.

I started doing some reading on vitamin D and learned that it seems to get underdosed. I decided to start taking 30,000 iu's/day. After a few months I got tested and I came in at 133. So too high. I decided to back it down to 10,000 iu's/day but I have not gotten it retested yet. For what it is worth, I don't think I have been sick since getting my Vitamin D towards the high end.

Vitamin D is fat soluble meaning it can accumulate in your body. But everything I have read seems to indicate that there is little risk of overdosing on Vitamin D. But if there is a risk, I would certainly appreciate being better educated on the matter.

For full disclosure, my doc almost shat his pants when I told him I was taking 30,000 iu's per day. He said he didn't recommend going over 5,000 per day on a long-term basis.

So as with testosterone replacement therapy (TRT), you are probably best off trying a dose and retesting your levels to see how you respond.

 

[willnorthwest]

Guys, is it possible that I might need to lower my dosage again? Im still feeling pretty bad. The last time I checked my Testosterone level was June 17th. Free T and SHBG were tested on May 28th
Total Testosterone 1040
Free Testosterone 37.8 Flagged High Range 8.7-25.1
SHBG 11.5 Flagged Low Range 16.5-55.9

Also, as most of you know, I recently had Prolactin, VitD, Cortisol, and DHEA-S levels checked. Cortisol was flagged high, and DHEA-S was only 1 point away from being flagged low. I have since added 25mg micronized DHEA, and 50mg pregnenolone daily to my testosterone replacement therapy (TRT) protocol. I have also added 5000iu Vitamin D per day. I have not had any positive affects as of yet.

I would like to explore the possibility now, that maybe I need to reduce my Testosterone intake even further.

My baseline T level was 218. For the first 3 months of my testosterone replacement therapy (TRT) protocol(Feb-Apr 2013), I was doing 100mg cyp every 7 days, with 500iu hcG the day before my inject. I felt great for the first 2-3months as my serum levels started to rise. I could tell that my body was definitely in an anabolic state. At that point, I decided to increase my dose, foolishly thinking that I would feel even better. This is when things started to turn around for the worse. I started to inject 100mg every 5 days(May 2013), with 500iu hcG the day before my injection. After a month of this, it seems like the initial surge of energy, well-being, and libido started to subside. I started to get tired again, and my pre-trt anxiety and depressive mood started to re-appear. As of June, I was feeling pretty much the way I had prior to testosterone replacement therapy (TRT). After consulting with many of you on this forum, I decided to try another protocol. Since June 1st I have been injecting 50mg cyp every 3 days, with 250iu hcG the day before each inject. I have not noticed any subjective benefits. In fact, at this point, I feel worse than I did before I started testosterone replacement therapy (TRT).

Im wondering if some of you on this forum would think it might be wise to reduce my dosage even further. Could it be possible that my Free T is too high and my SHBG is too low to maintain the current dose that I am taking? Maybe my body is rejecting a 1040 T score. Maybe I would be better off if I lowered my T level into the 600's or 700's. Is this a valid possibility? I am willing to lower my dosage to whatever is needed to make me feel better and closer to how I was feeling the first two to three months I was on testosterone replacement therapy (TRT). Is it possible that at some point I passed my optimal T level, or better put, the highest level in which I could feel good at? Should I maybe try 50mg every 4 days in the hope that lowering my total T level could actually make me feel better?

Sorry for the long post guys, but Im starting to feel just a little bit desperate at this point!

 

[Megatron28]

Guys, is it possible that I might need to lower my dosage again? Im still feeling pretty bad. The last time I checked my Testosterone level was June 17th. Free T and SHBG were tested on May 28th
Total Testosterone 1040
Free Testosterone 37.8 Flagged High Range 8.7-25.1
SHBG 11.5 Flagged Low Range 16.5-55.9

Also, as most of you know, I recently had Prolactin, VitD, Cortisol, and DHEA-S levels checked. Cortisol was flagged high, and DHEA-S was only 1 point away from being flagged low. I have since added 25mg micronized DHEA, and 50mg pregnenolone daily to my testosterone replacement therapy (TRT) protocol. I have also added 5000iu Vitamin D per day. I have not had any positive affects as of yet.

I would like to explore the possibility now, that maybe I need to reduce my Testosterone intake even further.

My baseline T level was 218. For the first 3 months of my testosterone replacement therapy (TRT) protocol(Feb-Apr 2013), I was doing 100mg cyp every 7 days, with 500iu hcG the day before my inject. I felt great for the first 2-3months as my serum levels started to rise. I could tell that my body was definitely in an anabolic state. At that point, I decided to increase my dose, foolishly thinking that I would feel even better. This is when things started to turn around for the worse. I started to inject 100mg every 5 days(May 2013), with 500iu hcG the day before my injection. After a month of this, it seems like the initial surge of energy, well-being, and libido started to subside. I started to get tired again, and my pre-trt anxiety and depressive mood started to re-appear. As of June, I was feeling pretty much the way I had prior to testosterone replacement therapy (TRT). After consulting with many of you on this forum, I decided to try another protocol. Since June 1st I have been injecting 50mg cyp every 3 days, with 250iu hcG the day before each inject. I have not noticed any subjective benefits. In fact, at this point, I feel worse than I did before I started testosterone replacement therapy (TRT).

Im wondering if some of you on this forum would think it might be wise to reduce my dosage even further. Could it be possible that my Free T is too high and my SHBG is too low to maintain the current dose that I am taking? Maybe my body is rejecting a 1040 T score. Maybe I would be better off if I lowered my T level into the 600's or 700's. Is this a valid possibility? I am willing to lower my dosage to whatever is needed to make me feel better and closer to how I was feeling the first two to three months I was on testosterone replacement therapy (TRT). Is it possible that at some point I passed my optimal T level, or better put, the highest level in which I could feel good at? Should I maybe try 50mg every 4 days in the hope that lowering my total T level could actually make me feel better?

Sorry for the long post guys, but Im starting to feel just a little bit desperate at this point!

Take it easy Will... Just breath and count to 10...

Here's we you need to do. It has been a couple of weeks now since your last labs, and if I recall correctly you have made some changes to your protocol recently. Let's get new labs this week and see what your numbers look like now. Let's cross the bridge of what you should do when we get to it. First things first -- let's get some new numbers to look at. Making "blind" changes before has gotten you into trouble.

 

[SicVic]

Well All in All, no matter where your hormones are at. Nothing beats a Nice Sweeet Energy Drink. Feel like shit? Crack open a monster and youll feel better. Or you can just make your own like I do. I was at 243 once. A sweet ass energy drink always made my day. Although the Crashes where whey harder. Still did da job.


P.S. don't mind me, im an idiot.

 

[halfwit]

*snip*Is it possible that at some point I passed my optimal T level, or better put, the highest level in which I could feel good at?

Outside what we discussed earlier, I do feel it is important to note that while I am not a doctor I do have some experience in seeing what testosterone does at all sorts of levels. I have yet to feel a level of testosterone (yes, I acknowledge that we're all different) that makes me feel worse. I hate saying this in the testosterone replacement therapy (TRT) forums as there is another place here for this type of talk, but I have been upwards of 10,000ng/dL and as low as 120ng/dL. Anything above 800 for me has been gravy as long as estradiol has been kept in check. I really don't think that's your issue here and completely agree with Megatron in that this will just take a bit more time to sort out than you had been hoping.

My heart-felt best wishes to you sir.