Testosteone Replacement not overly effectve???

[bradychu]

I have been undergoing TRT for about 3 years now, as the result of pituitary dysfunction (not properly releasing LH) most likely the result of surgery for a prolonged throat issue. Very long story short (if anyone needs the long story I am happy to post it), my current urologist is treating me with 100 mg Testosterone Cypionate 2x/week (on Monday and Friday) AND 0.5 mg Anastrozole 2x/week (on Monday and Friday).

Laboratory work is typically collected mid-week Tuesday or Wednesday. My last three analytical tests (Summer 2013, Winter 2013, Summer 2014):

Testosterone: 13.97, 13.25, 9.67 (ng/ml)
Estradiol: 0, 15.95, 29.64 (pg/ml)
PSA: not tested, 1.33, 1.34
Hemoglobin: not tested, 17.8, 17.2

I am getting ready to go in for lab work and meeting with the urologist in a few weeks. A couple things are going on and I am looking for advice.

1) Initially I noticed a pretty good spike in libido. However, now, my libido has flatlined and is almost non-existent (sex with my wife 3 times since October and though I know that isn't enough I am not overly horny).

2) Have noticed that when we did have sex, my erections are not nearly as hard and 2 of the 3 times I "faked" orgasm because it was taking way way too long (well over 90-minutes).

3) Hair is thinning on my head. Male pattern baldness is not in my family (neither grandfather nor my father had it). I still have hair; but, it is getting thin and daily I notice a LOT of it going down the drain.

4) I am getting hair growing in places where it never has before. Shoulders, back, sides, underside of my arms...all over.

5) Lots of joint / muscle pain. This was one of the things that led them to look at TRT for me. I am feeling overly weak and have a lot of joint and tendon pain.

6) I am still quite tired all the time, which is very unusual for me.

At one point my Urologist asked me to stop taking the injections so I could see the difference it was making. I quit taking it for 4-weeks and didn't notice any difference at all...

Thoughts? How should I approach my Urologist? Should I request additional blood analysis for other things?? I am just looking for some guidance. This is the 3rd forum I have tried (I generally try every year just before I go see the doctor). I just feel lost...

 

[3J]

what are the ranges on this bloodwork?

 

[Megatron28]

Looks like your estradiol is too low to me and several of your symptoms support that hypothesis. Back off on the anastrozole. Try .25mg twice a week.

 

[bradychu]

What do you mean ranges? The lab reports indicate "normal" for Testosterone is 1.8-10.03 ng/ml and Estradiol is 12.9-37.4 pg/ml. My urologist is insistent that my levels are just fine across the board.

As far as increasing estradiol levels, that makes me nervous. Early in this whole process my estradiol levels were testing between 114 and 92 pg/ml. These are considerably high. The throat issue that treatment is believed to have created this whole issue is linked to high estradiol levels. And, coincidentally, during these high testing intervals, I fell out of remission on the throat issue and had to have surgery again.

I am asking the Urologist to look at DHT, Free Testosterone, and Bioavailable Testosterone this round.

From what I am finding, the body hair and thinning hair appear to be linked to elevated levels of DHT? What about erectile issues and issues with climax?

 

[halfwit]

Yup, sounds like estradiol to me. Please go donate blood, your hemoglobin is getting up there, and you really don't want to end up having therapeutic phlebotomies added to your list of things to do.

 

[Chiefy]

Looks like your estradiol is too low to me and several of your symptoms support that hypothesis. Back off on the anastrozole. Try .25mg twice a week.

This.

OP it looks like you've been using the standard estradiol test rather than a sensitive test. The standard will greatly overstate values when dealing with lowish levels of E2.

The standard test is meant for women, the sensitive test is designed to measure the small amounts of E2 that are found in males.

 

[bradychu]

Hemoglobin levels have been right around 17 since I have started treatment in 2011. No problem donating blood; but, how frequently? Do I do this twice a week like I take my testosterone injections? I assume I will need to make an appointment to donate? Never done this before...

I called the urologist. His nurse has indicated that they are running the sensitive test (for men). They are concerned that letting my estradiol levels get much higher will create an issue with my throat. And, if low estradiol is the issue, why was my libido not high before the addition of the Anastrozole? My levels then (winter 2012) were:
Testosterone 8.86
Estradiol 114.1

Not trying to be argumentative, just trying to understand so that I can have a legitimate conversation with my doctor.

 

[halfwit]

Hemoglobin levels have been right around 17 since I have started treatment in 2011. No problem donating blood; but, how frequently? Do I do this twice a week like I take my testosterone injections? I assume I will need to make an appointment to donate? Never done this before...

I called the urologist. His nurse has indicated that they are running the sensitive test (for men). They are concerned that letting my estradiol levels get much higher will create an issue with my throat. And, if low estradiol is the issue, why was my libido not high before the addition of the Anastrozole? My levels then (winter 2012) were:
Testosterone 8.86
Estradiol 114.1

Not trying to be argumentative, just trying to understand so that I can have a legitimate conversation with my doctor.

Every 8 weeks is the best preventative maintenance you can do to prevent complications from a high hematocrit. Exogenous testosterone tells your body to start creating platelets/red blood cells at an accelerated rate. This is one of the reasons for the warnings on testosterone, but docs don't tend to know that it's preventable.

There is a range in which we function optimally. Some men prefer to be at the top of the range, some at the bottom of this ideal range. It varies from male to male, but there is indeed a "happy" range.

 

[bradychu]

I will reduce my anastozole to 0.25 2x/week. About how long until I notice some kind of change?

 

[Megatron28]

Hemoglobin levels have been right around 17 since I have started treatment in 2011. No problem donating blood; but, how frequently? Do I do this twice a week like I take my testosterone injections? I assume I will need to make an appointment to donate? Never done this before...

I called the urologist. His nurse has indicated that they are running the sensitive test (for men). They are concerned that letting my estradiol levels get much higher will create an issue with my throat. And, if low estradiol is the issue, why was my libido not high before the addition of the Anastrozole? My levels then (winter 2012) were:
Testosterone 8.86
Estradiol 114.1

Not trying to be argumentative, just trying to understand so that I can have a legitimate conversation with my doctor.

High estradiol and low estradiol both have negative side effects. You want your estradiol to be in the sweet spot. The "Goldilocks" zone. You might feel a lot better around 30pg/ml. That is where a lot of guys like their estradiol to be at.

 

[halfwit]

I will reduce my anastozole to 0.25 2x/week. About how long until I notice some kind of change?

That too varies from person to person. I usually notice changes from E2 in about a week or two.

 

[bradychu]

Meeting with the Urologist later today. One quick question. He has mentioned several times about putting me on Propecia for my hair loss. The potential side effects of being on Propecia worry me.

What are other men doing about hair loss? Rogaine?? Propecia???

 

[IMT staff]

When men do not get results from their TRT 99% of the time they are taking too much anastrozole and/or not enough or any HCG with it.

IM not a fan of propecia unless your pretty sure you will be on TRT for the rest of your life, it will crush your HPTA.

 

[bradychu]

Well, considering I have permanent pituitary damage, I am fairly sure I will be on this for the rest of my life...

Just got back from the Urologist. My lab results this time are:

Testosterone 9.17 (ng/ml)
Estradiol 14.6 (pg/ml)

He indicated that my numbers were "perfect" though he would like me to try laying off the Anastrozole for now. He has also recommended I see another Endocrinologist just to make sure everything is checking out.

Long story short, I had HPV on my vocal chords. After well over 20 surgeries, my ENT recommended I see a specialist who utilized MMR injections post microlaryngoscopy. The last Endocrinologist I saw believes these large doses of MMR may have damaged my pituitary, since the only analytical result he could see was that my pituitary was no longer secreting LH. Everything else appeared to be "normal".

 

[Chiefy]

Well, considering I have permanent pituitary damage, I am fairly sure I will be on this for the rest of my life...

Just got back from the Urologist. My lab results this time are:

Testosterone 9.17 (ng/ml)
Estradiol 14.6 (pg/ml)

He indicated that my numbers were "perfect" though he would like me to try laying off the Anastrozole for now. He has also recommended I see another Endocrinologist just to make sure everything is checking out.

Long story short, I had HPV on my vocal chords. After well over 20 surgeries, my ENT recommended I see a specialist who utilized MMR injections post microlaryngoscopy. The last Endocrinologist I saw believes these large doses of MMR may have damaged my pituitary, since the only analytical result he could see was that my pituitary was no longer secreting LH. Everything else appeared to be "normal".

Total T looks great, what was your free T value?

Estradiol is way too low though. The standard E2 test is very unreliable when levels are low, so I'd assume that your sensitive E2 is going to be damn near zero. When my standard E2 was around 30, the sensitve E2 test showed a value of 10.

I'd definitely back off the Anastrozole. Either .25mg after each injection, or maybe none at all. I'd be surprised if you didn't need a small dose of it while taking 100mg of testosterone twice per week, but stranger things have happened. If your doctor wants you to stop taking it, you should probably follow his orders, just keep a close eye on your E2.

 

[bradychu]

I go in for testing again in a couple months. I am debating using on of the testing services on here.

Side note, I have mentioned HCG to my Urologist before. He has never used it and is not overly comfortable prescribing it. From my understanding, the primary purpose was to prevent testicular atrophy and maintain fertility. That ship sailed for me over a decade ago (vasectomy and epididyectomy). Is this something I should fight for with the Endocrinologist I will be seeing?

 

[Chiefy]

I go in for testing again in a couple months. I am debating using on of the testing services on here.

Side note, I have mentioned HCG to my Urologist before. He has never used it and is not overly comfortable prescribing it. From my understanding, the primary purpose was to prevent testicular atrophy and maintain fertility. That ship sailed for me over a decade ago (vasectomy and epididyectomy). Is this something I should fight for with the Endocrinologist I will be seeing?

That's really going to be up to you on whether its worth a potentially awkward conversation with your doctor. As much as we would all like to consider our doctors to be our employees, and always having our best interest in mind, that's not reality.

If he's not comfortable with hCG, he may not budge, and he might take offense to a patient putting pressure on him to prescribe something he's not comfortable with. Some doctors are open to trying new things, most are not. Nobody likes being told how to do their job.

Again, that's going to come down to your individual relationship with your doctor.

My choice to use hCG was less about the atrophy and how my balls looked, and more about the discomfort that I was experiencing. Preserving fertility was also important to me. Some guys don't experience any pain or discomfort, but I did. My balls began moving upward and my sack was feeling uncomfortably tight, it didn't feel good.

HCG will keep this from happening to you. It will also keep your testes functioning normally, in that they will continue to produce other hormones like pregnenalone and progesterone. Neither are high on most guy's lists of important hormones, but they certainly play a role in overall health.

There isn't much research on long term deficiencies of these hormones in males, but if your body produces them naturally there is probably a good reason for it. I think the IMT guys here have some links if you'd like to read more on that subject.

 

[Alpin]

You are on too much arimidex. Before messing with propecia please know the side effects. Watch this link below.
This doctor knows TRT.

http://youtu.be/7DEdskgOWVI

 

[Mr.Port]

I will reduce my anastozole to 0.25 2x/week. About how long until I notice some kind of change?

Few weeks I noticed it.