My Personal HRT Story

I’ve had a number of men on the Peak Testosterone Forum (and in emails) ask why I started this site.  And they’ve asked what has worked for me and what hasn’t.  And they’ve asked how I boosted my testosterone.  Those are all fair questions of course.

When asked a question like this, I scarcely know where to start.  It has been a very long road and I’ve been through about five distinct stages.  I’m not trying to bore anyone into a coma, but I think most of the men coming to the site are very much going to relate to one of these and so I am going to do a thumbnail sketch of each:

NEWS FLASH: I was pretty excited to have an interview with Men’s Health Magazine, which was published in a recent 2015 issue, regarding TRT. You can read about it here: My Men’s Health Magazine Interview.

Stage I.  Pain and Suffering

Well, it all started for me in about 2007.  This is when I really hit “the Wall”.  As I’ve described elsewhere, I was absolutely miserable.  Here were some of my symptoms:

  • Intense Fatigue
  • Lowered Libido
  • A Nearly Constant Feeling of Melancholy
  • Some Erectile Dysfunction
  • Muscle and Joint Aches
  • Passionless; Joyless; Zombie-like
  • High Anxiety
  • Couldn’t Think Straight

Basically, I was just barely able to function at work and in my personal life. Survival was just about my only goal. Work, relationships – everything was a chore.

Of course, I searched for answers.  I began reading on the internet and tried to find what would cause my symptoms.  To my surprise, I found many syndromes that could supposedly cause these symptoms.  This included adrenal fatigue, yeast overgrowth/candididas, celiac’s disease, Lyme Disease, Epstein-Barr, fibromyalgia, Chronic Fatigue Syndrome and several others.  The doctors ran all the standard tests and found nothing.  I even had my colon checked for celiac disease and nothing turned up.  Everything was a dead end.

My doctor at the time was an excellent diagnostician if you had the flu or a stomach ulcer or a rash or broken leg.  But he absolutely did not know what to do with me. When I explained to him that I was beginning to experience a little erectile dysfunction, his solution was simple:  20 mg Cialis horse tabs.  And wow did those bad boys work!  It was like being back in high school!

There was one problem though:  Cialis gave me tremendous heartburn.  I knew that this was not going to be a good long term solution.  At the time I did not understand that Cialis and the other PDE5 inhibitors have issues with other similar enzymes in the ear, eyes and stomach and can cause very severe side effects.  I would occasionally get mild ringing in my ears as well and cut back on the dose. Plus, I found that Cialis was somewhat ingermittent (The PDE5 Inhbititors are notorious for decreasing in efficacy, something I discuss in this link on Viagra Failure.)

Stage II.  Diagnosis and Non-Treatment (Androgel)
I can’t remember for sure, but I am almost positive that I asked my doctor for a testosterone test.  I had run across an article that stated low testosterone symptoms and I had a lot of them.  Nothing else had worked, so maybe, just maybe it could be hormonal.  My testosterone reading came back in the low 300’s – I don’t remember the exact number – and my doctor told me I was fine.

In those days all the labs had the lower range at about 260 or maybe 280 ng/dl.  And I was around 320, so my doctor concluded I was okay.  Well, I’m a numbers guy and I was thinking things to myself like, “That’s only a little over 10% above this magic threshold.  So maybe I’ve got about 90% of the symptomology and not 100%, but that’s still bad!”

My reasoning was not bad if you think about it.  No man hits a magic number and then all of his low testosterone symptoms appear, right?  Obviously, as his testosterone lowers more and more symptoms appear at a greater and greater degree.  However, I really didn’t know any better and so I just let it lie, although I did bug him for another test or two and they were always in the 300-350 ng/dl range.  Unfortunately, he would not budge and I probably suffered for a year like this, going back and forth with him.

So was angry at this doc?  Well, no, that would be tough actually.   He was very personable, dedicated to his profession and did significant charity work with children.  I couldn’t get too upset with him!

I should also mention that during this time I tried everything I could think of to try to boost my testosterone naturally.  But nothing worked.  Changes in diet, sleep, etc. just gave me no significant increase in testosterone that I could see what so very.  And so my testosterone story seemed to have deadended.

Fortunately, we did another testosterone blood draw and it dipped into the 280’s.  Suddenly, my doctor was willing to designate me as hypogonadal!  I could not wait to start testosterone therapy but, at the time, knew absolutely nothing about it.  My physician’s solution – and I think this was the only HRT method he knew anything about whatsoever – was to give me Androgel.

Androgel, for those who do not know, is the blockbuster bioidentical testosterone that really brought HRT into the mainstream.  Suddenly, PCPs everywhere had a Big Pharma-backed method of giving a man testosterone that was easy and convenient.  This made testosterone therapy less “steroid like” and more palatable to those in primary care.

Androgel came in bottles with a pump on the top and applying was similar to lotion.  You just rub on the upper body and – voila! – the testosterone absorbs through the skin and you’re cured.

If it was only that easy!  I found out the hard way that Androgel is often poorly absorbed and some men get no boost in testosterone whatsoever.  (See my link on Testosterone and Androgel for more information.) I was one of “those men” and my next reading showed no significant increase in testosterone.  I I knew that I did not feel any better – that was for sure.  My doctor then – reluctantly! – allowed me to increase the number of pumps on my Androgel.  Soon I found I was slathering Androgel all over my upper body.  It was getting ridiculous as my upper body was just covered with the stuff in thick goopy layers.

I thought, “This ought to take care of the problem!” Well, it didn’t.  Strangely, I found that no matter how much Androgel I put on myself, my testosterone did not increase.  Androgel never got me out of the lower 300’s and with all that gel all over my upper body, I was worried about transferrence to my wife and kids.  (On the Forum, this is by far the most common complaint that we get about HRT, i.e. what one might call Androgel Failure.)

This was very disappointing as I felt I may have finally found the root cause of many of my problems. I assumed that HRT was just not going to work for me.  I did not know that there were actually many different forms of HRT that were much more effective than Androgel and just assumed that I was out of luck.  I did, however, ask my doctor if he knew of another physician that dealt with this kind of thing, i.e. “men’s issues”.  I think he couldn’t wait to get rid of me and so he referred me to a urologist that he had heard knew something about testosterone.  I made an appointment as fast as I could!

Stage III.  A Change in Diet and an Almost Effective Treatment (Compounding)

My urologist read my case and, fortunately, recognized that Androgel just was not going to work with me.  He did not know a lot about HRT, actually, but did know of a good compounding pharmacy.  He said that a compounded testosterone was cheaper and could be made with a stronger strength and absorption than Androgel.

And this turned out to be true.  The compounded testosterone did what I thought could never happen:  it brought up testosterone levels up into the 400’s.  I even had a reading around 550 one time.  But, in general, my testosterone readings during this period were less than 500.  My urologist was very comfortable with me at this level, because he had undoubtedly seen many men struggle and in many cases die from prostate cancer.  I told him how I had read a number of studies showing prostate cancer risk was not increased by giving men HRT.  His response, “Sure until they come up with a study that shows the opposite.”  This just showed his caution and who can blame him?

What I found was that I felt better but certainly not great. However, it was during this time that I had another big breakthrough:  I tried a Low Fat diet.  I had picked up a copy of Dean Ornish’s book and, being experimental, I tried it.  I was shocked at the results.  Within just a few days, it had greatly improved my fatigue and erectile dysfunction. This, coupled with the slight increase in testosterone, finally gave me hope:  I was actually feeling better for the first time in years!

NOTE: I actually follow mostly closely a Low Fat Diet build on the guidelines of another researcher named Neal Bernard, at least to a large part. Dr. Bernard shows how to reverse disabetes and slow down or even reduce your arterial plaque, something I cover in this link on Low Fat Diets and Diabetes and The Best Health Books. I also avoid the heavily GMO’d grains (wheat, corn, soy).

Stage IV.  Painful But Effective Treatment (Testopel Pellets)

Inside I was anxious to try to raise my testosterone more and was convinced that this would help me considerably.  I had been reading much more about testosterone and realized at this point that the 400’s was still quite low compare to normal youthful levels.  However, my urologist was clearly uncomfortable with the idea and I was very thankful to have found him in the first place, since finally I was at least moving in the right direction.

After being on the compounded testosterone for a couple of years, my doctor actually came to me and asked if I wanted to try pellets.  He had a change of heart and told me that he could probably get me into the mid 600’s with pellets if I was willing to try it.

Of course, I was all over that and, after making sure that my insurance covered it, I scheduled the procedure.  For those who don’t know how pellets work, it’s an interesting procedure where little mini-tubes are inserted into your hip tissue quite close to the surface.  These tubes have the pellets and basically the tube is withdrawn leaving the pellets under your skin.  You can actually feel the pellets after the procedure as a small bump.

The procedure wasn’t too bad.  Sure, you’re partially naked with the nurse and doc staring at your hemorrohoids for about 20 minutes while you lay on your side, but I would have done just about anything to get my testosterone levels up.  Of course, you have a good amount of anasthesia and cannot really feel anything except the pressure of your urologist wiggling the mini-tube (trocar) to get into place.

Now I had read somewhere that getting pellets was no more painful “than drawing blood.”  And that is true if you are just talking about the procedure itself.  However, afterward, I found it to be quite painful.  Basically, I could not exercise or lift weights for about five days afterward, which for me was a fate worse than death, and the area felt semi-infected.  (It was not actually infected – it was just painful and felt inflamed.)

However, after I recoved from the procedure itself, I was one happy guy.  We never measured my testosterone at the peak, but I would guess I went up to close to upper 600’s and so, finally, I had doubled my testosterone levels! The biggest change was “in my head”.  I FELT fantastic.  Testosterone has a big effect on a man’s brain and I definitely felt it right between the ears.  What I noticed in particular was that the anxiety and sense of melancholy that I had experienced for years and years subsided.  Testosterone was simply a fantastic “brain tonic” if you will.

I also noticed that I started to get some morning erections and my erectile strength became even more consistent.  I was sold on the power of testosterone!  Of course, anything to do with erections is always front and center for a guy, but I was particularly struck with the mental aspect.  I noticed feelings – and I don’t know quite how to describe this – that I had not felt since I was much, much younger.  I was always into music growing up and I found that music once again profoundly affected me the way it used to. And there were feelings of elation and joy in the everyday things of life that I just had not experienced for a very, very long time.

I can remember thinking:  “you’re just not really alive if you are low testosterone.”

One other thing I noticed was that my gains in the gym seemed to acclerate.  I had been able to put on muscle even when I was in the 300’s, but it was slow going.  However, during this relatively short time period, I picked up some nice increases in strength and leg and arm size.

But there was a gnawing thought in the back of my head:  could I go through that procedure again?  I’m a very thin guy – a card-carrying Skinny Bastard by any standards – and I had precious little fat tissue as buffer against those trocars.  Plus, my doc wanted me to take antibiotics for a few days before the procedure to insure that I did not get an infection.  This went against my tightly held health beliefs that antibiotics very often attack your all-important good gut flora.  So the whole thing seemed a messy, painful business.  And yet, I had to admit, it was literally a fountain of youth for me.

Another problem that arose was that after a couple of months my testosterone levels began to fall somewhat.  That’s the way the pellets work.  Everyman is a little different, but, depending on the number of pellets and other factors, your testosterone levels will gradually begin to fall and then you need another procedure.  I also found that my urologist seemed to be trying to spread out the time between procedures quite a bit and so I was concerned about having a month+ of lowish testosterone where I felt about like I did with the compounding.

Stage V.  Finally!  Testosterone Injections and Arimidex

All of my hesitation about pellets finally came to a head one day at work and I did a quick search for HRT clinics.  I noticed one just a couple of miles from my house and went in for an appointment.  By this time, I had become quite knowledge on HRT matters and had been wanting to get on HRT.  This particular clinic was great because 1) they were national and thus should be fairly stable/reliable, 2) they worked with my insurance companies and 3) they used cypionate with Arimidex, which was my preferred delivery system based on the research that I had seen.

NOTE: Injections must be well-managed to avoid most side effects and to be effective. I discuss that here in my link on Testosterone Cypionate .

I was really looking forward to my first shot as my libido was really slipping from being so long on the pellets. I believe that by the time I got into the clinic, it had been almost four months since my pellet procedure.

When I got my injection, the reaction I got was spectacular.  No, I didn’t start getting spontaneous erections like I was 14 again.  What I did get that evening was, as best I can describe it, “fireworks in my brain“.  I felt a little Jim Carrey in The Mask:  the feeling was really powerful between the ears.  Not painful.  Not scary.  But I definitely had the sesnsation that there was some “rewiring” going on.

Jumping ahead a little, the injections did something huge for me:  they completely vaporized my dysthymia.  I had had mild depression pretty much all of my adult life.  A Low Fat Diet got rid of some of it and exercise still another part of it.  But I could never really defeat it completely. What I noticed a couple of weeks after my injection was that I had absolutely no sense of melancholy about me.

Also, I have always been high anxiety.  I will sometimes call myself Captain Anxiety in front of my family and they always laugh, because they know it is true.  The injections greatly helped with this issue.  It was strikingly noticeable to my boss and he has commented several times to me about just this.  This goes along with a lot of research that shows that, counterintuitively to some, low testosterone animals are actually the ones most likely to fight.

And then I got the best gift of all. In fact, it was like Christmas:  I got my morning erections back.  I got occasional morning erections with a Low Fat Diet and compounding and even a few more with pellets.  But there was no comparison with the injections:  morning erections occurred almost every night.

The return of the morning erections also was a “Aha!” moment for me.  I suddely realized the obvious:  I had not had morning erections probably my entire adult life.  This coupled with the lifelong dysthymia makes me wonder if I was low testosterone my entire adult life.  (I have had zero dysthymia, a.k.a. mild depression, since going on testosterone cypionate.)

When I started cypioante at the HRT clinic, my protocol was the following:

–Testosterone Cypionate (130 mg weekly intramuscular)

–Arimidex (1/2 mg 2 X per week)

It took abou 9-12 months, but I was finally able to get completely off of Arimidex by doing the following:

1.  Dropping my dosage to 100 mg per week.

2.  Doing my cypionate injections subQ (subcutaneous) two times per week.  (50 mg each injection)

3.  Losing weight and getting down to about 12-13%% bodyfat.  (The more bodyfat, the more estradiol is produced.)

And I also faced another realization:  I probably had pretty bad venous leakage and my newfound testosterone levels finally helped me overcome that.  My HRT clinic has me at a trough of about 670 ng/dl and a peak of about 850 ng/dl.  And, because my last estradiol read was 21 pg/ml, I backed off my dosage of Armidex to the 1/4 mg.  One of my goals is to take as few pharmaceutical as possible.

So you can see why I am such a huge fan of HRT:  it literally gave me back the youth back that I never had.  I feel fanstic and have put on some extra muscle by the way.  I am now significantly stronger than I was in college and my physique is better too.

That said, I want to point out that not everyone has such a rosy experience with testosterone therapy and, like everything, there are certain risks and rewards.  I highly encourage every man interested in TRT to read my link on Weird Testosterone Risks for more information:  it has all the things that my doctor should have told me before I went on testosterone.

In the meantime, I am very much enjoying feeling about half of my age!  I seriously feel MUCH better than I did in my 20’s or 30’s and I feel that I owe it all to a Low Fat Diet, exercise, my HRT program and a good woman.

Elevated PSA

At the end of the year in 2013 I had to go off of HRT briefly due to a high PSA reading and even had a prostate biopsy. However, they found that there was no cancer (or even precancer) but did find inflammation. I was able to resume HRT. For details of my whole experience, see this page: My Prostate Scare (High PSA but No Cancer).

I got a PSA at my clinic about a month afterwards and already my PSA had dropped from a peak of 6.3 to 3.9.   This is a very good sign that my new “prostate program” was working, because the urologist said my prostate would be inflamed for several months afterward.  (They take 12 chunks out of the prostate when they do the biopsy.)

One interesting comment is that I implemented a bunch of natural anti-inflammatories (turmeric, quercetin, bromelain and IP6) and flaxseed along with a vegan diet in order to protect my prostate.  To be honest, as much as I love whole grains, vegetables and fruits, I don’t really want to be vegan but am doing it to make sure my IGF-1 levels stay in line.  And it seemed to work:  over about 6 to 9 monts my PSA dropped down to a low of 1.9, which is close to my early HRT levels.

In mid 2015 my PSA bumped jumped back up a bit to 2.9.  My urologist suggested that I try the new 4kScore test, which is able to tell with solid accuracy whether or not you have the aggressive form of prostate cancer.  I took this test and it found that I have a very low probability of having the aggressive form of prostate cancer, something I cover in more detail here:  My 4kScore to Test for Aggressive Prostate Cancer

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