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Topics - Nocturne

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1
Hey all - it’s been a long time.
Just wanted to drop in and give some of the newer people some encouragement.  When I first came here in 2015, I was a complete wreck.  My T was in the low 100s, I was completely impotent (which came on all of a sudden around April of 2015).  It was a long road getting better and I learned along the way that I have a genetic abnormality that has given me very premature heart disease (I was 41 in 2015).
But!  With Clomid (and a touch of Anastrazole), I was able to get my T levels into the 500s (and sometimes above that, as high as the 700s).  It took over a year, and the help of 2.5 mg of Cialis a day, but my erections returned to more or less normal (even strong on occasion), and I enjoy regular sex with my wife without a LOT of worrying (that never goes away entirely, I’m afraid).  In many ways, my nightmare has been over for a while.  I owe a lot to the good people here (and over at franktalk.org) for listening and giving support and advice when I really needed it.  There is hope!

2
Hey all - have not been active in a while.  More focus on the heart than the T.

Anyway, got my routine blood test results for the year and was a bit surprised. 

Total T, Bioavailable T, and Free T were ALL higher than they have EVER been, while SHBG was LOWER than ever.  This seemed odd because in the few days prior to getting the blood drawn, I had noticed the first slight issue with flagging erection during sex that I have noticed in a while.

I have only a dim understanding of low SHBG and what it does.  What do you folks make of this?

Total T: 622 NG/DL (Range 270-1070)
SHBG: 30.5 NMOL/L (Range 14.6-94.6)
Free T: 141.7 PG/ML (Range 48.2-169.6)
Bioavailable T: 332.2 NG/DL (Range 113.1-397.7)

All it all these numbers LOOK great to me, considering my original T reading three years or so ago was in the low 100s!  Clomid sure has done wonders for me! 

Just curious if any wiser and more experienced folks here had any input.  Thanks!

3
Testosterone, Hormones and General Men's Health / T-docs in Chicago area?
« on: December 03, 2018, 01:32:02 pm »
Hey all.  Hope all is well with you.  I’ve been pretty good - EQ is always up and down (har har) but has been significantly more reliable since I doubled my Clomid dose.  I do think it has lowered my libido somewhat as I rarely feel the same “edge” when in the presence of pretty young women these days - I mean I FEEL it, I notice, it just doesn’t seem as strong.  Still having plenty of sex though.

My question isn’t for me.  It turns out I have a female family member who recently confided in me that she has been frustrated for years new because her husband seems to have no interest in sex and she regularly goes six months or more without his touching her, and when he does it is only after a lot of begging and pleading.  I’ve been on the receiving end of that and it was horrible; real trauma.  I feel - anger - for this woman, who is attractive and sexual and in pain.  She loves her husband but - you know the drill.  It hurts.

I suggested that she might want to look into having him get his T checked.  I know that is not always the answer but it would not hurt to look.  She says he says he is “too tired” a lot and that could be low T as well.  Anyway she was receptive to that BUT - we all know that there are some docs out there who really have their heads up their asses when it comes to testosterone.  I’d rather this poor woman not waste her and her husband’s time on one of THEM.

So - can you who are in the know recommend a doc or two in the Chicago area whose names I can pass along?  Docs who take low T seriously?  If T is the reason this guy’s libido is so low. treatment could ultimately be saving a marriage or at least the mental health of this poor woman.  Thank you.

4
Testosterone, Hormones and General Men's Health / Update - good news
« on: August 10, 2018, 09:06:16 pm »
Hey all, it has been some time since I checked in here because I have been more concerned with my heart and prediabetes than T levels.

However, a few months ago, I doubled my Clomid dose to 50 mg EOD up from 25 mg EOD.  I was hoping to lower blood glucose by raising T.  I also went on Metformin for a while at the instruction of a private doc.

Since starting new higher dose, I have noticed a lot of positive changes - sexual function (getting not-perfect “throbbing 25 year old” but pretty consistent erections as I drift off to sleep and wake up, almost completely reliable erection for sex and masturbation (with the light Cialis dose anyway), and most recently regained the ability to orgasm from oral sex - it feels like a lot of sensation has returned.) and otherwise (I have regained the ability to “sleep in” in the mornings, which my wife has been less than thrilled with but I have greatly enjoyed.

So when I had my blood drawn this morning in prep for my six month visit with my hormone doc, I expected levels to be good.

What I just found out stunned me a bit.

Remember, my levels were near castrate three years ago - total T of around 120.  The 25 mg EOD of Clomid brought those up to a fairly stable high 300s to low 400s.

This morning, my total T level was 696!  Doctor just had their nurse call me to tell me.

Unfortunately, my post meal blood glucose appears to have gotten WORSE, even With the Metformin, which I stopped taking after three months because it seemed to do nothing.  Not happy about that.  But happy about the T.

What level is considered “average” for a 45 year old man?  I have been so low I have forgotten what average was because my numbers have never been close.  Now I’m wondering...

Anyway - good news in general!  I will report back again after I see my doc on the 13th.

5
If you haven’t felt sick yet today, and want to - check this out:

https://m.dailykos.com/stories/1756856

"In the case of infectious diseases such as hepatitis C, curing existing patients also decreases the number of carriers able to transmit the virus to new patients, thus the incident pool also declines …"

OMIGOD!  That's TERRIBLE!

6
Hoo boy.

So I got my genetic test results back from Doctor Brewer’s office.  Spoke to the other doc he works with there about them today.

Turns out I have two more genetic variants that predispose to heart disease.  I’m heterozygous for the bad variant of 9P21 and also heterozygous for the bad variant of Haptoglobin.  The former is apparently pretty common but has recently shown a strong association with T2DM; doc I spoke with felt that this might be a large part of why it is also associated with heart disease risk.

Did not recommend Vitamin E for the Haptoglobin variant but did mention that it appeared to help people who were homozygous for it AND had T2DM.

After reviewing my OGTT, which showed a FBG of 100 and glucose of 119 at the 2 hour mark, doc recommended putting me on a 500 mg dose of Metformin every night.

Reasoning was sound enough.  60 pound weight loss and radical change in diet and exercise routine should have done more than lower A1c from 6.0 to 5.8, so we need to look to genetics as a cause (especially considering my father has T2DM and my sister is in the same boat as I am, flirting with it with the same strange pattern of high morning FBG and boring post prandial levels).  For the average Joe this might not be a huge deal but since my heart is already screwed up, it might be best to be aggressive.  Just like how my cardiologist put me on enough statin to lower LDL to less than 70 even though for normal people that is not necessary.

On the one hand I agree with the doc here.  But then I remember hearing that Metformin can lower T, and probably has other side effects too.

Any thoughts or opinions?  I’m gonna talk this out with my wife this evening.

7
Testosterone, Hormones and General Men's Health / Changing Clomid Dose
« on: March 07, 2018, 02:09:18 pm »
I have been on Clomid for over a couple of years now, at a dose of 25 mg eod.  It brought my T up from 120 or so to the high 400s.

I want to raise T further in hopes of lowering my fasting blood glucose and my Lp(a), both of which can be lowered by T.  So I talked to my doc and he agreed to double my dose (which was his original dose for me anyway).

Last time I was on 50 mg eod, my estrogen went up, but I read that estrogen can lower Lp(a) so maybe this is not a bad thing.  Yes, I was crying at movies and overly emotional at times, but this might also be because at the time I was having pretty bad erectile difficulties that have mostly cleared up.

I’m even wondering if the higher dose might help there.  50 mg eod raised my Tto near 600 last time.

So, took my first full pill last night.  Wish me luck.

Even if this doesn’t work out I may just adjust meds myself for a while and not tell the doc, because it is such a bitch getting my Clomid on time from the pharmacy.  They want me there on the exact day the pills run out, and then are often out of stock or slow to refill.  This was they can play their little games and I can pretend to be upset about it while secretly knowing that I have plenty of pills at home and they are just wasting their time trying to be annoying.

8
Testosterone, Hormones and General Men's Health / OGTT results
« on: March 05, 2018, 12:24:45 am »
Finally had an official oral glucose tolerance test done the other day (Friday).

Morning fasting level (with home glucometer): 103
Morning fasting level (with lab gliucometer): 94
Morning fasting level (with lab blood draw, supposedly more accurate): 100

Two hours after ingesting 75 g glucose (with lab blood draw): 119

Three hours after ingesting 75 g glucose (with home glucometer): 96


Not sure what all this means other than that my pancreas isn’t dead yet.  Still think the fasting level of glucose is proportionally way higher than the post prandial one.

9
Testosterone, Hormones and General Men's Health / LDL and diabetes
« on: March 05, 2018, 12:18:23 am »
Wait — what?  LDL cholesterol PROTECTS you from getting diabetes?!?

https://www.sciencedaily.com/releases/2016/08/160803124428.htm

10
So I got my T and stuff tested again in preparation for my recent doctor visit with my T doc.

Pretty good news all around.  T of 497, free T of 89, BioAvailable T of 205.  Not too shabby.  Also my hematocrit is down to 45%!  Not sure why, but that's good news too.

I talked to my doc and he agreed to raise my Clomid dose to see if we can get T to go up and fasting blood sugar to go down.  My blood glucose is curious in that it is generally prediabetic when fasting (95-115 most of the time) but totally boring an hour after eating (also 95-115 most of the time).  The other day I was a 107 when I woke up and a 108 an hour after eating a mall food court plate of terikayi chicken, white rice, and undoubtedly sugared vegetables, and a free chocolate bonbon (I don't usually eat like that, it was for science -- honest!)

Had a long talk with my hormone doc where I mentioned some stuff about my Lp(a) levels.  He mentioned that he recently learned that HE has crazy high Lp(a) as well, almost as high as my own.  He is a very mellow guy but I could tell that he was stressed to learn that there is really not much that can be done to lower Lp(a).  He was unaware of the ongoing Ionic pharma trials of an antisense drug that can lower Lp(a) by up to 90%, or which alleles were causative for high Lp(a).  And was curious about what supplements I was taking for it.  Eventually he told me, "I think you know more about this than I do," and asked me to send him useful information to him via email. 

It's not a "funny" coincidence, it's gotta be stressful for the guy - although his CAC score is pretty good for a guy his age.  I'll send him all I can think of that might be useful.

Oh, also had my echo done for the year and -- no progression of my aortic valve stenosis!  That was cause for celebration!

Hope all is well here.  I miss Peak.

11
Testosterone, Hormones and General Men's Health / BENEFIT of High Lp(a)?
« on: January 11, 2018, 04:22:50 am »
Again, I realize this is off topic for this forum, but I am posting it because I think Peak will find it interesting and also because it demonstrates how sometimes in medicine what seems "bad" can really be something of a mixed bag:

http://clinchem.aaccjnls.org/content/63/11/1714

"CONCLUSIONS: High lipoprotein(a) concentrations were associated with lower risk of major bleeding in the brain and airways observationally and causally. This indicates that lipoprotein(a) may play a role in hemostasis and wound healing."

They specifically looked at the bum allele I have two copies of - the Lp(a) raising "G" variant of rs10455872.  People with one copy had a lower incidence of major brain and airway bleeding.  People with two copies (like me) had an even lower risk (risk ratio 0.59).

Interesting.  Of course it didn't help my mother, who died in her mid fifties from a burst brain aneurysm, but still.

12
Because my pharmacy cannot seem to understand “EOD” dosing and just NEEDS to operate on “pills per week”, of which they think I need “2”, I routinely end up with a gap in my Clomid dosing at the end of a scrip.  I missed picking my pills up yesterday and that means I missed two doses, and have not taken Clomid in... 4-5 days?

Would it be normal for a person to feel some effect from missing Clomid for that long?  I noticed this morning that I have felt a bit lethargic and not very sexual lately.  ???

13
Testosterone, Hormones and General Men's Health / Strange Glucose Readings
« on: December 16, 2017, 03:56:43 am »
OK, so I got my glucometer.  Been off the niacin for a couple of weeks, so I started testing when I woke up.

My first morning, it was 115.  I was depressed.  Then I waited a few hours without eating, and tested again at 11:30 am.  Down to 95.  OK, less bad.

I did that for a few days, and saw a consistent pattern.  Waking blood glucose (after not eating for at least 8 hours) is always between 99-115, but a few hours of not eating later, it is almost always in the 90s, generally 91-95.

I was still down about it.  Those are still not good numbers; you really WANT your FBG to be below 85, no matter what the docs say.  My father has type 2 diabetes and my sister, who runs marathons and eats much healthier than the typical American, has had morning glucose levels of 105-115 for 16 years, ever since she first had them tested.  It looked like diabetes was inevitable, although I knew that dropping the statin might bring my numbers down a bit (still have to experiment with that one).

Now comes the weird part.  Mostly as an excuse to eat at the faculty potluck holiday lunch, I decided to check my postprandial (after eating) blood sugar.  I checked my glucose before eating, then ate a holiday party meal (salad, chicken tikka masala, bean chili, a chicken wing, eggplant parmesan, some raw vegetables, a few tortilla chips in seven layer dip, a bite of bread, and even a small piece of gingerbread fudge with a diet cola).  This is a much larger and less healthy lunch than I typically eat, but I was making a sacrifice for science (yeah right).

Right before eating, my blood glucose was 95.

An hour after eating, my blood glucose was 115.  Pretty boring reading considering that prediabetes isn't indicated until you get above 140.

Two hours after eating, my blood glucose was 106.

This has been consistent the two meals I have done it with since -- once with a protein shake from the local place I usually grab one at (Readings 95/106/91), and again after eating half an onion teriyaki chicken Subway wrap (95/111/99).  And these are meals that are less healthy than what I usually eat -- the shake has over 9 grams of sugar in it, and the Subway wrap is, well, a Subway wrap.  Those are examples of "treat" meals for me.  Have not tried with a "typical" meal of, say, half a whole wheat pita bread with garlic hummus yet.

I understand that the home glucometers are not entirely accurate, but these numbers are NOWHERE NEAR the postprandial 140 when prediabetes would be flagged.  Even if they were off by 20% I'd still be safe.  They are boring, "why are you bothering with this?" glucose levels.

EXCEPT that my morning levels are consistently over 100, and my between-meal levels are almost never below 90 (today, for the first time, I was at 83 when I came home from work after not eating for about 4 hours -- the first time I have EVER seen my blood glucose outside the 90-115 range, regardless of when I do the draw).

Not sure what to make of this.  In a way I am ecstatic that my postprandial numbers are so (relatively) low, but it presents a puzzle.  Why are my morning levels so high, and how serious is that?

It seems like my body has a pretty good lock on glucose control, but the "thermostat" is set a bit high.

14
Testosterone, Hormones and General Men's Health / Inflammation Comes of Age
« on: December 14, 2017, 09:29:54 pm »
Interesting article on the CANTOS trial, with strong "official" evidence that inflammation breeds heart disease:

http://www.practiceupdate.com/c/61984/68/2/?elsca1=emc_coll_2017TopStories&elsca2=email&elsca3=practiceupdate_cardio&elsca4=2017TopStories&elsca5=collection&rid=MjI4MTI4MDExODQ4S0&lid=10332481

* * * * *

The Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS) put the inflammation hypothesis of atherosclerosis to the test. This study enrolled patients with stable coronary artery disease at least 1-month post myocardial infarction who were fully equilibrated on standard-of-care medications including high-intensity statin therapy. It further selected individuals who had residual inflammation despite usual care as demonstrated by an increase in high-sensitivity C-reactive protein (hsCRP) concentrations greater than 2 mg/L. The over 10,000 participants were randomized to placebo or one of three doses of a highly specific monoclonal antibody that targets the pro-inflammatory cytokine interleukin 1 beta (IL-1β). (Canakinumab is currently approved for use in some rare childhood diseases caused by excessive IL-1β activity and is currently marketed and priced as an “orphan drug.”) The anti-inflammatory drug was administered subcutaneously every 3 months.

The participants were followed for an average of almost 4 years and tracked for the primary endpoint of myocardial infarction, cardiovascular death, or stroke. The study met its prespecified endpoint, with the middle dose of the anti-inflammatory antibody associated with a significant 15% reduction.2 There was a 17% reduction in the key secondary endpoint expanded to include unstable angina requiring urgent revascularization. Myocardial infarction fell by almost one-quarter, and coronary vascular events by almost one-third. There was a small but statistically significant increase in fatal infections. A striking decrease in cancer deaths counterbalanced the infection risk: at the highest dose of canakinumab, lung cancer fatality fell by over 75%.3 In a prespecified subsidiary analysis of CANTOS, participants who responded to the anti-inflammatory treatment by a decrease in CRP to less than 2 mg/L by 3 months had a 25% decrease in the primary endpoint and over 30% reductions in cardiovascular and total mortality.4

15
Testosterone, Hormones and General Men's Health / Niacin and Blood Sugar
« on: November 24, 2017, 04:19:10 pm »
So...  My fasting blood glucose (FBG) back when this health mess started was 98, just under the cutoff for prediabetes.  Then I lost over 50 pounds and started walking and etc.  I figured I must have dodged a bullet with diabetes, at least.

Well, a few months ago I had my FBG checked again and it was 102.  Had my GP check it again and it was 105.  My A1C was 5.6, so GP pronounced me “fine” and sent me home.

The teledoc I have been working with ordered an oral glucose tolerance test just in case.  I’d suggested it to GP who had told me it was not necessary, but I wanted it done because I wanted to know more.  Why the Hell had FBG gone UP after major weight loss?  That was not right.

Well today I went in for the oral glucose tolerance test, and my initial draw (before the sweet drink) was 115!  Second draw was 118, and then they sent me home because that was too high to run an oral glucose tolerance test on.

What.  The Hell.

I have been on niacin and recently goosed my dose up from 900 mg to 1200 mg per day (going slow to 1500-2000 goal).  I am also on 20 mg Crestor every day.  I know both of these things can raise FBG, but 15-20 points?

I cannot afford to get diabetes too.  There is no doubt a genetic component here because my father has type 2 and my sister tells me her FBG is routinely between 105-115 (and she runs marathons and eats well, so well I used to think she was nuts).

Any ideas or suggestions?  My plan now is to take a holiday from the niacin and statin for a couple weeks and then retest FBG to get a “real” baseline.

Other than that I am stunned and in a fog.

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