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3001
Testosterone, Hormones and General Men's Health / HRT - The Best Is?
« on: January 19, 2013, 03:57:52 pm »
Hi Everyone,

As I investigate the different HRT companies out there I thought I would share my thoughts on the ones I have been in touch with and certainly interested in hearing your experience's with these or others.

Companies I have contacted:
1) National Medical Clinic - includes 15min phone consultation  REMOVED FROM CONSIDERATION DUE TO LACK OF COURTESY AND HIGH PRESSURE SELLING TACTICS
- Testing - Paid for by client - requires initial comprehensive panel and 1 Free and Total T Tests and Estrogen as follow up tests (possibly more) Additional Dr visits fee's are (unknown?)
- Initial Doctor Evaluation - Included
- Program (offers 2 programs) 1-$3195/yr; 2)$3295/yr 200mg/ml injectable
1) Alternating (Cycled) Testosterone and HCG with Continuous Anastrozole Hormone Replacement Therapy for Men’. This method of male hormone replacement therapy (HRT) consists of alternating (cycled) several weeks of testosterone and anastrozole administration followed by 2 weeks of HCG administration only in each consecutive testosterone and HCG treatment cycle during a patient’s total male hormone replacement therapy treatment period. The number of testosterone and HCG treatment cycles increase as the duration of the patient’s total treatment period is extended. Custom compounded Anastrozole tablets are administered periodically each week throughout hormone replacement therapy to prevent the aromatase conversion of increased testosterone in the blood stream resulting from the administration of testosterone medication to estrogens.
 
2) Continuously Administered Testosterone, HCG and Anastrozole Hormone Replacement Therapy for Men’. This method of male hormone replacement therapy consists of the continuous administration of testosterone cypionate, gel or cream, HCG and Anastrozole periodically during each week throughout the patient’s HRT treatment period. If the patient is administering testosterone gel or testosterone cream once daily, then only HCG and Anastrozole are administered on the same two days during each week throughout the duration of the patient’s NMC HRT program.

2) AAG Health - USA - Very professional presentation and straightforward.  Seemed comprehensive but  bit pricey.
- Testing - $495.00
       13 panel blood test to check your hormone levels and confirm candidacy. Can be completed at any number of LabCorp locations -   -- Initial Doctor Evaluation -$500.00
- Program - $3000-$5000/yr
       Includes Testosterone, HCG and Estrogen Blocker, Phone Consultations, 1 follow up visit/6months with tests
       Also offers HGH treatment for a combined cost of $6400-$16000/yr (depends on dosages)

3) BodyLogicMD - offers injections, pellets and gels through local MD's who manage you directly (franchise?)
- Testing (will update later)
- Initial Doctor Evaluation (will update later)
- Program (will update later)

4) SottoPelle - uses local MedSpa type facilities - Accepts any bloodwork completed within the past 30days - Pellets only.
- Testing (will update later)
- Initial Doctor Evaluation (will update later)
- Program (will update later)

I still have to confirm the cost on some of these and will update as I get the information.   If anyone has personal experience with these or other companies please share.

3002
I guess I am looking at it from an overall adrenal function point of view.  Clearly a 24 hour test would be more appropriate than just an am number especially since I am right at the edge of low.   It sucks I am having to make assumptions based on how I feel and limited data but I am trying to be patient.  Of course that is also why I am looking at just going outside my healthcare provider to get more tests done.

Here is a excerpt from the livestrong site regarding adrenal gland and testosterone.

"Testosterone Conversion

The zona reticularis of the adrenal gland itself produces a small amount of testosterone while predominantly secreting "weak" androgens such as dehydroepiandrosterone, or DHEA, and DHEA sulfate, or DHEA-S, into the blood. Compared to testosterone, DHEA and DHEA-S bind less efficiently to the androgen receptors that convert hormone signals into cellular results. However, some target tissues for DHEA and DHEA-S convert those weak androgens to testosterone, amplifying the strength of the cellular response. When scientists mention "adrenal testosterone," they really mean testosterone resulting from the target tissue conversion of the DHEA and DHEA-S produced by the adrenal glands. In this roundabout way, the adrenal glands are an important source of testosterone."



3003
Thanks Peak,

Reposted my test results here for your reference.  I have a 1.5 year old girl and a 4 year old boy.   I think we are done with kids:-)

It will be interesting to see if my ACTH stimulation test yield.   I guess it is possible that my Cortisol level is where it is due to my use of Ashwaghanda but that just frustrated me more because the Doctor told me he was ok with me taking that just stay away from DHEA.   

After the ACTH test(assuming I am still getting no where) I am going to go to my MD with a complete list of the tests I want run and discuss with him how long I need to be off all supplements to get an accurate baseline for my body and then hopefully be able to make a decision on HRT or something else. 

Here is a list of my test results so far: (normal ranges in parentheses)
1/15/13 – Cortisol-AM = 7.6ug/dL (8-25)

1/15/13 – TSH = 1.48uIU/ml (0.10-5.50)

12/31/12 – Lipid Panel
   Cholesterol =150mg/dL (<239)
   Triglyceride=58mg/dL(<199)
   HDL=45mg/dL(>40)
   LDLcalc=93mg/dL(<129)

12/31/12 – Testosterone(LC MS/MS) tested at 8am
   Total – 227ng/dL(250-1100)
   Free – 45.9pg/mL(35-155)

7/6/12 – LH – 2.1mIU/ml(1.0-12.0)

7/6/12 – Prolactin – 4ng/mL (2-18)

7/6/12 – Testosterone(LC MS/MS) tested around 10am
   Total – 154ng/dL(250-1100)
   Free – 45.4pg/mL(35-155)

3004
5). If Kaiser won't fix my varicocele or acknowledge it could be related to a low T condition that could be contributing to a medical situation worthy of treatment do I pay for the surgery myself and see how it impacts my T levels or do I just start HRT?


That's all that I'm worried about outside of paying for my kids college and how to make up for the shortfall in my paycheck from the SS tax increase;)

3005
Thanks Jack,   I am headed down that ride,  suffering from a little analysis paralysis right now.

I.e.1) how patient to be with Kaisers 1 test at a time philosophy to ensure nothing else is going on
2) what supplements should I be taking
3) what blood tests to get and from whom.  Do I go independent, push on Kaiser or just work with an HRT company.
4) pellets vs injections vs how important is working with a HRT company that offers HCG and anastrozole as an option vs not at all vs mandatory?

Well going to the gym now to sit in the sauna;)

3006
Appreciate the thoughts.   Funny enough I hurt my back a few months ago lifting something improperly which lead to sciatic.   (Couple times a day it feels like someone is stabbing me with a knife in my left ankle....yeah fun.).   Drs at Kaiser also told me I am SOL on this one so just sucking up the pain at the moment.  I did have an MRI done on my back and the results were not bad enough to warrant any intervention.   

What's interesting is that I wouldn't have noticed the bulge above my groin if it wasn't for my recent weight loss related to trying to get my T levels up so I guess in the end I do feel like all of this is making me take my overall health more seriously.

3007
In my ongoing research to understand why my Cortisol levels are low and how this might be linked to my low T and DHEA response I came accross a good link I thought I would share. Peak, feel free to delete if this isn't an appropriate link, but I found it to augment much of what I read on this site and also provided a unique perspective for me since I cycle quite a bit.   I think the take home message for me is to pay for a complete battery of tests myself ( thank you for the link to Life Extension).  They seem to be a comprehensive and reasonably priced outfit.

http://www.trifuel.com/training/health-nutrition/what-is-cortisol

I am withholding any judgement until I can get more tests run but I am curious if my low Cortisol is a good or bad thing and if it might be related to chronic Allegra use, Ashwaghanda use or just Adrenal failure. 

Peak, I also read the post by Anonomous as you suggested (great read, sent it to my wife also)and am at least confident HRT is worth a shot for me once I have a complete assessment by getting a more comprehensive set of tests.

One final comment is that I am going in to have an inguinal hernia repaired Feb. 5th and low cortisol and low T have been shown to slow healing after surgery so I am thinking of going off of my supplements prior to this.    Just gonna work with my MD on this one, but not sure Kaiser allows their MD's to venture very far outside of their little book of what to do next:(

3008
Testosterone, Hormones and General Men's Health / Sauna and Testosterone
« on: January 18, 2013, 09:36:56 pm »
Has anyone come across any info that would suggest sitting in a Sauna is bad for Testosterone production?

3009

Sorry for the rant, ultimately the decision is yours! (Not you and your Dr's!)
At this point I could give a crap what a Dr. Thinks about treating low T.
However you will need to be tested regularly at least in the
Beginning, so you at least need someone to work with you.

Good luck,

Great Rant, it's helpful to learn of others experience's and what they did.   Hopefully someone will ready my post someday and it will help them after this all plays out.

Cheers,

3010

Not my intent!  I believe that most middle-aged and senior men can rebuild themselves bigger, faster, stronger.  But you have to start with facing the facts.  That is my intent - not to scare anyone...

It was a great read and something I will go back to over and over as I learn more about my situation and interact with my Drs.   The scary part was just becoming aware of what Low T can result in if left unchecked.   I exaggerated a bit ::)

3011

I've just got a sec here - flat tire on the interstate if you can believe that! - but three important comments:

1) Your doc is right that someone who is obese can significantly raise their testosterone oft times.  I've got this in one of my books and will send it to you if you PM me.  However, you don't sound obese and your testosterone is still low.

2) Hypothyroidism can also cause low T.

3) Low T really messes with your head, or at least that's the experience of a lot of us around here.  And the studies bear it out:  low testosterone, especially super low like yours, can contribute to depression, anxiety, mental fog, etc.  You should read anonymous's description of what it was like to get on testosterone:  he want from a low energy/depressed guy to radically different.  (I think he may be taking one medication if I remember right, but the testosterone (and an Aromatase Inhibitor) made all the difference in the world.

Should you go on HRT?  Well, I have to leave that to you and the doctor of course.  Perhaps thyroid and adrenal issues coupled with being somewhat overweight could do it.  Let us know what you find out.

Thanks Peak.  Hope you got your tire fixed.   Seems oddly appropriate since I feel like I have a flat tire in life :)

I've had a few discussions with some of the HRT companies so far and some interesting experiences - Is it ok to talk about company names on this forum?

One issue that I am trying to understand better is the difference between pellets and injections.   It seems some of the pellet companies don't offer and HCG or Anastrozole.  One of the HRT companies I spoke to that does injections made it sound like this is malpractice and pellets are fraught with problems, i.e. infections, no way to adjust dosage etc.   They are appealing to me because I have little kids and worry a bit about cross contamination.  I also travel and this would certainly be more convenient.

The other area I am trying to understand is if I should stop the DHEA.  The simple fact is I feel markedly better when I use it and based on my low T and Cortisol levels I bet my DHEA levels are low also.  Unfortunately I haven't been able to get my MD to test for it.  It will be interesting to see how all this plays out.


BTW,  bought your book last night.   Would have paid more than $1.99 for it.  Some of the stuff did scare the hell out of me.

3012
go tell the endocrinologist to go fuck himself regarding the BMI crap. 

what does your diet consist of?

i had a 39 yo neighbor who is a chronic runner, 15+ miles per week.  his joints ached every day.  he had to ice his knees nightly.  he woke up almost nightly at about 3 am due to insomnia.  i had talked to him for years about how he needed to cut out gluten from his diet.  he is italian and thought that was blasphemy.  eventually he got desperate enough to give it a try.  he slept better, his joints felt better, and his energy levels went way up. 

you can read his comments here.  he goes by "leroy".

http://escapetheherdblog.blogspot.com/search?q=leroy

Thanks Bubba,

The diet stuff is interesting.   I had asthma as a kid and still have a little allergy induced asthma.   I didn't mention in my earlier post that my allergies have been significantly worse for the past year, meaning last year I probably only need allergy meds for 2-3months and this year I am taking 24hour Allegra as a daily Vitamin.  If I don't take it I feel much more tired throughout the day.

Typical day for me is around 2000 calories. 500 calories for each meal and about 500 calories in snacks.  25% Fat, 25% Protein and 50% Carbs.  Once I get to about 190 I plan to go up to about 2500calories/day and add more resistance training to my program.   I've been focused on cardio and weight loss for the past few months which has done wonders for my cholesterol but nothing for my Testosterone.

I only drink water and the occasional glass of wine or scotch.  I found getting Splenda and other artificial sweeteners out of my diet made a huge difference in how I felt.

Typical Meals
Breakfast,
ON Natural Whey Protein Shake - 2 Scoops + Almond Milk+ Berries or Banana+Greek Yogurt

Lunch&Dinner
Homemade Stews/Soups - Chicken with Mixed Veggies(different sauces), Wild Goose(I hunt) with Yams, Sweet Potatoes and Peppers
Usually served with Brown or Black Rice or Quinoa

I'll mix in the occasional treat i.e. Sushi, In and out Burger dinner out with my wife where I don't pay much attention to what I eat.
 
Snacks
Apples
Almonds
Dark Chocolate
Cottage Cheese

3013
After posting thought I should add a few comments on supplements I started taking about 1 month ago..  ( Before my blood tests I stopped all supplementation except fish oil and a multivitamin 3-4 days prior)

Currently taking
MultiVitamin
Fish Oil
50mg time-released DHEA in the morning ( I just learned this is controversial nowadays but honestly it seems to make a difference in my energy level)
Ashwaghanda in the mornings - Hard to tell if this is having an impact
ZMA + Fenugreek in the evenings

3014
Testosterone, Hormones and General Men's Health / So this is the 40's?
« on: January 17, 2013, 02:48:12 pm »
Hi,
Reading through this site has been amazing and eye opening for something I felt like I have been struggling with alone for the past 8+ months.   While I understand I need to make these discussions in conjunction with my doctor, I am hoping for some advice and counsel from people who have been thinking/living these conditions longer than me.  So thanks in advance for your time to read this.

About me: 41 year old male, 195lbs 6’ tall, medium-large frame, above average muscle mass, 34” waist..   i.e. I don’t have a six pack but I don’t have a gut either.  I could probably lose another 10lbs without cutting into essential fat.   My body fat % is 11.8% measured today actually in a water tank.  90% of my fat is right around the belly.

My story.  For what it is worth, I have Kaiser.  About 8 months ago I went to my Doctor because my sleep patterns were a mess and I just overall felt crappy.  I thought it was possibly related to allergies or low-T but also maybe because my 3 year old kept sneaking in bed at night.   At the time I was 220lbs and the Doctor told me I was obese and probably had sleep apnea.  They ran the sleep Apnea test in conjunction with an allergy panel and  Testosterone Tests.   The results.  Negative for sleep apnea, allergic to grass and weeds etc and Testosterone levels.  Total = 230(250-1100ng/dl); Free=56.9(35-155pg/ml).  After consulting with a staff endocrinologist they told me I was obese and my T levels were normal but likely low due to estrogen conversion, i.e. lose some weight.  So I did.   In the past 6 months I changed my diet to a low fat diet, am riding my bike 50+ miles a week and running 10+miles a week in conjunction with gym work outs 2-3 times a week.  I feel great about my physical accomplishments, but the fatigue, waking at night to urinate, low libido and mental fog hasn’t gone away.  Furthermore, I now seem to have developed an unexplained pain in my joints such that when I run and keep my arms bent my left elbow joint stiffens and hurts to extend as well as a non-specific knee pain.   I wake up at night sometimes with an overall sense of pain that keeps me from sleeping so am having to take daily ibuprofen
So after a bunch of tests and my doctor telling me I had Adrenal Fatigue but my Testosterone was normal and that the Free is all that matters I was left with no recourse but to go for a second opinion.    Luckily this Dr. was at least willing to acknowledge my Total was abnormal and that my Free seemed low.   He looked through his book and noticed my previous Dr. missed a TSH test and a Cortisol test and order those.  The Cortisol came in as 7.6 on a scale of 8-25 so my next step in this process is an ACTH stimulation test.  He also called the endocrinologist again who at first tried to say I was still overweight based on my BMI and when challenged indicated he saw I used 12 pills of Vicodin 6months ago for a back injury and that could be suppressing my Testosterone levels.   As it turned out during this I noticed a bump on my left testicle and was referred to a urologist who through ultrasound identified it as a Varicocele but indicated not to worry about it if I wasn’t planning on having more kids. 

Here is a list of my test results so far: (normal ranges in parentheses)
1/15/13 – Cortisol-AM = 7.6ug/dL (8-25)

1/15/13 – TSH = 1.48uIU/ml (0.10-5.50)

12/31/12 – Lipid Panel
   Cholesterol =150mg/dL (<239)
   Triglyceride=58mg/dL(<199)
   HDL=45mg/dL(>40)
   LDLcalc=93mg/dL(<129)

12/31/12 – Testosterone(LC MS/MS) tested at 8am
   Total – 227ng/dL(250-1100)
   Free – 45.9pg/mL(35-155)

7/6/12 – LH – 2.1mIU/ml(1.0-12.0)

7/6/12 – Prolactin – 4ng/mL (2-18)

7/6/12 – Testosterone(LC MS/MS) tested around 10am
   Total – 154ng/dL(250-1100)
   Free – 45.4pg/mL(35-155)

Honestly the MD’s have made me feel like I am a hypochondriac or depressed.   I guess I am hoping for a different perspective on my situation, what additional tests I should push for and any advice in general based on what is going on here.  I would rather get my hormone levels in balance without medication if possible but am considering HRT and currently evaluating pellets vs. injections(combined with HCG and Anastrozole)

Thanks for your thoughts.

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