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Author Topic: TRT failure - what to do next?  (Read 39433 times)

Sam

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Re: TRT failure - what to do next?
« Reply #15 on: April 15, 2013, 04:18:05 am »
Hey Kwn,

First time reading this post, but the only thing I could suggest is make sure you get your adrenal and thyroid tests.  If you can afford $255 bucks, join canaryclub.org(its free) and use their discount to order the HIS saliva/blood spot panel from ZRT labs.  I did this and between the questionnaire and 7 page response from them on my test results it helped me get a sense of where I was at.   I was actually going down a path thinking my low am-cortisol test from my primary was a bigger deal than it was and their 4 point test showed I had a normal diurnal cortisol cycle which indicated if I did have some adrenal fatigue it wasn't that bad.   This gave me the info I needed to be patient and wait for my Varicocele surgery without thinking I was gonna die some day because my adrenals where crapping out on me.  Kaiser was actually doing me a disservice by giving me 1 piece of data and leaving me in the dark about what it meant in the grand scheme of things.

Btw,  you had you total testosterone listed above, did they measure Free testosterone or SHBG?  What about all of the LH?

From reading your posts above and your BMI and E2 levels do seem to jump out as a big issue.   My advice would be to get your doctors to get a full battery of tests so 1) you have a baseline to look back on as you get older and 2) you have a complete picture on your hormonal health.

Kwn

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Re: TRT failure - what to do next?
« Reply #16 on: April 15, 2013, 03:54:21 pm »
Hey Kwn,

First time reading this post, but the only thing I could suggest is make sure you get your adrenal and thyroid tests.  If you can afford $255 bucks, join canaryclub.org(its free) and use their discount to order the HIS saliva/blood spot panel from ZRT labs.  I did this and between the questionnaire and 7 page response from them on my test results it helped me get a sense of where I was at.   I was actually going down a path thinking my low am-cortisol test from my primary was a bigger deal than it was and their 4 point test showed I had a normal diurnal cortisol cycle which indicated if I did have some adrenal fatigue it wasn't that bad.   This gave me the info I needed to be patient and wait for my Varicocele surgery without thinking I was gonna die some day because my adrenals where crapping out on me.  Kaiser was actually doing me a disservice by giving me 1 piece of data and leaving me in the dark about what it meant in the grand scheme of things.

Btw,  you had you total testosterone listed above, did they measure Free testosterone or SHBG?  What about all of the LH?

From reading your posts above and your BMI and E2 levels do seem to jump out as a big issue.   My advice would be to get your doctors to get a full battery of tests so 1) you have a baseline to look back on as you get older and 2) you have a complete picture on your hormonal health.

The only things that urologist checked were total T, TSH, prolactin, and PSA.  When I discussed it with him, he said - we can order any test out there.  But at the end of the day the treatment is the same - TRT.  So what is the point?

Peak Testosterone Forum

Re: TRT failure - what to do next?
« Reply #16 on: April 15, 2013, 03:54:21 pm »


Sam

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Re: TRT failure - what to do next?
« Reply #17 on: April 15, 2013, 04:06:29 pm »
Seems short sighted to me but ok.   I'm a bit analytical so I like to see the data, maybe its me:-)

PeakT

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Re: TRT failure - what to do next?
« Reply #18 on: April 15, 2013, 04:55:08 pm »


The only things that urologist checked were total T, TSH, prolactin, and PSA.  When I discussed it with him, he said - we can order any test out there.  But at the end of the day the treatment is the same - TRT.  So what is the point?

There's kind of two schools of thought out there on the board:  1) HRT (with E2 managment) will greatly help most men and possibly solve everything and 2) fix your adrenals/thyroid/varicoceles and then you can go with less or possibly no HRT.

Samson is in the latter group and I think that's where he is headed.  He is saying fix everything you can and then see if you still need HRT.

Philosophically, I think 1 and 2 go together.  Get monitored.  Get tested.  And find what is broken and then fix it.  The only debate may be the order that you do things.  I think boosting testosterone will likely help the adrenals and have a link on this:

http://www.peaktestosterone.com/testosterone_adrenal

But Samson and others are concerned about HRT and want to use it as a last resort. 

And the only thing that I would add to the above is that it is VERY important to get your endothelium back in shape.  NO is very tied to mental disorders as I have mentioned.  Too much NO may be related to bipolar disorder and the opposite with depression. 
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

Peak Testosterone Forum

Re: TRT failure - what to do next?
« Reply #18 on: April 15, 2013, 04:55:08 pm »


Sam

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Re: TRT failure - what to do next?
« Reply #19 on: April 15, 2013, 05:18:43 pm »
I agree with what Peak said, and just to clarify I am just looking at it as a significant change in my lifestyle.  Going from basically being a stressed out middle aged father of 2 who stopped taking care of himself focusing on kids to putting more energy in myself to give me the energy I need to be a great father.  If you don't have kids then do it for your own happiness and life satisfaction.  I might normally think hey isn't this what we hear doctors preaching all day long about taking better care of yourself, but I think the obesity epidemic in this country shows its not working.  Rather than seeing people on this board as the unfortunate few, I see it as individuals who have made a decision to make their health and happiness their first priority.  This stuff seems harder for men for some reasons since we are conditioned to just go grin and bear it.

I'm 42 so my efforts are to ensure I do what I can naturally first and prolong HRT if I can.  I am 8 months into this journey and absolutely considering HRT just making sure I do it in a way that is prudent and thoughtful.      I can imagine this is a harder process for some and TRT is actually the right first step for some who need the boost to get back on the wagon.

The most disheartening thing about all of this is learning how dysfunctional our medical system is for the first time in my life when I actually needed good counsel from my doctor.  I do see it as the system however and that the doctors are pawns within it.  It's really up to the patient to ensure they are getting the best treatment.

PeakT

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Re: TRT failure - what to do next?
« Reply #20 on: April 15, 2013, 05:25:06 pm »

I'm 42 so my efforts are to ensure I do what I can naturally first and prolong HRT if I can.  I am 8 months into this journey and absolutely considering HRT just making sure I do it in a way that is prudent and thoughtful.      I can imagine this is a harder process for some and TRT is actually the right first step for some who need the boost to get back on the wagon.


Yes and some men have very strong low testosterone symptoms.  HRT can bring them almost immediate relief in many cases.

I would also add that having testosterone below about 350 ng/dl is quite risky health-wise.  Osteroporosis, diabetes, metabolic syndrome, arteriosclerosis, erectile dysfunction, venous leakage - these are nasty conditions that can really hammer your long term health and low testosterone is a risk factor for all of them.

So for anyone reading this, you have to try to put all the facts together with your (hopefully knowledgeable) doctor and come up with some kind of a plan.
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

Kwn

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Re: TRT failure - what to do next?
« Reply #21 on: April 17, 2013, 06:37:04 pm »
Update:

went to endocrinologist today.  She said we need to order the tests for you:
- T4
- TSH
- testosterone serum
- LH
- SHBG
- estradiol
- complete metabolic panel

when I said I believe that estradiol is the reason for my anxiety attacks/palpitations/panics, she said maybe.  And she is not completely discarding the possibility of using Arimidex as a part of treatment.  She is not doing Testopel, clomid, or HCG.  Only things she is prescribing are gels, patches, and injections.
She also suggested that my occasional sleep apnea might by contributing to low T.  I asked her - I am 40, and my T is supposed to be ~500-600.  It was 120-146.  Do you REALLY believe that sleep apnea put me down 4-folds?  This was a big red flag for me.
Another red flag is that "she will not put people on TRT if they are at 350".  To me it sounds that she is one of the doctors who operates based on ranges, not symptoms.
Another red flag is - she starts people at 200 mg/ 2weeks.  Which to me sounds like a bad way to administer T.  Once or twice a week smaller dose seems to be a way to go.

So I have mixed feelings about continuing with her.  On one hand, she seems to be willing to do comprehensive hormonal analysis (which is what I expected from the first visit).  She is not opposed to use Arimidex, if needed.  Which, again, does  not mean she will not back out of it if it is "in the range".

On the downside - when I said a 40 yo male like me should have T~600, she said - where do you get this number?  I was lost.  If we do not agree on basic things then things are not going well.
Another minus - sleep apnea as a cause of low T.  Wow, no kidding?  Another minus - no HCG.

So what do you guys think?  Should I look for a TRT clinic, which believes that estradoil may be an issue??  And which also is not opposed to HCG?

I was thinking in fact about scheduling a visit with Dr. Crisler.

Any input will be much appreciated.

PeakT

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Re: TRT failure - what to do next?
« Reply #22 on: April 17, 2013, 06:49:06 pm »
Update:

went to endocrinologist today.  She said we need to order the tests for you:
- T4
- TSH
- testosterone serum
- LH
- SHBG
- estradiol
- complete metabolic panel

when I said I believe that estradiol is the reason for my anxiety attacks/palpitations/panics, she said maybe.  And she is not completely discarding the possibility of using Arimidex as a part of treatment.  She is not doing Testopel, clomid, or HCG.  Only things she is prescribing are gels, patches, and injections.
She also suggested that my occasional sleep apnea might by contributing to low T.  I asked her - I am 40, and my T is supposed to be ~500-600.  It was 120-146.  Do you REALLY believe that sleep apnea put me down 4-folds?  This was a big red flag for me.
Another red flag is that "she will not put people on TRT if they are at 350".  To me it sounds that she is one of the doctors who operates based on ranges, not symptoms.
Another red flag is - she starts people at 200 mg/ 2weeks.  Which to me sounds like a bad way to administer T.  Once or twice a week smaller dose seems to be a way to go.

So I have mixed feelings about continuing with her.  On one hand, she seems to be willing to do comprehensive hormonal analysis (which is what I expected from the first visit).  She is not opposed to use Arimidex, if needed.  Which, again, does  not mean she will not back out of it if it is "in the range".

On the downside - when I said a 40 yo male like me should have T~600, she said - where do you get this number?  I was lost.  If we do not agree on basic things then things are not going well.
Another minus - sleep apnea as a cause of low T.  Wow, no kidding?  Another minus - no HCG.

So what do you guys think?  Should I look for a TRT clinic, which believes that estradoil may be an issue??  And which also is not opposed to HCG?

I was thinking in fact about scheduling a visit with Dr. Crisler.

Any input will be much appreciated.

Yes, a couple of those would be red flags to me.  Well, really the big one is every two weeks.  Many guys have written in on the forum with the standard problems with that:  1) elevated estradiol and 2) four days of being hypogonadal.  It may be better than nothing - you'd just have to try it and see.

Also, is money an issue for you?  If it is, you can just go with her for awhile and then switch to another doc with a protocol that you consider more favorable later if you want.  (Many of the HRT clinics are out of pocket.)

One final comment:  you had such a strong reaction, you really need to tell whichever doc you go with about your history.  I'm sure you would do that, but you really want someone with some experience as your case is quite unusual.
« Last Edit: April 17, 2013, 06:51:46 pm by PeakT »
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

Quincy

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Re: TRT failure - what to do next?
« Reply #23 on: April 17, 2013, 09:19:17 pm »
Another red flag is - she starts people at 200 mg/ 2weeks.  Which to me sounds like a bad way to administer T.  Once or twice a week smaller dose seems to be a way to go.

Are you going to be shown how to self inject? If so, just cut your bi-weekly dose in half and do it weekly.

Sleep apnea can have some pretty big effects on T levels from what I've read. I would think it also depends on how bad it is.
56yo, Pre  T level 239
Previous dosage 180mg T.cypionate weekly BW @ 1056 on 7th day of cycle
Previous dosage 100mg T.cypionate weekly BW @   414 on 7th day of cycle

Current dosage  140mg T.cypionate weekly

PeakT

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Re: TRT failure - what to do next?
« Reply #24 on: April 17, 2013, 10:10:50 pm »

Sleep apnea can have some pretty big effects on T levels from what I've read. I would think it also depends on how bad it is.

Yes, about 30-35% on average.  See my site for details on the studies...
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

Kwn

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Re: TRT failure - what to do next?
« Reply #25 on: April 17, 2013, 11:28:52 pm »
Another possible explanation for my horror:

if T is low, metabolism rate is small.  Other hormones are tuned in with slow metabolism.  External T increases metabolism rate, and throws other hormones out of whack.  So this reaction comes from extra thyroid and cortisol as the result of metabolic rate change.

Does it sound plausible?

Prsartist

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Re: TRT failure - what to do next?
« Reply #26 on: April 18, 2013, 12:41:24 am »
Don't dump the DR. So fast!
You have already crossed a major hurdle in getting a DR. To recognize the problem!
Now you may have to educate them on how to treat symptoms, NOT labs!

If she wants to know who told you that??
Tell her a group of people who have lived through this nightmare
And dealt with ignorant Dr's!

Prsartist

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Re: TRT failure - what to do next?
« Reply #27 on: April 18, 2013, 12:44:51 am »
BTW.... It's only a nightmare because if Dr Ignorance!
It's pretty straight forward treatment if they have a clue.....

PeakT

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Re: TRT failure - what to do next?
« Reply #28 on: April 18, 2013, 12:49:02 am »
Another possible explanation for my horror:

External T increases metabolism rate, and throws other hormones out of whack. 

Testosterone supports the adrenals, especially in stress situations:

http://www.peaktestosterone.com/testosterone_adrenal

http://www.peaktestosterone.com/testosterone_cortisolj

And testosterone probably affects Metaboliic Rate a little long term due to muscle gain, loss of fat, etc.  However, this would not a fast-acting effect.  Do you know of any evidence that it really ramps up Metabolic Rate short term?

To me it sounds like you needed to be ramped up slowly and have your estradiol managed due to the neurotransmitter changes.  Just my two cents...
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

Kwn

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Re: TRT failure - what to do next?
« Reply #29 on: April 18, 2013, 01:20:21 am »
Another possible explanation for my horror:

External T increases metabolism rate, and throws other hormones out of whack. 

Testosterone supports the adrenals, especially in stress situations:

http://www.peaktestosterone.com/testosterone_adrenal

http://www.peaktestosterone.com/testosterone_cortisolj

And testosterone probably affects Metaboliic Rate a little long term due to muscle gain, loss of fat, etc.  However, this would not a fast-acting effect.  Do you know of any evidence that it really ramps up Metabolic Rate short term?

To me it sounds like you needed to be ramped up slowly and have your estradiol managed due to the neurotransmitter changes.  Just my two cents...

PeakT, thank you for your input.  What is the exact mechanism of ramping up slowly?  The way endocrinologist sounded today is - we will shoot 200 mg into you and measure your hormonal responses.  This does not sound like ramping up to me at all.

And, no, I do not have evidence of T affecting metabolic rate short term.  It was just a working hypothesis.

Peak Testosterone Forum

Re: TRT failure - what to do next?
« Reply #29 on: April 18, 2013, 01:20:21 am »