5 Years Hypogonadal, nothing works. Looking for any insight

Cliff's notes:

– 35 Y/O male, nonsmoker, non-drinker, no opioids, non-diabetic, non-obese. 6'0”, 180 lbs. No previous health issues.
– Hypogonadal beginning in 2019 due to complications from vasectomy, confirmed by ultrasound & pelvic MRI. Initial symptoms all the usual – sudden sexual deficiency, mood, poor sleep, etc.
– 2021 onward, secondary/more serious symptoms began, e.g. bone pain, bright blue varicose veins in feet & spreading to legs, joint deterioration, plantar edema.
– Been around the doctor denial/TRT merry-go-round with 4 protocols to date: Test-C IM 1x/wk [improved bone pain; fucked my heart; no sexual improvement] HCG mono EOD SubQ [no improvement of anything, did seem to slow decline]; 2% compounded cream ED, 1, then 2, 3, 4 ml/day [huge improvement first 4 days –then back to baseline, no improvement w/ titration]; Test-C SubQE3.5D, then EOD + 250 iu HCG [no improvement]

Nothing has worked. First diagnostic lab report & more-detailed synopsis below:

9/22/21
Testosterone, total - 455 ng/dL
Free testosterone - 23.07 nmol (range 35-92.6)
Estradiol 12.6 pg
SHBG 48.48 nmol
FSH 5.18
Prolactin 5.6
Vit. D 31.1 ng/ML
Iron 49
Ferritin 66
T3 Free 2.97
TSH with Reflex 3.396
Reverse T3 20
Cortisol - 15.8

Went back and forth with the usual MD dipshits, they said I was fine/mentally ill/refused treatment/offered clomid/etc. Sought out local TRT mill – insurance paid for injections based on workup. Results below:
12/21
Serum T, 608 ng/DL
Free T, 8.8 ng/dL (range 9.6-26.5)
SHBG 58.7
LH 6.3
FSH 4.6
TSH 3.14

On Test-C IM 1x/wk from January-July2022, 160 → 130 → 110 → 90 mg, titrating down every 6 weeks. Responded to an insane degree as far as serum & free T, still felt like shit. Absolutely fucked my heart – BP 140/100, PR 110+,that kind of thing. Improved my bone pain, didn't resolve sexual symptoms Asked for some kind of explanation or tailoring, they were stumped. Cycled off w/ 8 weeks of HCG. Sample lab work below, measured@ trough:
Serum T >1500 ng/DL
Free T 22.9 pg/mL (range 8.7-25.1)
LH .3
FSH .3
Prolactin 7.8
Estradiol 43.9
T3 free 3.0
SHBG 59.7
Vit. D3 74 pg/mL
Folate 4.0 ng/ML

June 2023, went to vasectomy reversalist for consult as a Hail Mary – he said I'm crazy but offered HCG mono as an olive branch. Guinea-pigged myself to 250iuSubQ ED, June 2023-October 2023. Didn't do shit. Sample bloodwork 10/23:
Serum T 953 ng/DL
Free T 121 pg/mL
% Free T 1.3
Estradiol 28.6
Estrone 38.1
TSH 2.81


October 2023, found an NP who was willing to play ball, explained the non-response on injections. He offered 2% compounded cream. First four days I felt GREAT – i.e. my bones didn't pop, veins didn't hurt, dick worked, felt attracted to women, yadda yadda yadda.

Day 5 – gone. No effect whatsoever. Titrated UP to 1.5, 2, 2.5, 3ml. Zero effect whatsoever. On follow-up NP refused a higher-concentration cream or other modality, said, “Let's try injections.” 100mg Test-C SubQ 1x/wk, self-administered; I disobeyed given previous response to that protocol, did 50mg SubQ E3.5D.

First 3 weeks, it got rid of my plantar edema. Heart didn't get all fucked up. No other improvements. Beginning of week 4, feet were back to being swollen and purple whenever they're below waist level.

On follow-up, he jacked dose to 150mg,changed subQ → IM, threw an AI at me. Currently NOT taking AI, b/c my bone pain only fades when E2 is 40+, and no symptoms of excess estrogen. Ignored the 1x/week/IM, trying EOD with the dose lowered to~135mg split into three. No improvement thus far.

Current supplementation:
20,000 iu D3 (only that dosage meaningfully decreases bone pain)
K2
Flameout
Zinc, Magnesium (the Biotest one)

It's been five years. Nothing works. Beyond just feeling like shit and getting no enjoyment from life, since 2022 I've had the type of symptoms that might actually kill me, e.g. bulging veins, chest pain, painful circulation in legs, all suggestive of venous insufficiency. I'm worried I'll throw off a clot some time soon.

Defy's up next week, although I don't have much hope for them coming up with a magical protocol that will punch through my seeming treatment resistance. Vets, old heads, medical savants – what would you do if you were in my shoes?

winky12345 said:

Ferritin 66

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I would feel like crap at these ferritin levels! In my experience I don't feel well with a ferritin of <80. <80 for ferritin, my feet swell up, IBS, heart palpitations, high blood pressure, sleepiness, fatigue and generally feeling like I'm dying.

Systemlord said:

I would feel like crap at these ferritin levels! In my experience I don't feel well with a ferritin of <80. <80 for ferritin, my feet swell up, IBS, heart palpitations, high blood pressure, sleepiness, fatigue and generally feeling like I'm dying.

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Do you still take an iron supplement since switching to an all meat diet? 6 months ago my ferritin was 88. Increased my injections from 100 mg E5D to 70 mg E3D. Last month my urologist ordered labs. Ferritin was 22! Higher T = lower ferritin? My total was 1072 and free was 263(Quest). Don't eat meat but do consume shellfish, as well as salmon. Wary of supplementing iron though I bought a bottle of NOW ferrous bisglycinate for my wife because she eats vegan. Her ferritin is low.

tropicaldaze1950 said:

Do you still take an iron supplement since switching to an all meat diet?

Click to expand...

Yes, 152 mg of elemental iron.

tropicaldaze1950 said:

Higher T = lower ferritin?

Click to expand...

Yes, a dosage increase would require more iron supplementation.

Systemlord said:

Yes, 152 mg of elemental iron.

Yes, a dosage increase would require more iron supplementation.

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Thank you.

I'm puzzled about the form of your hypogonadism. Testicular damage from surgery would cause primary hypogonadism. This is somewhat reflected in the maintenance of LH and FSH under the earlier injection protocol. However, with hCG monotherapy you appear to have robust testosterone production, which implies decent testicular function.

In the provided measurements estradiol is on the low side relative to testosterone. It's notable that this is true even with hCG monotherapy, which is notorious for increasing aromatization. If it were me I'd want to see if higher levels of estradiol would help, even if it required supplementation. It also wouldn't hurt to measure progesterone to ensure it's reasonable.

I agree with the above. Several things jump out in your labs. In addition to the points already made, your SHBG is fairly high, so your free estradiol is likely low. GIven your low aromatization, I would also want to see DHT tested to try and get a more complete picture. Also, your TSH is high enough to indicate possible hypothyroidism, but your free T3 is also normal. You should have a full thyroid workup.

Cataceous said:

I'm puzzled about the form of your hypogonadism.

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That makes two of us. Unfortunately despite testicles shrinking 30%, they say, "Within range, doesn't matter, testicular damage from vasectomy is impossible." My guess would be primary, given the atrophy and that I didn't feel any type of resolution w/ HCG mono, but it's just that.

Cataceous said:

In the provided measurements estradiol is on the low side relative to testosterone. It's notable that this is true even with hCG monotherapy, which is notorious for increasing aromatization. If it were me I'd want to see if higher levels of estradiol would help, even if it required supplementation. It also wouldn't hurt to measure progesterone to ensure it's reasonable.

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Is 40+ estradiol low? In my first go-round with Test-C it got as high as 60; nothing improved except the bone pain, but I didn't get gynecomastia et al. either. FWIW eating foods with phytoestrogens, e.g. broccoli, helps a bit.

testiculus said:

possible hypothyroidism,

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Sorry, idk shit about the thyroid. Could you explain for a dumb guy how hypothyroidism would complicate the presentation of hypogonadism/response to HRT?

Your problems do not seem related to T deficiency, since you have tried rather high doses TRT and no symptomatic improvement. It is time to accept that TRT is not the answer to every problem.

The current medicine does not understand well the origin of venous insufficiency - which in my case is inflammation driven by the immune system. I myself have varicose veins that appeared out of the blue a few years ago and have found out that not eating any sugar, not even "natural" fruits, honey, or milk, decreases my symptoms (itching or aching leg shins, occasional ankle swelling) 99%. Whenever I eat fruit, leg shins start itching so sugar is a sure trigger for me and I try to avoid it.

Whenever I give in to my sweet tooth and eat sugar, I take Milk Thistle Extract or Quercetin - these suppress the immune system reaction and correspondingly the varicose vein inflammation.

A third thing I would try for venous insufficiency is Diosmin or Pycnogenol. These decrease inflammation and tighten the veins so they are less leaky.

sammmy said:

Your problems do not seem related to T deficiency.

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lol. That's about the most unscientific assertion I've ever heard. It walks like a duck, quacks like a duck, and atrophied the eggs where other little baby ducks are made. It's more likely that I'm dealing with an idiosyncratic version b/c of complications from whatever the vasectomy broke, or there's a compounding condition that hasn't yet been uncovered.

I'll add your recommendations to the list for venous deficiency, though. Thank you.

The problem is that it "doesn't walk like a duck". Not every sexual problem is related to low T and you had trough Testosterone >1500ng/dL and some high normal values on TRT, which didn't resolve any of your problems.

You could try low normal doses of TRT like 30mg T, twice per week (60mg total/week) but I wouldn't hold my breath.

sammmy said:

The problem is that it "doesn't walk like a duck". Not every sexual problem is related to low T and you had trough Testosterone >1500ng/dL and some high normal values on TRT, which didn't resolve any of your problems.

You could try low normal doses of TRT like 30mg T, twice per week (60mg total/week) but I wouldn't hold my breath.

Click to expand...

That's interesting. What I'd ask in response is, free T, not serum, is where the rubber meets the road, and mine has never risen to the top of the scale on TRT, in conjunction with consistently high SHBG. Is it possible SHBG prevents TRT from being effective despite high serum levels?

sammmy said:

didn't resolve any of your problems.

Click to expand...

I'm sorry, that's not accurate. Both Test-C & compounded cream resolved my bone pain, but only once E2 went past 40. It also makes my heart "feel" better -- i.e. my chest doesn't feel filled with old motor oil.

winky12345 said:

...
Is 40+ estradiol low? In my first go-round with Test-C it got as high as 60; nothing improved except the bone pain, but I didn't get gynecomastia et al. either. ...

Click to expand...

Estradiol in the 40s pg/mL is still on the lower end of normal relative to total testosterone > 1,500 ng/dL. I consider a normal estradiol/testosterone ratio to be about 0.3-0.6.
4.4 ng/dL / 1,500 ng/dL = 0.29%, and your value is lower.

TRT resolving your bone pain does NOT mean the origin of pain is lack of hormones. Testosterone can be immunosuppressive and reduces inflammation. Excess Testosterone will simply override the underlying problem, doesn't mean the problem is lack of testosterone.

Your reasoning resembles "taking ibuprofen resolved my headache, therefore I am deficient in ibuprofen".

winky12345 said:

Cliff's notes:

– 35 Y/O male, nonsmoker, non-drinker, no opioids, non-diabetic, non-obese. 6'0”, 180 lbs. No previous health issues.
– Hypogonadal beginning in 2019 due to complications from vasectomy, confirmed by ultrasound & pelvic MRI. Initial symptoms all the usual – sudden sexual deficiency, mood, poor sleep, etc.
– 2021 onward, secondary/more serious symptoms began, e.g. bone pain, bright blue varicose veins in feet & spreading to legs, joint deterioration, plantar edema.
– Been around the doctor denial/TRT merry-go-round with 4 protocols to date: Test-C IM 1x/wk [improved bone pain; fucked my heart; no sexual improvement] HCG mono EOD SubQ [no improvement of anything, did seem to slow decline]; 2% compounded cream ED, 1, then 2, 3, 4 ml/day [huge improvement first 4 days –then back to baseline, no improvement w/ titration]; Test-C SubQE3.5D, then EOD + 250 iu HCG [no improvement]

Nothing has worked. First diagnostic lab report & more-detailed synopsis below:

9/22/21
Testosterone, total - 455 ng/dL
Free testosterone - 23.07 nmol (range 35-92.6)
Estradiol 12.6 pg
SHBG 48.48 nmol
FSH 5.18
Prolactin 5.6
Vit. D 31.1 ng/ML
Iron 49
Ferritin 66
T3 Free 2.97
TSH with Reflex 3.396
Reverse T3 20
Cortisol - 15.8

Went back and forth with the usual MD dipshits, they said I was fine/mentally ill/refused treatment/offered clomid/etc. Sought out local TRT mill – insurance paid for injections based on workup. Results below:
12/21
Serum T, 608 ng/DL
Free T, 8.8 ng/dL (range 9.6-26.5)
SHBG 58.7
LH 6.3
FSH 4.6
TSH 3.14

On Test-C IM 1x/wk from January-July2022, 160 → 130 → 110 → 90 mg, titrating down every 6 weeks. Responded to an insane degree as far as serum & free T, still felt like shit. Absolutely fucked my heart – BP 140/100, PR 110+,that kind of thing. Improved my bone pain, didn't resolve sexual symptoms Asked for some kind of explanation or tailoring, they were stumped. Cycled off w/ 8 weeks of HCG. Sample lab work below, measured@ trough:
Serum T >1500 ng/DL
Free T 22.9 pg/mL (range 8.7-25.1)
LH .3
FSH .3
Prolactin 7.8
Estradiol 43.9
T3 free 3.0
SHBG 59.7
Vit. D3 74 pg/mL
Folate 4.0 ng/ML

June 2023, went to vasectomy reversalist for consult as a Hail Mary – he said I'm crazy but offered HCG mono as an olive branch. Guinea-pigged myself to 250iuSubQ ED, June 2023-October 2023. Didn't do shit. Sample bloodwork 10/23:
Serum T 953 ng/DL
Free T 121 pg/mL
% Free T 1.3
Estradiol 28.6
Estrone 38.1
TSH 2.81


October 2023, found an NP who was willing to play ball, explained the non-response on injections. He offered 2% compounded cream. First four days I felt GREAT – i.e. my bones didn't pop, veins didn't hurt, dick worked, felt attracted to women, yadda yadda yadda.

Day 5 – gone. No effect whatsoever. Titrated UP to 1.5, 2, 2.5, 3ml. Zero effect whatsoever. On follow-up NP refused a higher-concentration cream or other modality, said, “Let's try injections.” 100mg Test-C SubQ 1x/wk, self-administered; I disobeyed given previous response to that protocol, did 50mg SubQ E3.5D.

First 3 weeks, it got rid of my plantar edema. Heart didn't get all fucked up. No other improvements. Beginning of week 4, feet were back to being swollen and purple whenever they're below waist level.

On follow-up, he jacked dose to 150mg,changed subQ → IM, threw an AI at me. Currently NOT taking AI, b/c my bone pain only fades when E2 is 40+, and no symptoms of excess estrogen. Ignored the 1x/week/IM, trying EOD with the dose lowered to~135mg split into three. No improvement thus far.

Current supplementation:
20,000 iu D3 (only that dosage meaningfully decreases bone pain)
K2
Flameout
Zinc, Magnesium (the Biotest one)

It's been five years. Nothing works. Beyond just feeling like shit and getting no enjoyment from life, since 2022 I've had the type of symptoms that might actually kill me, e.g. bulging veins, chest pain, painful circulation in legs, all suggestive of venous insufficiency. I'm worried I'll throw off a clot some time soon.

Defy's up next week, although I don't have much hope for them coming up with a magical protocol that will punch through my seeming treatment resistance. Vets, old heads, medical savants – what would you do if you were in my shoes?

Click to expand...

If

winky12345 said:

Cliff's notes:

– 35 Y/O male, nonsmoker, non-drinker, no opioids, non-diabetic, non-obese. 6'0”, 180 lbs. No previous health issues.
– Hypogonadal beginning in 2019 due to complications from vasectomy, confirmed by ultrasound & pelvic MRI. Initial symptoms all the usual – sudden sexual deficiency, mood, poor sleep, etc.
– 2021 onward, secondary/more serious symptoms began, e.g. bone pain, bright blue varicose veins in feet & spreading to legs, joint deterioration, plantar edema.
– Been around the doctor denial/TRT merry-go-round with 4 protocols to date: Test-C IM 1x/wk [improved bone pain; fucked my heart; no sexual improvement] HCG mono EOD SubQ [no improvement of anything, did seem to slow decline]; 2% compounded cream ED, 1, then 2, 3, 4 ml/day [huge improvement first 4 days –then back to baseline, no improvement w/ titration]; Test-C SubQE3.5D, then EOD + 250 iu HCG [no improvement]

Nothing has worked. First diagnostic lab report & more-detailed synopsis below:

9/22/21
Testosterone, total - 455 ng/dL
Free testosterone - 23.07 nmol (range 35-92.6)
Estradiol 12.6 pg
SHBG 48.48 nmol
FSH 5.18
Prolactin 5.6
Vit. D 31.1 ng/ML
Iron 49
Ferritin 66
T3 Free 2.97
TSH with Reflex 3.396
Reverse T3 20
Cortisol - 15.8

Went back and forth with the usual MD dipshits, they said I was fine/mentally ill/refused treatment/offered clomid/etc. Sought out local TRT mill – insurance paid for injections based on workup. Results below:
12/21
Serum T, 608 ng/DL
Free T, 8.8 ng/dL (range 9.6-26.5)
SHBG 58.7
LH 6.3
FSH 4.6
TSH 3.14

On Test-C IM 1x/wk from January-July2022, 160 → 130 → 110 → 90 mg, titrating down every 6 weeks. Responded to an insane degree as far as serum & free T, still felt like shit. Absolutely fucked my heart – BP 140/100, PR 110+,that kind of thing. Improved my bone pain, didn't resolve sexual symptoms Asked for some kind of explanation or tailoring, they were stumped. Cycled off w/ 8 weeks of HCG. Sample lab work below, measured@ trough:
Serum T >1500 ng/DL
Free T 22.9 pg/mL (range 8.7-25.1)
LH .3
FSH .3
Prolactin 7.8
Estradiol 43.9
T3 free 3.0
SHBG 59.7
Vit. D3 74 pg/mL
Folate 4.0 ng/ML

June 2023, went to vasectomy reversalist for consult as a Hail Mary – he said I'm crazy but offered HCG mono as an olive branch. Guinea-pigged myself to 250iuSubQ ED, June 2023-October 2023. Didn't do shit. Sample bloodwork 10/23:
Serum T 953 ng/DL
Free T 121 pg/mL
% Free T 1.3
Estradiol 28.6
Estrone 38.1
TSH 2.81


October 2023, found an NP who was willing to play ball, explained the non-response on injections. He offered 2% compounded cream. First four days I felt GREAT – i.e. my bones didn't pop, veins didn't hurt, dick worked, felt attracted to women, yadda yadda yadda.

Day 5 – gone. No effect whatsoever. Titrated UP to 1.5, 2, 2.5, 3ml. Zero effect whatsoever. On follow-up NP refused a higher-concentration cream or other modality, said, “Let's try injections.” 100mg Test-C SubQ 1x/wk, self-administered; I disobeyed given previous response to that protocol, did 50mg SubQ E3.5D.

First 3 weeks, it got rid of my plantar edema. Heart didn't get all fucked up. No other improvements. Beginning of week 4, feet were back to being swollen and purple whenever they're below waist level.

On follow-up, he jacked dose to 150mg,changed subQ → IM, threw an AI at me. Currently NOT taking AI, b/c my bone pain only fades when E2 is 40+, and no symptoms of excess estrogen. Ignored the 1x/week/IM, trying EOD with the dose lowered to~135mg split into three. No improvement thus far.

Current supplementation:
20,000 iu D3 (only that dosage meaningfully decreases bone pain)
K2
Flameout
Zinc, Magnesium (the Biotest one)

It's been five years. Nothing works. Beyond just feeling like shit and getting no enjoyment from life, since 2022 I've had the type of symptoms that might actually kill me, e.g. bulging veins, chest pain, painful circulation in legs, all suggestive of venous insufficiency. I'm worried I'll throw off a clot some time soon.

Defy's up next week, although I don't have much hope for them coming up with a magical protocol that will punch through my seeming treatment resistance. Vets, old heads, medical savants – what would you do if you were in my shoes.

Click to expand...

winky12345 said:

Cliff's notes:

– 35 Y/O male, nonsmoker, non-drinker, no opioids, non-diabetic, non-obese. 6'0”, 180 lbs. No previous health issues.
– Hypogonadal beginning in 2019 due to complications from vasectomy, confirmed by ultrasound & pelvic MRI. Initial symptoms all the usual – sudden sexual deficiency, mood, poor sleep, etc.
– 2021 onward, secondary/more serious symptoms began, e.g. bone pain, bright blue varicose veins in feet & spreading to legs, joint deterioration, plantar edema.
– Been around the doctor denial/TRT merry-go-round with 4 protocols to date: Test-C IM 1x/wk [improved bone pain; fucked my heart; no sexual improvement] HCG mono EOD SubQ [no improvement of anything, did seem to slow decline]; 2% compounded cream ED, 1, then 2, 3, 4 ml/day [huge improvement first 4 days –then back to baseline, no improvement w/ titration]; Test-C SubQE3.5D, then EOD + 250 iu HCG [no improvement]

Nothing has worked. First diagnostic lab report & more-detailed synopsis below:

9/22/21
Testosterone, total - 455 ng/dL
Free testosterone - 23.07 nmol (range 35-92.6)
Estradiol 12.6 pg
SHBG 48.48 nmol
FSH 5.18
Prolactin 5.6
Vit. D 31.1 ng/ML
Iron 49
Ferritin 66
T3 Free 2.97
TSH with Reflex 3.396
Reverse T3 20
Cortisol - 15.8

Went back and forth with the usual MD dipshits, they said I was fine/mentally ill/refused treatment/offered clomid/etc. Sought out local TRT mill – insurance paid for injections based on workup. Results below:
12/21
Serum T, 608 ng/DL
Free T, 8.8 ng/dL (range 9.6-26.5)
SHBG 58.7
LH 6.3
FSH 4.6
TSH 3.14

On Test-C IM 1x/wk from January-July2022, 160 → 130 → 110 → 90 mg, titrating down every 6 weeks. Responded to an insane degree as far as serum & free T, still felt like shit. Absolutely fucked my heart – BP 140/100, PR 110+,that kind of thing. Improved my bone pain, didn't resolve sexual symptoms Asked for some kind of explanation or tailoring, they were stumped. Cycled off w/ 8 weeks of HCG. Sample lab work below, measured@ trough:
Serum T >1500 ng/DL
Free T 22.9 pg/mL (range 8.7-25.1)
LH .3
FSH .3
Prolactin 7.8
Estradiol 43.9
T3 free 3.0
SHBG 59.7
Vit. D3 74 pg/mL
Folate 4.0 ng/ML

June 2023, went to vasectomy reversalist for consult as a Hail Mary – he said I'm crazy but offered HCG mono as an olive branch. Guinea-pigged myself to 250iuSubQ ED, June 2023-October 2023. Didn't do shit. Sample bloodwork 10/23:
Serum T 953 ng/DL
Free T 121 pg/mL
% Free T 1.3
Estradiol 28.6
Estrone 38.1
TSH 2.81


October 2023, found an NP who was willing to play ball, explained the non-response on injections. He offered 2% compounded cream. First four days I felt GREAT – i.e. my bones didn't pop, veins didn't hurt, dick worked, felt attracted to women, yadda yadda yadda.

Day 5 – gone. No effect whatsoever. Titrated UP to 1.5, 2, 2.5, 3ml. Zero effect whatsoever. On follow-up NP refused a higher-concentration cream or other modality, said, “Let's try injections.” 100mg Test-C SubQ 1x/wk, self-administered; I disobeyed given previous response to that protocol, did 50mg SubQ E3.5D.

First 3 weeks, it got rid of my plantar edema. Heart didn't get all fucked up. No other improvements. Beginning of week 4, feet were back to being swollen and purple whenever they're below waist level.

On follow-up, he jacked dose to 150mg,changed subQ → IM, threw an AI at me. Currently NOT taking AI, b/c my bone pain only fades when E2 is 40+, and no symptoms of excess estrogen. Ignored the 1x/week/IM, trying EOD with the dose lowered to~135mg split into three. No improvement thus far.

Current supplementation:
20,000 iu D3 (only that dosage meaningfully decreases bone pain)
K2
Flameout
Zinc, Magnesium (the Biotest one)

It's been five years. Nothing works. Beyond just feeling like shit and getting no enjoyment from life, since 2022 I've had the type of symptoms that might actually kill me, e.g. bulging veins, chest pain, painful circulation in legs, all suggestive of venous insufficiency. I'm worried I'll throw off a clot some time soon.

Defy's up next week, although I don't have much hope for them coming up with a magical protocol that will punch through my seeming treatment resistance. Vets, old heads, medical savants – what would you do if you were in my shoes?

Click to expand...

Get away from all the Doctors. They and the US medical system is not about you feeling better or healthy. It’s about separating you from your money.

Buy your own online by mail (napsgear.org not .com)

Crank your test levels up to minimum 1,200 mg/dl minimum. Give it a couple months or so….

Those test level are ins company bs btw to get you just over a fabricated level then say we aren’t paying anymore you are in range.

The sooner you realize you are being scammed by US Doctors and Insurance companies the sooner you recover your life.

winky12345 said:

Cliff's notes:

– 35 Y/O male, nonsmoker, non-drinker, no opioids, non-diabetic, non-obese. 6'0”, 180 lbs. No previous health issues.
– Hypogonadal beginning in 2019 due to complications from vasectomy, confirmed by ultrasound & pelvic MRI. Initial symptoms all the usual – sudden sexual deficiency, mood, poor sleep, etc.
– 2021 onward, secondary/more serious symptoms began, e.g. bone pain, bright blue varicose veins in feet & spreading to legs, joint deterioration, plantar edema.
– Been around the doctor denial/TRT merry-go-round with 4 protocols to date: Test-C IM 1x/wk [improved bone pain; fucked my heart; no sexual improvement] HCG mono EOD SubQ [no improvement of anything, did seem to slow decline]; 2% compounded cream ED, 1, then 2, 3, 4 ml/day [huge improvement first 4 days –then back to baseline, no improvement w/ titration]; Test-C SubQE3.5D, then EOD + 250 iu HCG [no improvement]

Nothing has worked. First diagnostic lab report & more-detailed synopsis below:

9/22/21
Testosterone, total - 455 ng/dL
Free testosterone - 23.07 nmol (range 35-92.6)
Estradiol 12.6 pg
SHBG 48.48 nmol
FSH 5.18
Prolactin 5.6
Vit. D 31.1 ng/ML
Iron 49
Ferritin 66
T3 Free 2.97
TSH with Reflex 3.396
Reverse T3 20
Cortisol - 15.8

Went back and forth with the usual MD dipshits, they said I was fine/mentally ill/refused treatment/offered clomid/etc. Sought out local TRT mill – insurance paid for injections based on workup. Results below:
12/21
Serum T, 608 ng/DL
Free T, 8.8 ng/dL (range 9.6-26.5)
SHBG 58.7
LH 6.3
FSH 4.6
TSH 3.14

On Test-C IM 1x/wk from January-July2022, 160 → 130 → 110 → 90 mg, titrating down every 6 weeks. Responded to an insane degree as far as serum & free T, still felt like shit. Absolutely fucked my heart – BP 140/100, PR 110+,that kind of thing. Improved my bone pain, didn't resolve sexual symptoms Asked for some kind of explanation or tailoring, they were stumped. Cycled off w/ 8 weeks of HCG. Sample lab work below, measured@ trough:
Serum T >1500 ng/DL
Free T 22.9 pg/mL (range 8.7-25.1)
LH .3
FSH .3
Prolactin 7.8
Estradiol 43.9
T3 free 3.0
SHBG 59.7
Vit. D3 74 pg/mL
Folate 4.0 ng/ML

June 2023, went to vasectomy reversalist for consult as a Hail Mary – he said I'm crazy but offered HCG mono as an olive branch. Guinea-pigged myself to 250iuSubQ ED, June 2023-October 2023. Didn't do shit. Sample bloodwork 10/23:
Serum T 953 ng/DL
Free T 121 pg/mL
% Free T 1.3
Estradiol 28.6
Estrone 38.1
TSH 2.81


October 2023, found an NP who was willing to play ball, explained the non-response on injections. He offered 2% compounded cream. First four days I felt GREAT – i.e. my bones didn't pop, veins didn't hurt, dick worked, felt attracted to women, yadda yadda yadda.

Day 5 – gone. No effect whatsoever. Titrated UP to 1.5, 2, 2.5, 3ml. Zero effect whatsoever. On follow-up NP refused a higher-concentration cream or other modality, said, “Let's try injections.” 100mg Test-C SubQ 1x/wk, self-administered; I disobeyed given previous response to that protocol, did 50mg SubQ E3.5D.

First 3 weeks, it got rid of my plantar edema. Heart didn't get all fucked up. No other improvements. Beginning of week 4, feet were back to being swollen and purple whenever they're below waist level.

On follow-up, he jacked dose to 150mg,changed subQ → IM, threw an AI at me. Currently NOT taking AI, b/c my bone pain only fades when E2 is 40+, and no symptoms of excess estrogen. Ignored the 1x/week/IM, trying EOD with the dose lowered to~135mg split into three. No improvement thus far.

Current supplementation:
20,000 iu D3 (only that dosage meaningfully decreases bone pain)
K2
Flameout
Zinc, Magnesium (the Biotest one)

It's been five years. Nothing works. Beyond just feeling like shit and getting no enjoyment from life, since 2022 I've had the type of symptoms that might actually kill me, e.g. bulging veins, chest pain, painful circulation in legs, all suggestive of venous insufficiency. I'm worried I'll throw off a clot some time soon.

Defy's up next week, although I don't have much hope for them coming up with a magical protocol that will punch through my seeming treatment resistance. Vets, old heads, medical savants – what would you do if you were in my shoes?

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Go see a cardiologist. Heart disease can negate the beneficial effects of testosterone. In your posts it sounds like you don't feel well regardless of treatment and test results numbers. The human body does strange things when your heart does not get enough oxygen.