Death of My Doctor Leaves Me Confused

I everybody. New to the forums. Need some advice/help. A little about me: I'm a 42-year-old emergency physician who is been on testosterone replacement therapy for about 11 months. I think I may have gotten trapped into the easy way out by taking TRT. When I separated from active-duty Air Force in 2013 and started my civilian job, I was overwhelmed, depressed, and injured with a chronic nagging sciatica. A good friend of mine from the military had stopped practicing emergency medicine and had gone into an online concierge TRT business. Initially, when I found out he was doing this, I had my testosterone checked and it was around 500 total. for a while, I ignored it because I knew that that couldn't be the source of my problems. After about a year and a half, I was up 40 pounds, unhappier than ever with my job, and drinking too much. I decided to get rechecked and my total testosterone levels were in the 320s. Though looking back,I realize that it was my lifestyle that was physically driving my testosterone down, it seemed easier to go ahead and blame everything on my low T. Through my friend, I began TRT , Injecting a total of 100 mg of testosterone cypionate divided twice weekly. At the same time, I cut back on my alcohol intake, started eating clean, and went back to the gym. I dropped 30 pounds and for the first few months I felt like the king of the world. I have always been "high strong" with some occasional mild anxiety. This was completely resolved during the first few months, and I felt like I was breathing for the first time in a long time. Everyone noticed that my mood was improved, especially my wife and kids. My morning erections were so strong sometimes they were really painful. At my first follow-up lab studies, he noted that my testosterone was in the 600s but my estrogen levels had creeped up some to the high 30s. He started me on arimidex , 0.5 mg twice weekly on the day of my injections which we increased to 60mg twice a week. At some point during this process I noted that I wasn't feeling as good as I had the first couple of months. I wish that I had kept a diary because I'm not sure exactly when the symptoms started to creep back. They were still not as intense as prior and I was still maintaining in the gym. We had a follow up set of labs earlier this year and my total testosterone was in the mid to high 800s but my estrogen level had dropped to 13. He advised that I go to a half a milligram of the AI once weekly after allowing the AI to "wash out" for a week to 10 days. At some point during this time, I started having significant anxiety. I was having hot flashes so significant that i would soak through my clothes at work. I describe the anxiety as an internal eye that will not stop running around inside of me checking to see if I'm OK. I even have a hard time focusing on conversations because I'm so lost in my own head when this is happening. I get strange tinglings to my left arm and face, and being a position, I suppose that this is feeding into the anxiety. Unfortunately, while my symptoms were beginning to ramp up, I could not contact my friend. I found out in the middle of all this that he committed suicide.
So now I am floating through this journey on my own. I have been back-and-forth trying to decide if my symptoms were secondary to elevated estrogen or significantly depressed estrogen. I have been tweaking on and off of the AI trying to find a symptomatic sweet spot. I seem to have found it for about a month, but this weekend the symptoms returned. On my own, I had dropped my testosterone dosage back to the original dose and discontinued the AI trying to find the feeling that was there in the beginning. I took a quarter of a pill yesterday as the symptoms were really starting to ramp. I still didn't sleep well last night, but maybe slightly better today than yesterday. In the short-term, I'm going to try taking the anastrozole a quarter of a milligram every third day and continue my testosterone at 50mg twice weekly.

What I would really like to do is , since I'm out here floating alone, is to come off of the testosterone completely and see if I can restart. I have read through 1 million threads on PCT and found Defy's protocol with the HCG, nolva and clomid. I have ordered this meds, but just saw an updated thread today where apparently they are recommending hCG for two weeks followed by Clomid for 28 days and then off. Curious to see if anyone has done this exact protocol and their success with it. I would like to give myself a year of actually living right to see what my Natural testosterone levels really are. I am fearful that the symptoms that have been bothering me will worsen dramatically on the restart and I'm curious for some expert advice. My friend in town is a urologist and Is happy to prescribe me testosterone supplementation, however, he really doesn't know much about dialing things in. We were talking about this, and he told me he doesn't even check estrogen on the guys he is treating. So I would in essence, be experimenting on myself since there are no people doing this in small-town Indiana. Your thoughts?

When you wrote "doctor dead" in the title, I thought it was a figure of speech. I'm very sorry about your friend. I think the issue here comes down to the classic fallacy of treating numbers instead of symptoms. Your estrogen was high "on paper" on your initial protocol, but you felt greater and healthier than ever. Of course, hindsight is 20/20 but I think a truly skilled trt physician wouldn't have prescribed an AI knowing you felt like king of the world with those numbers. Not only that, but you didn't mention whether or not that estradiol reading came from the standard estrogen test or the sensitive. If it was the former, it will read higher than it actually is. Even if it was the sensitive estradiol test, high 30s isn't that bad for estrogen. Generally speaking, men with estrogen in that range have better long-term health outcomes than men below 20. I'm not a medical professional, but that's my two cents. You could pursue a restart protocol, and I'd recommend starting with Defy Medical, since they're one of the best clinics in the nation for both, conventional testosterone replacement as well as restarting. In my opinion, you'd be better off staying on testosterone, eschewing the AI entirely. You felt great and healthy when you were just on 100 mg of testosterone, and there's no good reason to think that once you kick the AI and your hormones re-stabilize that you won't start to feel good again. Of course, no matter what you decide to do at the moment, you need to get with an experienced trt doctor.

Thanks for responding. Yeah- it's been tough. Because the anxiety symptoms are so intolerable I become almost paralyzed when they hit. For days and days. I have read that the aromitization starts later in the course, so I'm screwed up. Not having someone on call to reach out to doesn't help. Does defy do telemedicine? I'm nowhere near a clinic. Though I do have my own script pad and access to basically whatever I want. Just need the balls to reset I think. pun intended. I never had a huge sack, but this shit is ridiculous.

i can guarantee your estradiol dropped too low.. I know symptoms you are talking about.. classic low e2 anxiety, hot flashes. do yourself a favor and stop taking anastrozole.. why would you stop trt? i guess you started trt for a reason and you did experience how good you feel when on proper trt.

Supermansings said:

Thanks for responding. Yeah- it's been tough. Because the anxiety symptoms are so intolerable I become almost paralyzed when they hit. For days and days. I have read that the aromitization starts later in the course, so I'm screwed up. Not having someone on call to reach out to doesn't help. Does defy do telemedicine? I'm nowhere near a clinic. Though I do have my own script pad and access to basically whatever I want. Just need the balls to reset I think. pun intended. I never had a huge sack, but this shit is ridiculous.

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Yes, they specialize in telemedicine. As someone else noted, your anxiety is typical of crashed estrogen. It's true that recovering from an estrogen crash takes some time, but you will probably feel a little better every day. Just ditch the AI.

Yeah. That's what I thought as well. But then my symptoms came back this past weekend after being off for a week or so. To 1/4 pill and some better today. So who the hell knows. Can't do a blood draw every time I have symptoms, and I don't know when to draw anyway after first starting or stopping. Don't know how long E2 takes to move.

being off for a week after you e2 crashes isn't enough to recover usually.. hormones work slowly

Welcome, Brother...USAF 91-04, myself. Being that you have access to the meds what I would do is do a consult only with Dr Saya @ Defy, he offers this service.
But I would too continue with the Cyp and just come off the AI entirely and pull labs @ 4-6 weeks and see where you are.

Your situation is unusual and unfortunate. Thankfully, you can sort get this sorted out. The advice you received from members is solid. Best of luck to you.

Thanks man- good advice. I panicked when my symptoms hit again this weekend. Not sure why the AI would make me feel better, but it seems to be. I suppose it is possible that I am completely losing my mind, or have an entirely different problem, but my lay set of labs were dialed in. At least on paper. What is the best way to get a phone consult with the doc?

Contact Defy Medical, www.defymedical.com, and they can explain the process.

Supermansings said:

. My friend in town is a urologist and Is happy to prescribe me testosterone supplementation, however, he really doesn't know much about dialing things in. We were talking about this, and he told me he doesn't even check estrogen on the guys he is treating. So I would in essence, be experimenting on myself since there are no people doing this in small-town Indiana. Your thoughts?

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You have a lot going in here, but I'm going to narrow the response to the above for now. Why not work with a doc experienced in HPTA restarts directly? As a doc, and ret mil, you know what's your expertise and lane, and what is not, and going outside of that can end badly. Would you throw a opthamologist into the ER?

Work with someone who has extensive experience and expertise in that area, and you'll get best responses. It would also help ease the anxiety a bit.

Two that end, don't underestimate the psychological aspects here. As a physician, you may be overly focused on biological causes yet ignoring the psychological, which may or may not be an aspect of your hormone levels.

Depression, anxiety, PTSD (and working in an ER regardless of prior mil experience could sure as hell give a person PTSD), OCD, and so forth, are serious and powerful issues not to be ignored and in my view, should be addressed along with TRT/HRT but low T etc, is not a magic bullet for those issues.

Without knowing more, can only speak in general terms here, but I have a good nose/instinct for spotting such things, and no matter the level of sci/med training one has (what is it they say about doctors making the worst patients?) instinct plays an essential aspect of medicine as you well know.

One of my personal interests/focus is working with mil and ret mil.

You have come to the right place to get squared away, that much I can say with full confidence.

Your story is very similar to mine , my T levels after doing a blood test in an ant-aging clinic were 500 was out on TESTO CYPIONATE for 3 years continously . I have stopped in order to do a restart to my system and have followed the PCT road of HCG 14 days and clomid 28 days . To cut the story short , it has not worked as of yet and have gone through some very down times . I am now on Clomid 12.5 mg EOD and have achieved around 550 T levels , but i hate the clomid side effects and have recently stopped to give myself a break .
I think you should consult with a top centre like DEFY , as i have seen thousands of referrals and recommendations to them and as a guy who is similar to you in case , i would really advise you in contacting a top professional and don't waste your time and wellbeing with other different dinasour doctors that are not up to date on these methods