Three Docs One Patient

TreeTopFlyer · Jan 3, 2018

Gentlemen:

200 mg Test Cypionate compounded with .5mg Anastrozole- Weekly
50 Insulin Units = 500IU HCG compounded with 100 mg Theanine - Twice weekly
70 mg Vyvance - Daily
10 mg Adderall - Daily - Sometimes 20mg
50 mg Doxycycline - Daily (for acne)
10 mg Atorvastatin - Daily (Cholesterol)
20 mg - Lisinopril - Daily (Blood Pressure)
100 mg - Trazadone - Daily (Sleep)

Total Test: 774 (Trough)
Hematocrit: 52 (Donate whole blood every 60 days or "Double Red" every 120 days)
Estradiol: 16.8
TSH (Thyroid): 1.360

Age: 55
Height: 5'-9"
Weight: 180
Pull ups: 12

I've been injecting Testosterone for over a year and feel great except for the occasional cascade of emotion when irritated. My Internist says its ok as long as I'm aware of it. ~ lol ~ Sex drive, energy and mental acuity are high.

I'm getting the Test and HCG from Royal Men's, Amphetamine from an MD and everything else from my Internist.

I'm looking for input relating to the commingling of medications and thoughts about finding one doctor who can manage everything.

I had one "Men's Health Clinic" doc tell me that the Adderall was "burning through the test"
whatever that means...

Sean Mosher · Jan 4, 2018

You feel okay with your estradiol under 20 pg/ml?
My only thought would be to have the Anastrozole dose cut in half and let your e2 rise a little bit.
I can't really speak to the mingling of those Rx with TRT to be honest.

FeelingLost · Jan 4, 2018

Hi TreeTopFlyer, Welcome.
That is a pretty interesting and complicated protocol.
Most of the fellas here that take an AI and have not crashed their E2 take <1 mg /wk of Anastrozole.
I take 150mg/wk Tcyp divided into 3 shots and my AI is .125mg pill EOD.

TreeTopFlyer · Jan 4, 2018

Hi Sean,

Low Estradiol Symptoms:

Fatigue along the lines of sleepiness - No but I'm taking Vyvance and Adderall
hypersomnia (sleeping too much and too often) - I spring out of bed singing a song
strong erections but limited sensitivity - Maybe
loss of erections - Maybe
osteoporosis and osteopenia - Don't know
joint pain, clicking or popping joints - Don't know
eye fatigue (eyes seem more tired despite adequate sleep, dark circles) - Yes
loss of libido (interest in sex) - Yes, feels like a governor has been put on the Test.
difficulty retaining water (constant urination) - Kinda
anxiety, depression, irritability - Irritable but no depression

To me, it feels like a reduction in sex drive and tolerance for people who fail to reciprocate respect.

I'm sourcing the Test and HCG from Royal Men's Health Clinic. $195/month (includes blood work) They reviewed the numbers I posted but didn't say anything about the Estradiol being too low. They continue to ship the same protocol.

Vince · Jan 4, 2018

Is that the right estrogen test, the sensitive estradiol test for men. If not your numbers are pretty much worthless.

Why All Men Should be Tested with the Sensitive Estradiol Test

https://www.excelmale.com/forum/sho...d-be-Tested-with-the-Sensitive-Estradiol-Test

TreeTopFlyer · Jan 4, 2018

Vince said:
Is that the right estrogen test, the sensitive estradiol test for men. If not your numbers are pretty much worthless.

Hi Vince! Thanks for the reply.

It's the LabCorp Roche ECLA Methodology: 004515 - Ordered by Royal Men's Medical Center. Based on what I read in your link I need to request test: LabCorp 140244.

Vince · Jan 5, 2018

Yes the sensitive, LC,MS/MS test

OMI100 · Jan 5, 2018

"Estradiol: 16.8"
Standard test seems to ALWAYS read higher than sensitive.
Based on that you may have tanked your E2, or at least are LOW.
I would recommend that you get a copy of Lee Myer's book "Natural Versus Testosterone Therapy" ASAP...
I just finished reading last night and last 40 pages or so cover estradiol and testosterone.
Excellent discussion on the impact of estradiol and what impact low or high has on the body.
Read and educate yourself on this complex subject ASAP.
Also the rest of the book is excellent and covers a number if items that may of interest to you.....
BTW if you don't want to wait to test your E2, you can order your own labs (there are a few states still do not allow you to order your own labs) from Discountedlabs and the E2 sensitive is reasonable (around $55.00) and you get the results directly back to you in a few days.

Systemlord · Jan 5, 2018

When I was on Vyvanse I would experience a crash midday, a sudden drainage of energy. Imagine you're snorkeling in the ocean during a crash like that and you're caught in a rip current. These medications could be contributing to your symptoms of fatigue. Vyvanse can me a hyper focus (hypersexualaity) but couldn't regulate it down, it's either full speed or nothing.

low E2 is the cause of your symptoms, I'm currently rebounding off similar symptoms do to high E2.

lowe2sucks · Jan 5, 2018

Systemlord his e2 is below 20 its not high in any way.. you probably meant low e2 is the cause of his symptoms

ratbag · Jan 5, 2018

It would be interesting to see your thyroid labs. I concur with the comments that your E2 is too low. This could be the irritability part easily. 5mg a week is an abnormally huge dose. I had that problem too and was taking 1mg daily for a few years then they found my DHEA-S and progesterone was low and put me on those and for some reason I was able to stop taking anastrozole because of that. At the very least I think you ought to increase your E2 level by cutting back on the AI. Also you take 50iu of HCG? or did you mean 500iu? Because we know from studies that 50iu twice weekly does nothing for you. The smallest amount of HCG taken is typically 250iu twice weekly and the highest is 500iu 3 times per week.

OMI100 · Jan 5, 2018

1st order of business should be the correct E2 test.
2nd order of business is to get a copy of Lee Myer's book "Natural Versus Testosterone Therapy" ASAP...

TreeTopFlyer · Jan 5, 2018

ratbag said:
It would be interesting to see your thyroid labs. I concur with the comments that your E2 is too low. This could be the irritability part easily. 5mg a week is an abnormally huge dose. I had that problem too and was taking 1mg daily for a few years then they found my DHEA-S and progesterone was low and put me on those and for some reason I was able to stop taking anastrozole because of that. At the very least I think you ought to increase your E2 level by cutting back on the AI. Also you take 50iu of HCG? or did you mean 500iu? Because we know from studies that 50iu twice weekly does nothing for you. The smallest amount of HCG taken is typically 250iu twice weekly and the highest is 500iu 3 times per week.

Hi ratbag,

Thanks for your response. The Anastrozole is actually .50 and is blended with the Testosterone in Grape seed oil. I looked at my labs from before I began the Test/Anastrozole combo and my Estradiol was 15.8. Previously I had been injecting Test with no Anastrozole so it appears it's naturally low. The 16.8 is four months into the Test/Anastrozole combo. Looks like it has risen in spite of the Anastrozole. Any explanation? The HCG is 50 insulin units and 5,000 I/U which translates into 500IU twice per week.

TSH (Thyroid): 1.360 - Dont now anything about Thyroid so all input is greatly appreciated.

As I read through all this it occurs to me that I've created a monster. He smiles.

ratbag · Jan 5, 2018

Hmm not sure I understand fully how HCG is blended into the seed oil. HCG is water based unless they are blending the liphilosled powder which I have never heard of. I'm not sure I believe that story... not you, but what they tell you. We have all heard some unusual stories of special blends etc to justify their so called expertise or rationale.

TreeTopFlyer · Jan 5, 2018

ratbag said:
Hmm not sure I understand fully how HCG is blended into the seed oil. HCG is water based unless they are blending the liphilosled powder which I have never heard of. I'm not sure I believe that story... not you, but what they tell you. We have all heard some unusual stories of special blends etc to justify their so called expertise.

The Test/Anastrozole combo is blended in grapeseed oil....sorry for the mistake

OMI100 · Jan 5, 2018

"TSH (Thyroid): 1.360 - Don't now anything about Thyroid so all input is greatly appreciated."
Start here and read.
The best Thyroid site on the web:
http://www.tiredthyroid.com/
next is 2nd best:
https://stopthethyroidmadness.com/

LTChris · Jan 6, 2018

With so many variables, it almost seems impossible to make head way. I hope you can get your E2 in line and thyroid understood. Maybe then eliminate some of these prescriptions to dial in your numbers. What is your diet like? Could that possible allow you to adjust/eliminate some of the meds? Not sure about mixing medications. Cholesterol can be stressed over too much in my opinion.

TreeTopFlyer · Jan 6, 2018

LTChris said:
With so many variables, it almost seems impossible to make head way. I hope you can get your E2 in line and thyroid understood. Maybe then eliminate some of these prescriptions to dial in your numbers. What is your diet like? Could that possible allow you to adjust/eliminate some of the meds? Not sure about mixing medications. Cholesterol can be stressed over too much in my opinion.

Hi Chris,

I know it sounds like a lot but it's only dove tailing a common protocol of Statin, Blood Pressure medication and off label antidepressant for sleep with HRT. The amphetamines are wonderful and I highly recommend. Unfortunately, my diet is undisiplined and has lots of room for improvement but, as you know, life and environment can make eating right difficult; I do the best I can. I'm 55, 5' -9 180 lbs, wear a size 30/32 jean and can engage in any sport or physical activity at will. Agree with your cholesterol view; I think we'll find out soon if we did any damage with the amount of statins prescribed over the past 20 years.

Thanks for your response and all the best.

rmrodriguez · Mar 21, 2018

We at Royal Men's Medical Center look at each patient individually. E2 levels are different in each patient. Some patients perform much better with a lower range of E2, while other patients perform better with a higher E2. As "TreeTopFlyer" stated, his sex drive and mental clarity is great at an E2 level of 16.8.

I am a physician and I am able to give medical advise, and I will tell you that there is no set E2 number for any patient, there is a range but that is why we manage each patient individually based on labs and symptoms, along with my many years of experience in hormone therapy.

Sean Mosher said:
You feel okay with your estradiol under 20 pg/ml?
My only thought would be to have the Anastrozole dose cut in half and let your e2 rise a little bit.
I can't really speak to the mingling of those Rx with TRT to be honest.

rmrodriguez · Mar 21, 2018

Hi "TreeTopFlyer",

This is Dr. Rodriguez, in your original post you said your libido was fine, if you have any problems or concerns, as you well know you can simply call us and we would be more than glad to address and/or adjust anything for you to solve your problems. That is our mission. I only can assume the reason I did not consider you to have a "low" E2 is because you did not have any symptoms that you advised us of. Therefore, we did not change your protocol.

TreeTopFlyer said:
Hi Sean,

Low Estradiol Symptoms:

Fatigue along the lines of sleepiness - No but I'm taking Vyvance and Adderall

hypersomnia (sleeping too much and too often) - I spring out of bed singing a song

strong erections but limited sensitivity - Maybe

loss of erections - Maybe

osteoporosis and osteopenia - Don't know

joint pain, clicking or popping joints -Don't know

eye fatigue (eyes seem more tired despite adequate sleep, dark circles) - Yes

loss of libido (interest in sex) - Yes, feels like a governor has been put on the Test.

difficulty retaining water (constant urination) - Kinda

anxiety, depression, irritability - Irritable but no depression

To me, it feels like a reduction in sex drive and tolerance for people who fail to reciprocate respect.

I'm sourcing the Test and HCG from Royal Men's Health Clinic. $195/month (includes blood work) They reviewed the numbers I posted but didn't say anything about the Estradiol being too low. They continue to ship the same protocol.

Three Docs One Patient

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