TRT risk vs reward - Cortisol

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DB32

New Member
Hi all,

I posted here earlier in the year describing my symptoms and shared some blood results demonstrating low free T.

After two further blood tests confirming I have low free T I finally made the move and went to see a men's health specialist privately.

I am still awaiting an appointment on our national health service but given the horror stories and my previous expose with endocrinologists following procedure I figured it is highly unlikely that I will be prescribed replacement therapy so have taken a different route.

My most recent bloods were

Total test 15.7 (9-30)

Free T 22 (45-220)***low

SHBG 72 ***(20-55)high ...(have been in a calorie deficit since march which may have bumped this up slightly, it's usually between mid forties and early fifties)

Estradiol - can't find result page but was also low(unsurprisingly)

So I am faced with two options

Testosterone enanthate and hcg or clomid 25mg/d

i have to now weigh up wether to risk TRT at the cost of my adrenal function as test has previously lowered my cortisol down to a level I cannot function at or hope that my body is In a better state to deal with TRT and this may not happen.Previous history and science tells me I will get a drop in cortisol but I think that from a numbers perspective TRT would be a better route for me given my SHBG.

Second option is Clomid, I haven't used clomid since my bodybuilding days for pct which was around 10 years ago so I have no idea what impact this will have on cortisol.from what I have read it will raise the testosterone via increased Lh signalling and should keep the adrenal pathways in tact..like anything the "on paper" result tends to be quite different from the real life so I am still apprehensive about this.I am also concerned about the side effects such as blurred vision and the estrogenic effect of the clomid itself(basically don't want to feel even less masculine than I do already)

Things I do know:
Testosterone did lower my cortisol
ACTH on blood test a week after last shot of T was in upper quartile of range so it may be more of a conversion /cascade issue
My SHBG is high so I will likely need quite a high dose of T to get the free levels up

Things I don't know:
Wether HCG will sufficiently backfill the hormonal cascade
Wether the ACTH will also drop with the increase in test or if it will remain high normal
Wether Clomid will cause same/similar issues with test
Wether there is a link between estrpgen and lower cortisol rather than Testosterone (would then an AI from the start be less disruptive to the adrenal system)
No idea what my pregnenolone ,DHEA and progresterone levels are
Wether my body will somehow "adapt" after a short period of time on testosterone
Wether I could have another negative reaction to TRT which could render me unfit to work or worse ,clinically dangerously low levels of adrenal hormones and requiring emergency intervention.

When I run through the above the most logical/ risk averse option would be to try clomid and see what happens, should anything go wrong it will not leave my HPTA in a worse state and my adrenal hormones should experience the least amount of disruption.

Most of the doctors I have encountered in the UK have a very standard approach and even the more liberal "specialists" don't tend to know much about the link between TRT and adrenals.

At this junction I felt it would be a good time to post up my situation to see if anybody has walked a similar path or perhaps some input from the Drs here could prove really valuable.


Thanks for reading, if you have time I would appreciate any responses, help and support.
 
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DB32

New Member
Thanks Ratbag

Hertoghe looks pretty good actually.

How do the docs like saya and crisler work with UK patients? Do you need to be on TRT already ?

i think a general consult would be good from one or the leading TRT guys and then Segway into a more deep hormonal specialist such as hertoghe.

Thanks
 

ratbag

Member
Hertoghe is a leading hormone specialist. Perhaps the best in Europe. I think for Dr. Saya or crisler it would be by phone as long as you can provide them with the recent labs they require and a copy of your physical. I'm in Canada and I did that so I could consult with Dr. Saya. It worked out great and he even will Rx me what I need. (this part obviously won't work for you) The problem you face is if Dr. Saya suggests a change to your protocol and your treating MD doesn't agree then it's all for not. If your current physician is willing to follow recommendations from an American MD then it'll work for you. Something you need to know beforehand.
 

Gman86

Member
These are all great questions, as I am currently trying to raise my cortisol while on testosterone and HCG. Clomid is a tough one, simply because it raises estrogen and partly is an estrogen blocker. Maybe it can be a viable option at a low dose per day, but I personally wouldn't even try it. If I could go back, I would of skipped the part of my journey when I was trying Clomid mono therapy. It was the darkest point in my whole entire life hands down, scary stuff. But again, I used 50mg/ day, so maybe 12.5mg/ day would work better, or even 12.5mg EOD. Never had Cortisol tested while on Clomid.

I tried HCG mono therapy for a while. Couldn't stay on it due to E2 being uncontrollable while on HCG at high doses. I was using 2,000iu's/ week, split into EOD injections, which brought my total t to 1145. I have a high SHBG, so this is the total t that I needed to get my free t in range. So couldn't really go lower on my HCG dose. And at this dose, E2 and nipple sensitivity/ itchiness was just too much of a problem, even while on an AI. I also never had Cortisol tested while on HCG, so unfortunately have no info on whether it backfilled the pathways enough.

I'm on testosterone + HCG now, and my Cortisol keeps coming back on the low side of normal. So trying to get it up naturally. I don't want to ever have to take corticosteroids, as the long term risks while on those things look pretty scary.
 

DB32

New Member
Hertoghe is a leading hormone specialist. Perhaps the best in Europe. I think for Dr. Saya or crisler it would be by phone as long as you can provide them with the recent labs they require and a copy of your physical. I'm in Canada and I did that so I could consult with Dr. Saya. It worked out great and he even will Rx me what I need. (this part obviously won't work for you) The problem you face is if Dr. Saya suggests a change to your protocol and your treating MD doesn't agree then it's all for not. If your current physician is willing to follow recommendations from an American MD then it'll work for you. Something you need to know beforehand.

Thanks for the reply.

I think I am going to have to take a leap of faith and have a TRT doc, a adrenal/wholistic doc and then maybe a consult with defy.

Unfortunately these consultations aren't cheap and neither are blood tests, giveny sensitivities I think I will require quite an extensive test panel done and will need to be closely monitored to avoid any major issues.I have a small budget to work with and am going to do the best with what I can in the short term but I can imagine you will probably see me posting a lot more frequently once I have officially started treatment.

I find it quite fascinating how there are now so many people coming forward with Cortisol issues from TRT with and without HcG.

Time to be brave and take the leap of faith....

I want to get a full adrenal blood test panel done before starting trT(my TRT doc just testing the ususal rather than prog,preg,dhea)

What tests shall I have to capture all adrenal ifnfo before starting test? The objective being to see what declines , the ACTH or the cascade hormones and/or cortisol

Was thinking

Am cort
ACTH
Preg
Prog
Dhea s
lH
Fsh
Cort
Cbg
Crf(is this needed or will acth suffice?)

Any others I am missing?

Is there a way that can measure your p450 enzymes or assess wether you have a deficiency?

How would I also test why certain vitamins lower my cortisol too? For example magnesium is needed for TRT but I know for a fact that it lowers my cortisol, how do I find out why?

So many questions and so many rabbit holes to go down...where to start!!!
 

Systemlord

Member
Dr. Crisler and Dr. Saya will work with with you, but also your doctors, but that requires an open minded doctor. The doctors over there could benefit greatly from the knowledge, it's a win on both fronts in my book.

Free testosterone converts to free estrogen, so if free testosterone is low...
 

DB32

New Member
These are all great questions, as I am currently trying to raise my cortisol while on testosterone and HCG. Clomid is a tough one, simply because it raises estrogen and partly is an estrogen blocker. Maybe it can be a viable option at a low dose per day, but I personally wouldn't even try it. If I could go back, I would of skipped the part of my journey when I was trying Clomid mono therapy. It was the darkest point in my whole entire life hands down, scary stuff. But again, I used 50mg/ day, so maybe 12.5mg/ day would work better, or even 12.5mg EOD. Never had Cortisol tested while on Clomid.

I tried HCG mono therapy for a while. Couldn't stay on it due to E2 being uncontrollable while on HCG at high doses. I was using 2,000iu's/ week, split into EOD injections, which brought my total t to 1145. I have a high SHBG, so this is the total t that I needed to get my free t in range. So couldn't really go lower on my HCG dose. And at this dose, E2 and nipple sensitivity/ itchiness was just too much of a problem, even while on an AI. I also never had Cortisol tested while on HCG, so unfortunately have no info on whether it backfilled the pathways enough.

I'm on testosterone + HCG now, and my Cortisol keeps coming back on the low side of normal. So trying to get it up naturally. I don't want to ever have to take corticosteroids, as the long term risks while on those things look pretty scary.


Thanks for sharing re clomid, given my high SHBG I am not sure if it's the right move but the science behind clomid tells me that it will at least get my Total test into a decent range.

How did you feel on the HCG mono therapy? I know you mentioned you didn't have cortisol tested but did you feel that your cortisol was lower/higher in comparison to being on TRT ?

I know blood tests are more definitive in assessing exact numbers for cortisol but I usually find that when cortisol is low or mid range I can usually feel the symptoms which then prompts me to get bloods done.

Off Testosterone my levels are upper quartile (just )in the AM and on test the result was around mid range and I was very symptomatic especially palpitations and hypoglycaemia (which are the two most frustrating symptoms ) not to mention the dizziness and lethargy.

What methods are you using to naturally get cortisol levels up?

I agree - replacement is a last resort, I was literally unable to function on cort replacement and couldn't even walk to my local shop without shaking, palpitations,sweating and hypoglycaemia.I remember having to stress dose just to have a conversation with a family member, was just awful.

I can now train 6 days a week and work a very stressful job and lead a very normal life.The missing piece of the puzzle for me is estosterone, I have lost muscle and just feel pretty un-masculine which really sucks.I feel like I have to put all of my "normal life sub optimal health" on Red and hope that the gamble to optimise testosterone pays off...else I could end up completely back in adrenal pergatory 👍
 

DB32

New Member
Wow - so I enquiried with Hertoghe practice and it's waaaaay out of my budget.

What other doctors are leaders in the adrenal /cortisol /mens health field?

I need to put together a list and do a bit of a cost analysis and decide who will be the best doctor to work with.

To make it worse my adrenal glands have crashed again so I am back to low blood sugar, fog and dizziness.

I don't want to believe adrenal fatigue exists but it seems that over exertion and poor diet for the last few days has somehow burnt through too much cortisol and I am having to slow down again to "recharge "

The more I look into this the less I realise I actually know about my condition and how to manage it....
 
Last edited:

DB32

New Member
Another strange observation, I have recently upped my carbohydrate intake to over 300g and had a few consecutive refeed/cheat days which has really effected my adrenal health.

I woke up today and was very heavy headed and hypo and decided to take out carbs in my morning breakfast and just have protein and fats instead.

It may be short lived but I feel less hypo and have a bit more energy.

Not sure what this means just curious to know if carbs /lower carbs effect people's adrenals good and bad?
 

FOX1

Member
DB32; interesting to read that you have no faith in UK doctors and plan to go it on your own, which in turn can be very expensive as TRT is usually for LIFE.
.
I was also like yourself with a total testosterone of 14 (within limits)
But my free testosterone was Very Low
further investigation found I had osteopenia due to low free testosterone.
for 2+ years now I have been on Testogel which has increased both my total & free testosterone to the top end of the limits. I am due my next dexa scan shortly and I suspect this will show good results with bone density.
.
Obviously I pay nothing for all treatment and prescriptions as I am from Scotland, you say you are of short budget, so why not get your doctor to refer you for a initial private consultation and take things from there.
.
Don't get caught up in the roller coaster of constant blood checks, altering meds and trying new meds same time as old meds as some venture on this forum. And Why Inject when in the UK, when Gels work just as well, often far better than injections as they follow the natural testosterone route which is high testosterone in morning, dropping off during day.
.
You will get many on here saying Gels do not work, you then ask what experience they had of gels and they say "none" but they heard from another, who heard from another.
.
wish you well, but follow the medical route so that if something goes bad, you will get proper attention.
 

Gman86

Member
The reason I started TRT was extreme brain fog and losing my zest for life. Not sure if this is related to cortisol or not. On HCG I really don't know how it effected me cortisol wise, but I do know that it didn't really help with the brain fog or give me my zest for life back. Overall on HCG mono I felt about the same, just had increased sex drive and nipples were itching like crazy.

After years of TRT, I still have the brain fog. I currently think it's due to very low magnesium RBC, as it's been low on multiple blood tests. I think also the low cortisol does have something to do with it tho. From the very beginning, even before treatment, I've always had very high out of range DHEA-S levels. And they've stayed high throughout treatment, while never supplementing with DHEA. I've read that this could be due to being in a certain stage of adrenal fatigue. I believe they say when DHEA is high, cortisol is usually low. They are antagonistic from what I remember. So I think adrenal fatigue is probably part of the problem for me, along with the low magnesium. Both are contributing factors to my issues I think.

Thats interesting that u say magnesium lowers cortisol. That sucks for me since one of the most important things you can do for your health is have healthy magnesium RBC levels. How can u tell that magnesium lowers your cortisol?

And what I'm doing to help my adrenals naturally and get my cortisol up is going outside and getting sunlight in my eyes as soon as I wake up. I read it helps reset your circadian rhythm and then your body will start to make more cortisol in the mornings like it's supposed to. I also read for adrenal fatigue it's important to eat within an hour of waking, and eat small frequent meals. Opposed to what I was doing before which was intermittent fasting and eating 2-3 meals. I guess this is a bad idea for people with adrenal fatigue. Lastly, I take an “adrenal ****tail” twice a day. Morning and around 2-3pm, which is just water, 1/4 tsp of himilayan pink salt, 1/4 tsp of creme of tartar for the potassium, and vitamin C. Thinking about taking out the potassium tho due to not being sure whether potassium lowers or increasss cortisol.
 
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