What is next?

johndoesmith said:

This is strange, while they're doing the right thing with hCG, and are correct about hCG being a part of a healthy protocol(for most), the removing AI and then adding it back in, without a lab test or symptoms to justify it is ridiculous.

Not everyone NEEDS an AI.

Low estrogen is TERRIBLE. Seriously.

hCG dose is rather high btw, that's almost an hCG monotherapy dose, for TRT it'd be more 500-1000IU a week split into 2 doses.

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I agree on the AI. I will wait until next test in three weeks.

I really want to wait on the hCG until my libido returns. With being so early in the process of introducing testosterone, can't I wait a month or so before I started in on the hCG?

johndoesmith said:

This is strange, while they're doing the right thing with hCG, and are correct about hCG being a part of a healthy protocol(for most), the removing AI and then adding it back in, without a lab test or symptoms to justify it is ridiculous.

Not everyone NEEDS an AI.

Low estrogen is TERRIBLE. Seriously.

hCG dose is rather high btw, that's almost an hCG monotherapy dose, for TRT it'd be more 500-1000IU a week split into 2 doses.

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CoastWatcher said:

Why take an AI if labs and symptoms don't require it? That is utterly foolish and likely to push you back into the pit you just climbed out of. As my own doctor has said, it's easy to lower estradiol, and a painful ride for the patient of it needs to be raised. But it's certainly your health and your choice. Time will tell. I wonder, but wish you the best.

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No matter how much time goes by, I will not even touch a small amount of the blocker, until I feel my libido return. Even then I may only do an 1/8th of a tab EOD. I will need to feel a strong comeback before then. Perhaps even wait until my next BT in three weeks.


What do you think about the Thyroid answer?

Worried said:

No matter how much time goes by, I will not even touch a small amount of the blocker, until I feel my libido return. Even then I may only do an 1/8th of a tab EOD. I will need to feel a strong comeback before then. Perhaps even wait until my next BT in three weeks.


What do you think about the Thyroid answer?

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NEVER take an AI in the absence of confirmed elevated estradiol levels. How do you know you need one? Most men don't. They perform a necessary function but they are over used. My e2 rose and I went to more frequent injections. It slid right into place. Has that even been suggested? It's a standard of treatment your doctor's seem ignorant of. But we've covered all this.

Your thyroid situation needs more attention than it is receiving. A TSH that high should not be ignored. My opinion is that you are the victim of substandard care across the board and you deserve better.

Worried said:

No matter how much time goes by, I will not even touch a small amount of the blocker, until I feel my libido return. Even then I may only do an 1/8th of a tab EOD. I will need to feel a strong comeback before then. Perhaps even wait until my next BT in three weeks.


What do you think about the Thyroid answer?

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Wait, so if libido returns, you're going to take AI? Why? Explain your thought process here.

johndoesmith said:

This is strange, while they're doing the right thing with hCG, and are correct about hCG being a part of a healthy protocol(for most), the removing AI and then adding it back in, without a lab test or symptoms to justify it is ridiculous.

Not everyone NEEDS an AI.

Low estrogen is TERRIBLE. Seriously.

hCG dose is rather high btw, that's almost an hCG monotherapy dose, for TRT it'd be more 500-1000IU a week split into 2 doses.

Click to expand...

CoastWatcher said:

Why take an AI if labs and symptoms don't require it? That is utterly foolish and likely to push you back into the pit you just climbed out of. As my own doctor has said, it's easy to lower estradiol, and a painful ride for the patient of it needs to be raised. But it's certainly your health and your choice. Time will tell. I wonder, but wish you the best.

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johndoesmith said:

Wait, so if libido returns, you're going to take AI? Why? Explain your thought process here.

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I am torn on this. I am not sure if it was just too much, or if I should have never had it at all. I would like to never take it again. But at the same time, it seems like a small enough dose would keep it regulated without ever getting to high or low. At the same time some never need it.

Worried said:

I am torn on this. I am not sure if it was just too much, or if I should have never had it at all. I would like to never take it again. But at the same time, it seems like a small enough dose would keep it regulated without ever getting to high or low. At the same time some never need it.

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The ONLY way to know if you need estradiol is to measure serum levels via the sensitive lab test. It's not a lethal substance that needs to be purged from your bloodstream, it's a necessary hormone - for women and men. Should it rise to uncomfortable levels it can be lowered either with an AI or by adjusting the elements of your TRT protocol. To have it prescribed in the absence of objective evidence that it's necessary is akin to being told you should take Amoxicillin regularly because it eradicates streptococcus. Do you have a strep infection at the moment? No, but such infections exist and, who knows, you may one day encounter one.

It's not good medicine.

Good luck.

Worried said:

I am torn on this. I am not sure if it was just too much, or if I should have never had it at all. I would like to never take it again. But at the same time, it seems like a small enough dose would keep it regulated without ever getting to high or low. At the same time some never need it.

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If you're not sure now, even facing low E2 symptoms, and a lab test showing "6" as E2, I'm not sure what will be your smoking gun.

Please do explain how a low dose of E2 will keep you from going too low.

You are overthinking this, and that is common with low E2, it causes obsessive thoughts, and inability to make a decision. I've been there. It WILL get better, but only in time, and in the absence of AI.

I can only make suggestions, at the end of the day, it is up to you. Hopefully you take the experience of people on this board seriously.

Here are the latest labs. I agreee and will not do it again. Thank you for your support.

I have to say. I really do not want to put anything into my body now. I am suppose to inject 60 mg of cypionate this morning. I'm leery even do that.

Worried said:

I have to say. I really do not want to put anything into my body now. I am suppose to inject 60 mg of cypionate this morning. I'm leery even do that.

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You have crashed the hell out of your E2.

If you stop injecting testosterone, you will see even lower results than above, you need to stick to a consistent protocol.

I think you are causing your own problems, no offense, but constantly changing doses based on how you feel is dangerous and there isn't a single disease I know of where a patient changes doses based on feelings.

I am not sure what you want us to tell you.

I will speak only to the thyroid issue as everyone on here has already spoken to the abysmal protocol you are following which your doctors are calling TRT and you don't seem to acknowledge their near malpractice. So be it.

Your doctors say your thyroid hormones are “normal”. They are not when combined with the high TSH! Any doctor following the latest protocols would call your T4 low and your pituitary gland is working overtime producing TSH to attempt to correct this situation. They should have performed an examination of your thyroid including an ultrasound exam to check for growths and nodules. The thyroid is the master gland of the body and is ignored at your peril. You are setting yourself up for Hashimoto's syndrome, depression, goiters, nodules and potentially cancer by continuing to brush aside these symptoms.

Chivato said:

I will speak only to the thyroid issue as everyone on here has already spoken to the abysmal protocol you are following which your doctors are calling TRT and you don’t seem to acknowledge their near malpractice. So be it.

Your doctors say your thyroid hormones are “normal”. They are not when combined with the high TSH! Any doctor following the latest protocols would call your T4 low and your pituitary gland is working overtime producing TSH to attempt to correct this situation. They should have performed an examination of your thyroid including an ultrasound exam to check for growths and nodules. The thyroid is the master gland of the body and is ignored at your peril. You are setting yourself up for Hashimoto’s syndrome, depression, goiters, nodules and potentially cancer by continuing to brush aside these symptoms.

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Thank you - concise and to the point. It's serious issue.

Chivato said:

I will speak only to the thyroid issue as everyone on here has already spoken to the abysmal protocol you are following which your doctors are calling TRT and you don't seem to acknowledge their near malpractice. So be it.

Your doctors say your thyroid hormones are “normal”. They are not when combined with the high TSH! Any doctor following the latest protocols would call your T4 low and your pituitary gland is working overtime producing TSH to attempt to correct this situation. They should have performed an examination of your thyroid including an ultrasound exam to check for growths and nodules. The thyroid is the master gland of the body and is ignored at your peril. You are setting yourself up for Hashimoto's syndrome, depression, goiters, nodules and potentially cancer by continuing to brush aside these symptoms.

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Based on this comment, I will schedule an appointment with my GP, and explain my concerns. Just so I don't panic in the meantime, is there a chance that this could be a minor, simply corrected issue? (Prior to TRT I believe I was suffering from adrenal fatigue. I was pushing myself way to hard with legal stimulants) Or does it have to be a "serious" issue?

How should this affect my TRT protocol? Or my decision to continue with it? Does higher levels of testosterone exasperate an elevated thyroid?

I want to do what is right, but there does not seem to be a clear path. Cutting out my current TRT physician means no more TRT for a period of time. Or I just go it alone until I get a new doctor.

I appreciate all of your imput, but it is all just bits and pieces that I have to put together.

I have an appointment with my GP Feb 22nd 17. I could push the issue and call every morning for a same day appointment, or I could walk into an emergency room with my blood work and have them determine how urgent this is.

Worried said:

I have an appointment with my GP Feb 22nd 17. I could push the issue and call every morning for a same day appointment, or I could walk into an emergency room with my blood work and have them determine how urgent this is.

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,

You won't die as a result of your seriously disordered thyroid gland before February 22 (your primary care physician can't see you for over six weeks?), so a trip to the emergency room is unnecessary.

Call Defy Medical in the morning, after looking in their website, and ask about becoming a patient. Yes, they are a site sponsor, but, no, I am not a patient. Many members here are. Go to the search box and enter Saya as a search term. Dr. Justin Saya is Defy's medical director, a moderator, and a fine guy. Read the quality of his posts and you'll understand why, no matter where you live in the United States, the telehealth model of care can work for you.

Yes, they can manage your TRT protocol as well as your thyroid issues. Yes, it will cost you something, but how much is your health worth? And it is likely to not be as expensive as you fear. When you speak to them in the morning, ask the bluntest questions you can - they don't dodge or try and wiggle out of a direct answer about cost or treatment. A call costs you nothing but a few minutes.

You are under the care of incompetent doctors, you alter your protocol based on how you feel at the moment, you are the victim of raging anxiety, and you feel miserable. Bring some order to this aspect of your life.

I contacted Defi medical two days ago. Their wait is a minimum of two weeks to see a doctor. Although they do discuss pricing, they do not discuss any current medical conditions.

I also called the helpline with a 24 hour nurse through my medical insurance. She read directly from a medical manual. She said that (TSH) .03 of an elevation out of range does not denote any kind of serious medical condition.

I am not saying that I'm not going to get it checked, but at this point it does not appear to be something so serious that I am in immediate danger.

In addition I would like to ask about your statement about the T4 level being low. Her answer for that is that every lab has different ranges depending on how they test. I have to look at what that lab has for ranges. So a low range with with some labs may not be a low range with other labs. So my question to you is how is it that you are determining that this is a low T4 level.?

Worried said:

I contacted Defi medical two days ago. Their wait is a minimum of two weeks to see a doctor. Although they do discuss pricing, they do not discuss any current medical conditions.

I also called the helpline with a 24 hour nurse through my medical insurance. She read directly from a medical manual. She said that (TSH) .03 of an elevation out of range does not denote any kind of serious medical condition.

I am not saying that I'm not going to get it checked, but at this point it does not appear to be something so serious that I am in immediate danger.

In addition I would like to ask about your statement about the T4 level being low. Her answer for that is that every lab has different ranges depending on how they test. I have to look at what that lab has for ranges. So a low range with with some labs may not be a low range with other labs. So my question to you is how is it that you are determining that this is a low T4 level.?

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Did that nurse tell you that it's understood that t4 should be well in excess of the 60% mark of the reference range (any reference range)? I don't think anyone suggested you were in immediate danger, but you have presented labs indicating issues, serious issues, that need to be addressed. In doing so, you are likely to feel remarkably better.

It does astonish all of us that your care is so slipshod. It upsets us because you deserve better.

As for the two weeks wait for Defy, if you have testosterone you can maintain your protocol, awkwardly constructed as it is, until that time passes. A thought.

Worried said:

I contacted Defi medical two days ago. Their wait is a minimum of two weeks to see a doctor. Although they do discuss pricing, they do not discuss any current medical conditions.

I also called the helpline with a 24 hour nurse through my medical insurance. She read directly from a medical manual. She said that (TSH) .03 of an elevation out of range does not denote any kind of serious medical condition.

I am not saying that I'm not going to get it checked, but at this point it does not appear to be something so serious that I am in immediate danger.

In addition I would like to ask about your statement about the T4 level being low. Her answer for that is that every lab has different ranges depending on how they test. I have to look at what that lab has for ranges. So a low range with with some labs may not be a low range with other labs. So my question to you is how is it that you are determining that this is a low T4 level.?

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Look, this may be all new to you, and reasonably confusing, I get that. You need to understand that established medical guidelines are intended to keep you alive, not to make you feel alive.

You can live with low thyroid hormones, just like you can live without being able to get an erection, it's not THAT severe. You won't enjoy your life as much, that's for sure.

Your doc isn't looking out for your quality of life, and all the members here, are. You seem a bit defensive, or not accepting that you can improve your quality of life, if that's not something you want that's fine.

Oh well.

So if you look back at some of the prior posts,you will see words such as "serious" and "dangerous". So all I'm saying is that I am not ignoring this issue. I'm going to continue to monitor it. Even get a second opinion on it. But to use those descriptive words... well you can understand how that can affect my posture.

Worried said:

So if you look back at some of the prior posts,you will see words such as "serious" and "dangerous". So all I'm saying is that I am not ignoring this issue. I'm going to continue to monitor it. Even get a second opinion on it. But to use those descriptive words... well you can understand how that can affect my posture.

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I'm a bit confused by what you're saying.

No, hypothyroidism isn't life threatening, it's similar to hypogonadism in terms of severity.