Blackhawk's journey with TRT

[Deleted member 16042]

Putting it all in one place:

I had a previous thread asking for help prior to consultation with Dr Saya at Defy. I just had that consultation and am now embarking on a more hopeful journey towards hormonal balance and health. Figure I'll contribute to the forum by documenting my journey.

I'd like to say that between Excelmale and PEAK, and by following many links to other resources from these forums, I am becoming very well educated.I am extremely grateful for this education. The learning curve has been steep and I have been cramming for the consultation.

This prepared me very well for starting care with Dr Saya. I feel my consultation today was comprehensive, I knew what to expect and feel very comfortable with both Dr Saya's approach, and our ability to come to mutual decisions for my care and ongoing follow up... Much more so than with my previous MD who initiated my TRT.


The following post will include my history leading to TRT, and the questionable "protocol" I was put on by previous MD

The post after that will include the problems on TRT

The next one info about today's consultation with Dr Saya.

Subsequent posts will be updates as things progress.

 

[Deleted member 16042]

My history leading to TRT, and the questionable "protocol" I was put on by previous MD:

(currently 58 yo, 5'10" 145 lb)

Prior to 2013, I was physically healthy overall, though had PTSD, anxiety and depression issues >20yrs. Very likely my stress contributed to the following cardiac issue... my other cardiac risk factors aside from low HDL were and remain quite low

Spring 2013, age 54: Cardiac angina, no heart attack, LAD stent. Put on Lipitor, Plavix, Ramipril, aspirin (all said to be beneficial for future cardiac outcomes). They said I should not have any physical deficit, since I did not have a heart attack, but my physical fitness started declining very slowly from that point. By December 2014, I was diagnosed with a serious statin reaction: Elevated CK, muscle wasting, fatigue and pain, lost 16 lb (11%) body mass, possible liver SxS.

I had notable hypocholesterolemia at that time and suspect the comprehensive effect of the Lipitor impaired Testosterone and other hormone production, I was in a catabolic state and it took many months to pull out of it

Discontinued Lipitor Dec 2014 (Plavix also DC after 1 yr, and Ramipril within a few months of that after dizziness and syncope). I regained normal weight over the course of the following year (december 2015) with highly controlled diet, lifestyle and work out program though mMy "high weight" in high weight low rep routine were more like warm up weights for most strong/fit guys. Had continuing difficulties with energy levels, exercise capability and exercise recovery.

As part of attempt to recover from statin, starting Feb/March 2015, I started a relationship with Functional/Intergrative MD who helped with multi faceted approach to recovery with limited success. He wanted me on TRT from the get go, but I was resistant and went with every other natural aspect I could to try to elevate T: diet, lifestyle, exercise program, etc. Had small successes, but overall had a downward trend until December 2016

At that point my valiant efforts and denial took me to serious hypogonadal territory

December 2016
-Total T 281 ng/dl (ref 348-1197)
-Free T 3.1 ng/dl (ref 7.2-24.0)
-Sens E2 10.1 (ref 8-35)

Doc put me on Testosterone/chrysin compounded cream T 150mg, Crysin 50mg/gm, 1 gm/day

So yeah, how 'bout the need for that AI with E2 at 10.1? I didn't know that was a recipe for disaster at that time


Other associated info:

Daily supplements:
CoQ10 100mg
Ubiquinol 200mg
Glutathione 500mg
Balanced Amino acid blend plus glycine, glutamine, taurine
Alpha Lipoic acid 300mg
NAC 500mg
Food based Multi Vitamin no iron
Vit C 3000 mg
Vit D3 1000 iu
Vit E 400iu
Vit K2 100mcg
Fish oil 1100mg
Magnesium glycinate
Zinc carnosine

Diet: Incredibly clean diet of almost entirely organic fresh and dried fruits, vegetables, grains, nuts legumes, tubers, grass fed meats, wild caught fish, yogurt, cheese, butter olive oil. Zero processed packaged food

Alcohol 1-2 drinks/day beer, hard liquor

Non smoker

Environmental: Residence at over 9000' elevation. Returning/re-adjusting to altitude after travel always involves AMS symptoms 1-2 weeks.

 

[Deleted member 16042]

Problems encountered on TRT (and other potentially related issues)

So whaddya think happened?

Short honeymoon, a bit of increased libido and general feeling of well being.

Then:
-Pain and shrinkage of testicles
-Decreasing energy levels
-Decreased exercise capability and recovery
-Increasingly unstable mood swings, a couple emotional breakdowns more intense than anything since early childhood, increased anxiety and a depression that has lasted months. I have experience with PTSD, anxiety and depression and this has been as bad or worse than any period in the rest of my adult life.

The time elapsed from the first negative changes from TRT and waiting for consultation/change with Dr Saya has been a nightmare.

Concerns from initial labs for Defy:

Total T 498 (ref 348-1197)
Free T 6.7 (ref 7.2-24.0)
E2 sens 12.1 (ref 8.0-35.0)
DHEA-S 39.7 (ref 48.9-344.2)
(Saya said DHEA also implies probably low pregnenelone and possible adrenal/cortisol concern)
-TSH 4.07- (ref 0.450-4.500

I went back through my previous lab records and found pretty consistent thyroid numbers... one set a year ago:

Thyroid
TSH 3.880 uIU/mL 0.450 - 4.500
Thyroxine (T4) 4.7 ug/dL 4.5 - 12.0

And:

T4F+T3F
Triiodothyronine, Free, Serum 2.1 pg/mL 2.0 - 4.4
T4, Free(Direct) 1.21 ng/dL 0.82 - 1.77
Reverse T3, Serum 17.8 ng/dL 9.2 - 24.1

And in a thyroid antibody test: Thyroglobulin ABS at 2.0, (ref 0 -1.0)

(Note: I have a few hypothyroid type symptoms: slow resting pulse, low body temp and tend to run a little cold, but not overweight, normal eyebrows, hair etc)

 

[Deleted member 16042]

About today's consultation with Dr Saya:

We covered all these bases, and we discussed a couple different approaches, needing to balance protocol changes with the ability to monitor cause and effect.

-Increase Testosterone dose, switch to gel 200mg/day, apply one click to scrotum every third day

-Eliminate Chrysin

-Add HCG 350 iu Every 3 days

-Increase DHEA to 25mg BID

-Add Pregnenelone 25mg/day evenings

-Follow up blood tests @ 8 weeks:

Include additional tests:

-Thyroid and thyroid antibodies (Previous blood tests show that I have very likely been mildly hypothyroid for many years, and a single antibody test in early 2015 shows slight potential for an auto-immume thyroid problem.

-Cortisol 24 hr salivary

-IGF-1 (growth hormone).


Follow up consultation at 10 weeks once all follow up test results are in.

Wish me luck!

 

[Deleted member 16042]

Other curiosities for me at this point TBD from followup bloods:

-What will T levels be after increasing dose and adding HCG? And will Gel end up effective?
-What will DHEA level be with 50mg/day plus HCG?
-Will we overshoot E2 levels by discontinuing chrysin and adding HCG?

 

[Deleted member 16042]

Received my syringes for HCG and alcohol prep pads from allegro... thanks for the tips on other threads. Forgot about sharps containers, what do you guys use, and where do you dispose?



In the meantime, With Dr Saya's Rx, I upped the DHEA to 25mg BID, and this time no problems, no headaches. Possibly having some positive effect. I have not had such crazy mood swings in the last week, and have been able to up my exercise to around 2.5-3 mountain miles walking/day plus some very light calisthenics and theraband work. I figure I need to do a lot of band therapy to strengthen support musculature and joints prior to starting to lift seriously again.

I hope this trend of doing better continues. It's been so long I almost can't imagine feeling normal again.

 

[CoastWatcher]

A question, slightly off the main highway: you discontinued Ramipril. Has your blood pressure been stable since? Weight loss, which you acknowledged, certainly would help with that.

 

[Deleted member 16042]

My blood pressure was never a problem, They prescribed Ramipril just because of getting the stent.

Re: weight loss, I have NEVER needed to lose weight. I have always had a skinny disposition. I have needed to redistribute fat to muscle just a bit a couple times through the decades, but weight has just never been a problem for me. 5' 10", high school weight 142. When I lost weight from statin muscle wasting was down to 129. Now 142. Size 30 waist. I could use a few more pounds of muscle!

 

[Deleted member 16042]

Update, less than a week into the new protocol:

T gel transdermal 200mg/day, 1 click to scrotum every third day
HCG 350mg every 3 days
DHEA 25mg BID morning and evening
Pregnenelone 25mg evening

Plus all the other supplements in post 2 above.

Noticeable changes:

I started taking 25mg DHEA evenings prior to the consult with Dr Saya and got a headache for 3 days straight, however, this supplement also had added maltodextrin which can mess with MSG sensitivities which I have. I switched to a purer brand without the additive and headache disappeared.

Was on that dose for a couple weeks, then Dr Saya doubled DHEA to 25mg each morning and evening plus 25mg pregnenelone evenings. Now about 3 weeks with DHEA and 1 with the other changes.

Since starting DHEA, my daily exercise has increased to 2.5-3 miles vigorous mountain walking/day, and I have started to add carrying about 20lb in a backpack and have started adding some basic HIIT intervals sprinting uphill both just bodyweight and with the pack. This is feeling pretty good, I am recovering pretty well day to day, and I'm feeling a bit more confident redlining it after a cardiac stress test with Vo2max of 55 a few weeks ago (Not shabby for a 58yo!)

Also started trying to lift and do basic body weight calesthenics, but already hurt myself. I think not only is my body just not conditioned any more from the last few months of inactivity, but I suspect the low T and E2 have left my tissues impaired. I got a little too enthusiastic. First day doing knee pushups and assisted pullups, my tricep tendons were painful and the next morning the right elbow bursa popped up big time... never had elbow bursitis before, not painful to speak of, but the amount of swelling is alarming. So, going to wait on further arm exercises until this heals. Also apparently strained my back day before yesterday doing squats with the pack on. Didn't feel it then, but yesterday had lower back spasms with twisting movements. A bit better today, but lessons learned. This body isn't going to bounce back to previous fitness levels without a lot of reconditioning.

Otherwise, moods swings have evened out, though I feel a bit duller; calmer, less stressed but also less excited about things. Overall outcome better to lose some of the anxiety.

With my increasing comfort with the hill walking and intervals, I am feeling physically stronger though prone to injury for now, and a bit more mentally stable. Seems good, but just the beginning. Hopeful...


Also of note, some diet changes:
-Radically increased veggie intake via juicing. Wasn't deficient before, but now adding on average a pint of Kale, carrot, cuke, celery, parsley, ginger, turmeric etc fresh juice/day
-Substituting more veggies for fruit. Fruit used to be 3-4 pcs/day, now more like 1-2
-Cutting back on grains, probably have slightly reduced overall carb intake, but definitely reducing higher glycemic foods like white potatoes, rice etc. Making up with squash, beets, turnips, fermented beans.
-Slightly increasing fats/ cholesterol intake: eggs, whole milk, coconut oil, a little more generous with olive oil on salad
-Slight increase of animal protein, from 2 up to 3 eggs on average every other day, a bit more grass fed whole milk yogurt, whey, etc

 

[Deleted member 16042]

3 weeks into new protocol:

Getting back into training has been rough. Some very modest gains in terms of amount of exercise overall, and slight increases in weight and reps/sets. Did my first full weight push ups today. Still have joint pain/stiffness and sore tendons. Muscles are not perking up real well, getting better but still long recovery between workouts if I push at all.. Bursitis is not clearing up, but arm works.

Testicle size has not increased much at all on HCG, but I am not having testicular pain at all any more.

Overall I have been more emotionally even, but have had a couple shorter (day or three) episodes of anger and depressive thoughts/feelings. Definitely notice if I don't meditate for a few days I get off kilter. It's like the brain packs up until I can empty it again. At least I am not feeling the "hormonal" type swings, just more back to my usual stressed self.

Wish I could prod things along and get to the thyroid piece of the puzzle. Patience is a virtue but wanting this to go faster!

 

[ratbag]

I'm glad your feeling better. You seem aggressive on pushing yourself physically while you don't yet know if the cream even works for you. Ease up until you know your numbers are good. Then it'll take a few months for the testosterone to build muscle. At this point if all is well with your protocol you'll be feeling pretty good and and can start your exercise regime slowly. Pushing yourself this early can only hurt you. It takes time for your body to adjust. Slow and steady is what works best.

 

[Vince]

I should add for a Sharps container I use how old liquid laundry soap container and label it sharp container. You can take it to most local hospitals.

 

[Deleted member 16042]

I'm glad your feeling better. You seem aggressive on pushing yourself physically while you don't yet know if the cream even works for you. Ease up until you know your numbers are good. Then it'll take a few months for the testosterone to build muscle. At this point if all is well with your protocol you'll be feeling pretty good and and can start your exercise regime slowly. Pushing yourself this early can only hurt you. It takes time for your body to adjust. Slow and steady is what works best.

Thanks.

Point taken, yes, need to go easy on myself. But as long as I am progressing at all, I need to at least keep pushing at the level where there is some progress. I've been dealing with low T for at least 3 years, but had gains whenever I switched to weight and HIIT training. And that is happening now though you are absolutely right, I need to have a different body awareness than before of what my joints, muscles and tendons can handle right now.

I realize I was put on the wrong replacement therapy last December, which caused its own problems and it is taking time to come around. But I started improving as soon as I started taking DHEA around 5 weeks ago. I am having minor improvement and so can't sit idly by and call it good. I will walk that edge to challenge myself.

BTW, yesterdays workout was heavier than anything in the last year and I am a little tired but fine, no worse for the wear today!

Oh, as far as whether the gel works, still a while to go before blood work, but am having good nighttime erections, have good libido and am growing more body hair.

 

[Deleted member 16042]

I should add for a Sharps container I use how old liquid laundry soap container and label it sharp container. You can take it to most local hospitals.

Thanks,

I just got a zip lock kind of hard plastic container for now, seems OK, though not closed/spillproof. I recap, so low risk.

 

[Deleted member 16042]

New labs are in. Next consult will be Oct 17.

Pleased on some counts:
Free T is in much better range
E2 in good range
DHEA is up (maybe too far)

but I have a few questions





1- Hemoglobin/Hematocrit, borderline. Should I expect to have to find the local Red Cross?

2-Total T is low, but Free T finally in normal range, and DHT is high. I am on gel. Seems I may need to switch to T cyp to raise total and bring down DHT?

2.5- A little surprised SHBG was not specified this time?

3-My DHEA-S was previously very low, now supplementing with 25mg 2x/day, I expect dosage to come down to 25mg/day? (Also on 25mg/day pregnenelone)

4- I have no idea how to interpret ACTH? (Also will have 4 point salivary cortisol results sometime soon)

5- I have no idea how to interpret IFG-1?

6- Thyroid... Appreciate any comments. Looks pretty close to 14 months ago (Post #3 above), so seems I'd probably benefit from some supplemental Thyroid. Certainly T3 is low, and Thyroglobulin is high, not sure whether T4 is good or low, but if good, is it under converting to T3? Am I interpreting correctly could be Hashimotos? Surprised Reverse T3 was not ordered this time, nor iron/ferritin. Hope to hear from Vettester Chris!

Edit: I found last year's iron numbers, could be a bad assumption, but I expect this is pretty consistent as related to Thyroid this year. I have had no great changes in iron intake in diet.

Iron Bind.Cap.(TIBC)313 ug/dL 250 - 450
UIBC 146 ug/dL 111- 343
Iron, Serum 167ug/dL 38 - 169
Iron Saturation 53%15 – 55


Ferritin 44 ng/mL 30 – 400
Transferrin 261mg/dL 200 - 370

Appreciate any knowledgeable input!

 

[ERO]

Switching to T cyp could be a smart move to get your total T up, but don't worry about bringing down DHT unless you have hair-loss or prostate issues. DHT is not something "bad" - it is required for libido.

 

[Vettester Chris]

As you noted, no Reverse T3 on this round. I looked at your previous labs with RT3, and your FT3/RT3 ratio was 11.8. That's a pretty good sign that something is going on, as RT3 demand (at least at that point) was in excess, compared to the amount of T4 in your system, and of course based on the FT3/RT3 ratio.

I would suspect it to be similar, but anything is possible? Iron Serum is at the top of range, but as you see ferritin is on the lower end. Without adequate ferritin, iron storage in the body is inadequate, so it's basically like having low iron. As you mentioned to me before, there could be a genetic correlation; possibly MTHFR mutation, or maybe something else taking place in the liver (?). It's speculation coming from an Internet standpoint, and I would encourage you to dig further with your doctor(s).

IMO, it will be hard to transport T3 into the system (optimally or adequately) with ferritin that low, a little > 100ng/dl would be about right. Mine also got too low because of frequent blood donations, and I'm a hemochromatosis carrier, who once had ferritin above 1400ng/dl! Needless to say, it's needed and required on my end, but it's also a balancing acting of keeping adequate elemental iron in my body in between the donation periods.

 

[Deleted member 16042]

Thanks Chris, I appreciate your input.

Do you think the antibody aspect implies Hashi's?

 

[Deleted member 16042]

Questions Post #15 above; Is there somewhere else on the forum I should post this for more response?

Thanks

 

[Vince]

Questions Post #15 above; Is there somewhere else on the forum I should post this for more response?

Thanks

Blood Test Discussion would be a good place to post your labs and questions about your results.

https://www.excelmale.com/forumdisplay.php?58-Blood-Test-Discussion