Crazy Crash after 6 weeks of cypionate. Any Suggestions?

[Xerxes]

Hi Guys, 35 y.o married with two kids. Been on TRT since May of this year. Numbers for total T were all below 300 before starting. Uro put me on Testim to start. 1 tube. Felt ok at first, then shitty. After blood draw in one month down my T numbers DOWN to 220. Uro upped me to 2 tubes. Still felt horrific. Switched to cypionate on June 16. started at 100 mg per week (split into 2 shots on Tues/Thursday). Felt good again then shitty, Doc told me to up dosage, I went to 160 mg...he would have let me go up to 200mg. Started to feel really good. Went in for blood draw a few weeks ago Numbers up to 497.Doc said they were "perfect" and to continue of dosing and intervals etc. see you in 6 months. .Was feeling the best I had in a long time (energy, libido, exercise, even ED better).

Now just since this weekend I feel worse then ever. What in the world is going on? My anxiety is through the roof, I can't sleep, and my libido/energy/well-being is gone.

Emailed doc and he was confused. He never checked anything except for total T even before putting me in the Testim. I am frustrated as can be. I just want to feel normal again.

I now have an appointment to see an endo on Aug 24, but it seems real hard to wait for answers and solutions. Uro said I could come in and have him check blood for E2 and maybe we could up dose, but I think I've lost faith in him. Have an appointment with my GP this Tuesday and am hoping to convince him to test my E2.. But even if it's high, who knows if he'll be comfortable prescribing an AI? Maybe it's an E2 problem, so I have been taking some OTC DIM for the last day and a half but hasn't seemed to do anything...

Really don't know what to do or how to handle this. I feel like I am worse of now then when I started. Really can't come off now? How do you get tuned in for a good protocol?

Maybe the endo will find the underlying cause?

Any suggestions/help would be appreciated.

 

[Helboi]

Don't have much insight on your overall issue, other than to say that you have to be tested for a lot more than just total T.

But I will add that if you're going to use DIM, make sure it's the kind "with I3C". I use two different products, one is DIM 200mg (Smoky Mountain Naturals: http://www.amazon.com/gp/product/B006KL4TYG?) and I3C 200mg (Absorb Health http://www.amazon.com/gp/product/B00JROML5W?). These have been working pretty well for me in keeping hot flashes down (high estrogen). Might also want to consider adding 50mg Zinc in the AM and PM.

 

[Xerxes]

Thanks for the response. That Smoky Mountain Naturals is the DIM I'm using. Been doing 400 mg per day for two days. About how long did it take before you started to feel some relief? I already take Zinc orate (http://www.amazon.com/Zinc-Orotate-60-200-Tabs/dp/B004UAPG46) two in am and two in pm. Thanks for your help!

 

[HarryCat]

If you really can't wait you may want to consider self-testing. I'm sure you've seen the banners for DiscountedLabs.com on this site.

If you lower your dose back down that should also allow your E2 to come back down while you wait to see the endo. You'll need to decide if you felt better at 100mg/wk.

 

[Helboi]

I noticed some positive change after a week or so. It's not dramatic, but it's enough for me right now and I'd rather not take an AI.

 

[CoastWatcher]

Your doctor did you no favour when he failed to perform a full set of diagnostic tests before you started TRT. At a minimum, you need to check testosterone, free testosterone, sex hormone binding globulin (if low, you may be clearing your testosterone dose too quickly), a full thyroid panel (tsh, free t3, free t4, reverse t3), estradiol/sensitive assay, prolactin, cbc, dht, and - possibly - cortisol. If any of these are less than optimal you will be working against yourself in trying to achieve optimal results. I presume, working with a urologist, you had a baseline PSA run before starting treatment. If you want results now you can run your own testing through Discountedlabs.com, linked from this site, or one of the other self testing services.

 

[Xerxes]

Thanks for all the responses. It makes me feel that there might be some hope here. If my sbhg is low, what can I do? I have to say that I experimented with some chelated Boron last week (2 days 6 mg each day) bc I read it increased free testosterone . Just actually remembered that just now. I stopped bc my mood got worse..but then I had a few v good days after...

 

[croaker24]

You do shots on Tue / Thu? Shouldn't they be spaced out more? You do your shot on Thu, then it's over 4 full days before your next shot. I am far from being any TRT expert - but my understanding is you want them spaced roughly every 3.5 days. I do mine Sat night, and Wed AM.

 

[Xerxes]

Typo by me... I pin on Tuesdays and Fridays in the am..

 

[Gene Devine]

You need a full blood work-up done as sooner the better.

My guess E2 is elevated as it's usually the case if not being monitored.

Remember; E follows T.

Here are the labs you need to get done for a proper evaluation of where you are living right now:

Testosterone Total
Testosterone Bioavailable
Testosterone Free
DHEA-S
Estradiol (“sensitive” assay only)
Blood Chemistries
SHBG
CBC
LH/FSH
PSA
Prolactin
DHT

Thyroid
TSH
FT4
FT3

 

[CoastWatcher]

Thanks for all the responses. It makes me feel that there might be some hope here. If my sbhg is low, what can I do?

If you deal with low SHBG, you will want to inject small doses on a frequent basis. I moved from twice a week to every-other-day injections. It stabilized my levels and brought down my high E2 without the use of an AI. Still, without testing, you are driving in the dark with no headlights.

 

[Vince Carter]

You're changing far to many things in 6 weeks time to get any kind of reading...1 tube, 2 tubes, 100mg Cyp, 160mg Cyp...pick ONE regimen, get on it and stay on it, CONSISTENTLY for at least 6 weeks. I agree that you should have had some additional testing, but that's a glaring issue, the inconsistency. You simply can't shotgun hormone replacement therapy, take a test and keep on changing things...minimum of 4 weeks on a steady program.

 

[Re-Ride]

Hi Xerxes, Lots of helpful information here which should put you and others on a path to success. Most of us have made exactly the same mistakes: changing modalities and doses too frequently, expecting that a point of stability will be rapidly achieved and not getting proper baseline or follow-up labs.

If the state of CA can require logging and informed consent with discussion on imaging involving radiation perhaps its time for tighter regulation over the docs prescribing HRT. HeY! I am not at all fond of the idea of injecting yet another layer of regulation and bureaucracy but cases like yours involving less than ideal therapy are the norm rather than the exception in an era where aromatization is well documented.

When it comes to labs perhaps we need to have standing orders for a series in hand before we depart from the very first appointment. Getting needed labs out of some of these docs is like pulling teeth.

I don't see any mention of hCG. This may not be your immediate concern but if and when I go to cyp it will absolutely be included.

Good luck, report back on your progress and if you cross paths with anyone named Artabanus, run don't walk especially if there is a eunuch shadowing.

 

[Xerxes]

Thanks so much for all the encouragement and advice. I actually was able to get an appt with a doctor in my town this morning who seemed open to testing for the stuff that Gene listed. His office is near my gym and I just walked in yesterday before doing my workout and he happened to be chatting with the receptionists and I was able to tell him my story and problems and he said he couldn't promise anything, but he's be happy to draw blood and check for these things and try to figure out what's going on, but if he couldn't that the endo appt I have on Aug 24 should be helpful and at least I'd have some up to date labs to compare with the endo. Thanks again. I'll keep you guys updated...

Just to give a fuller picture of the timing of all this:

May 8 - started Testim with a number of 281
June 6 - after blood test 1 month on Testim numbers down to 226, doc instructed to go up to 2 tubes
After still feeling horrible, we moved to cypionate shots on 6/16
June 16- 1 200 mg dose at dr office and left with script for 200mg/week, but was told to only take 100 mg/week. (Doc in city, I'm in burbs) It was a way to cut down visits.
Felt great for a few weeks, then felt terrible.
After an email to doc on June 29 he told me to up dose to 200mg/week if I wanted or to 150/mg as long as I felt comfortable. I decided on 160mg split into 2 shots a week. Was feeling pretty good for a while.
July 20 blood draw confirmed testosterone level of 497.7. Doc said it was "perfect"...Not sure less than 500 is perfect, but ok. left with 3 month script and thought I was good to go. Then about 5-6 days ago my current crash happened and brought me here.

Thank you again for all your comments and support...I'll keep you updated.

 

[Vince]

Xerxes, sounds like you're working hard at doing all the right stuff, hang in there brother.

 

[ERO]

Yes, hang in there! And don't let anyone tell you a total T of under 500 is 'perfect' - That statement basically means its time to switch doctors - which you have already done.

 

[Xerxes]

Hey guys, I need some advice here. So far since last post i'v been taking 3 Dim cpas per day to try to get my e2 down. At first it seemed like it was working a bit. I was doing half-decently from Friday to Sunday: even spent a nice weekend away, but had some anxiety and insomnia , but it was tolerable ( I used some gaba supps and a xanax or two). The last few days have been HELL. Cannot sleep at all (maybe an hour here and hour there with the help of xanax and maybe an OTC sleep). When I am awake during the day and trying to go about my business (watching my kids, etc bc I 'm a teacher and am off for the summer) my anxiety is the highest it's ever been. I'm simply just coping with my xanax right now which is not a long term solution. I normally never take them, and when I do it's never this often or frequently. I dont want to have to take more and more and become dependent, but for right now it's all that's working. I also got some calcium D-glucarate yesterday and took two 500 mg tabs before dinner. It's insane. Have no idea if I drove my e2 down too low with the DIM (not likely with an OTC supp, right)? Or if it is still high (if it ever was)? FYI, my last injection was Friday in the am (normal 80 mg bi weekly: I do tues and Friday).

I had bloodwork down for all the stuff that gene mentioned that I should be able to over with today or tomorrow. I also am due to do my bi weekly 80 mg cypionate injection today.

So my questions are:
1. could my 3 tabs of dim a day for a week have taken me too low that quick? I mean my anxiety/insomnia is INSANE right now. Should I stop taking the DIM completely and not take the Calcium D-glucarate?
2. should I do my test injection today? I think I kind of have to, right? You can't stop cold turkey, correct? Should I just do a lower dose?
3. Where do I go from here? I guess that is dependent on the bloodwork, but I can't deal with this anymore. I am even considering getting off TRT all together at this point, but don't know how to do that safely.
4. Does anyone have any advice about doctors (TRT specials, endos, whomever) in the Long Island, NY area? I dont think my original prescribing uro really knows what he is doing with expert TRT. I got my blood drawn just from a nurse practicioner in my town simply b/c he was willing to do the blood work I was requesting. NOt sure how much help he'll be even when we get the bloodwork, but I'd be happy just to have it.

Please, any help would be much appreciated.

 

[ERO]

I use DIM and also in everything I have read about it, it works well for guys that are not "high converters" to E2, (In other words if you are a guy that needs a huge dose of AI every week to control E2, its not for you) but it cannot tank your E2 in a week like a too-high dose of Anastrozole can.

Honesty, I would stop fighting incompetent doctors and go with Defy Medical. Yes, its is out of pocket, but they know what they are doing, they are fast and they have very good prices. (I have no affiliation with them)

 

[CoastWatcher]

I use DIM and also in everything I have read about it, it works well for guys that are not "high converters" to E2, (In other words if you are a guy that needs a huge dose of AI every week to control E2, its not for you) but it cannot tank your E2 in a week like a too-high dose of Anastrozole can.

Honesty, I would stop fighting incompetent doctors and go with Defy Medical. Yes, its is out of pocket, but they know what they are doing, they are fast and they have very good prices. (I have no affiliation with them)

Take a few minutes and check the Defy site, linked from this page, or give them a call. I am not a patient of theirs, but would not hesitate to turn to them if my situation changed and my excellent local doctor was no longer providing my care.

 

[Xerxes]

So I got some numbers back:
e2 42 - range <40 HIGH .. I think this is the culprit I had it checked about a month ago when I was exploring a clinic on Long Is,and and it was 26

fsh and Lh= less than .0.3 no surprise there

dhea 168 range up-560

shbg 20.7. Range 10-57

free test : 18.2 Range 3.5-15.5 HIGH

free T calculated 2.6 %No range
Total Test : 693 RAnge 160-853. (This was taken the day before my Friday shot

albumin 4.7 range 3.2-4.7

evwrything else is in order. I asked about arimidex and he really didn't know about it, but was willing to research a bit

so for now its Otc stuff and more frequent but lower doses. Does this make sense? Any suggestions? Should I beg my original urologist for. Script? Any other ais out there?

i took my biweekly shot of 80 mg this am and feel better than I have in days.
Should I cut back my dose if my trough is 693?
Thanks for help