Hypochondriac:

[Sterling]

For decades I've always worried about my health. I just turned 51. My dad had a quintuple bypass at 50 but he's still kicking at 77..actually I can't keep up with that guy. Anyway, I have been diagnosed with low T. My last labs showed I was at 205. I'm convinced my low T is due to my use of Finasteride but my PCP and urologist believe it's not the cause. As I said, I constantly worry about my health and always think the worst. I understand anxiety and depression could be a side effect of low T. I haven't felt good physically in about 6 to 7 years. I've gained weight, lost all energy for exercise, have ED but have zero interest in sex anyway.

My main concern is starting a lifelong commitment to HRT. I'd consider quitting my Finasteride to see if my T level returns to normal but I'm not willing to sacrifice my hair. I've been battling hair loss since 1991 and I don't want to throw in the towel yet. I've done pretty well. I guess I've said all that to say this. I'm afraid of having new labs drawn for fear that they'll find some disease or significant medical problem and I don't want to find out.

Any suggestions guys?

 

[Nelson Vergel]

I would get off finasteride and use Rogaine foam, Nizoral shampoo and/or one of the compounded multi-ingredient hair gels ( https://www.excelmale.com/?s=46-Options-for-Hair-Loss-Beyond-Propecia ) and get on testosterone replacement. Most of our hair loss occurs before we are 45 anyway.

For the constant worry about your health, I would wait to see how you feel after 8-10 weeks of TRT. If you are still having obsessive health worries, then a low dose SSRI may work. I have known hypochondriacs who do well on them to stop worrying so much about what may or may not happen in the future.

As you know, having low T is a risk factor for cardiovascular disease.

 

[OMI100]

Nelson is right on as always...
I would add one more thing for you to consider and that is finding a DR who knows and understands TRT. If your PCP or URO is clueless that will only confuse you more and add to your worry. If you have not gotten Nelson's book to get up to speed on TRT, I would recommend that as 1st item. That way you can ask all the right questions and see if the DR has a clear understanding of the current TRT protocol. If not, get another DR for your TRT/HRT who understands it...... And if you have problems finding one who understands TRT Defy is always an option to consider.

 

[CoastWatcher]

I echo Nelson's remarks in regard to your use of Finasteride. There is no doubt that particular drug can cause terrible problems with men's health. My own doctors refuse to prescribe it as they have seen men in their practices sent into a physical tailspin - intractable erectile dysfunction and loss of libido being the two main issues - that are terribly challenging to correct. But, that said, it is certainly possible to maintain one's hair using the information provided by Nelson. I am older than you are, and Rogaine and Nizoral have done an excellent job for me. The compounded products he references in the link provided can be added to a protocol in order to provide additional support.

As for your hypochondria, have you considered a course of cognitive- behaviour - therapy? That particular form of psychotherapy, frequently conducted with a regimen of SSRIs has proven to be successful in helping people manage phobias and free-floating patterns of anxiety. Hypochondria can be dealt with; it doesn't have to hold you captive indefinitely.

I would also urge you to initiate TRT. The overall benefits that come from reversing hypogonadism far outweigh the issues surrounding the ongoing commitment of time and energy. I really wish you well as you work through your challenges.

 

[Sterling]

Nelson, Thank you for your response. I'm seriously considering stopping the Finasteride. I should have mentioned that I started TRT and my hair went to pot so I stopped cold turkey. That was over a year ago. My labs were drawn again this past February when they came in at 205.

I was taking 200mg/wk and that got my levels to nearly 1100. Morning erections were returning, I can't recall the last time I had one (circa 1999), and my drive was through the roof. Mild ED was still an issue but I was only on TRT for about 8 weeks and I am aware that low T is a risk factor for cardiovascular disease. I believe the minimum level is closer to 500 or 550.

I'l see what I can do to investigate other hair loss alternatives in lieu of foregoing TRT. As always, thanks for your help.

 

[Sterling]

Thank you, Orrin Isreael for your input. I have been in contact with Dr. Crisler but I just haven't pulled the pin yet and moved into a TRT protocol.

 

[Sterling]

CoastWatcher, I have been in CBT for the last year and a half. I have that going for me and thank you for your well wishes. I have a few decisions to make and a little investigating before I can do that. I'll use this forum for the great tool that it is as well as the input I receive from the helpful guys here like you.

 

[Re-Ride]

What did your PCP say about your T resulting at 205 ng/mL?
Did he offer you TRT? If so did he discuss a serum goal or anything else? Did he discuss a way to kick-start your natural production?

If he hasn't done all of the above it's time to:

(1) get full labs as described in the intro pages here by asking your MD for them or ordering from Discounted labs, no Rx required

(2) take them to a TRT specialist such as Defy

(3) educate yourself about all aspects of endocrine and general health from these pages

The use of hCG on this site is discussed as both FDA approved on-label mono-therapy and "experimental" off-label (long term in combination with T ).

If you are limited to using in-network care then ask any MD for a rule-out "primary" hypogonadism diagnosis.
One of the two FDA approved on-label hCG protocols for short term treatment of hypogonadic hypogonadism aka "secondary" hypo are typically used.

Attached is the pdf of actual FDA prescribing info for the physician. Since the safety and efficacy of the peptide is proven there is no legitimate reason ( assuming otherwise good health ) to not offer hCG as a first line approach prior to committing to lifelong TRT.
View attachment 1712

As you can see the FDA approved protocols are:

(a) Six week protocol: 500-1000 I.U. three times a week for three weeks followed by the same dose two times a week for the remaining three weeks

OR,

(b) Six to 12 month protocol: 4,000 USP Units three times weekly for six to nine months, following which the dosage may be reduced to 2,000 USP Units three times weekly for an additional three months

If you are diagnosed with hypo-secondary and you are otherwise healthy upon exam there are few reasons NOT to try one of the above before resorting to TRT.

Men often realize relief from the symptoms you described in as little as four weeks. The therapy is only contraindicated in those with serious underlying conditions.

Men who feel energized from T restored to a healthy normal range will almost certainly make better progress on lifestyle changes which, in turn, might allow them to avoid TRT. It is not uncommon to realize relief from anxiety and depression and have improved mental focus and productivity with hCG.

To sum up this approach you and your doc want to identify the cause of low T. A few practitioners really dig in such as ordering an MRI to rule out a pituitary tumor however most do not. Once a diagnosis for secondary hypo is confirmed treatment with hCG continues in conjunction with dietary and lifestyle changes. After 6 weeks to 12 months on hCG the pt is either weaned off hCG and an HP axis re-start attempted ( success at achieving satisfactory endogenous T is limited ), or the pt enters TRT or TRT combined with hCG as described on these pages.

The majority consensus is not to bother with hCG mono beyond confirmed hypo diagnosis and delve directly in to TRT preferably in combination with low dose hCG. IMO they are overlooking the benefit of quickly restoring energy levels and functionality in those men who are unsure if they wish to commit to lifelong TRT.

 

[Re-Ride]

Sterling, you added additional important information while I was typing, particularly the fact that you've already tried TRT. This introduces questions such as whether or not your doc properly withdrew you from TRT and followed up with a HP re-start. I still think that you should explore hCG for the possible relief from the cognitive issues which you mentioned.

My apologes for the pdf on the Novarel insert not showing up. It's easy to find with a search though.

 

[Loki]

I am a long time user of Finesteride (14-15 years) as well and I am switching to a topical version as soon as my order is fulfilled in Italy. My understanding is Fin actually increases testosterone rather than decrease. Obviously it lowers DHT which is the root cause of hair loss but I think imbalance of DHT, the body try's to correct by producing more T to convert to DHT... Also from what Dr. Ron Shapiro has told me he feels it has been his experience that over time it becomes less effective and it really slows the process but doesn't stop it... With that being said when you have been fighting a battle that long it is hard to stop in fear of what could happen...

 

[Sterling]

Re-ride, With my low levels, my PCP offered T gel. I was using Axiron and it did nothing but seem like an inconvenience. I hated the application process and felt no change. My doctor had me start at two pumps per day and we'd increase until I felt good. At least he was open to judging my use of T on how I felt versus a standard chart of normal. I eventually quit and moved towards a urologist in hopes of moving to injections. My experience with the urologist wasn't a very good one. I discussed my issues but he required just about every test of my prostate before he would consider prescribing T. After all the testing, he absolutely forgot the reason I came to him to begin with. That pissed me off and I never followed up with him. That led me to Defy. I had blood work done and started T with HCG and Anastrozole at 1mg a day. That protocol was created by Dr. Saya. Well, the side effects almost killed my hair but what was worse was that although my T level was nearly 1100 and my sex drive was through the roof, the ED was also worse. I was told that the AI that was prescribed was way too much and my E levels were tanked leading to extreme ED. After those experiences, I quit cold turkey and haven't been back since. I simply know that at 51, this is not the way I want to live what's likely to be my last 3rd of life. That's my story.

 

[Sterling]

Mica, I too have used Fin since 1999 and I do know Dr. Shapiro. What is his opinion of typical Fin?

 

[Loki]

Mica, I too have used Fin since 1999 and I do know Dr. Shapiro. What is his opinion of typical Fin?

I haven't started it yet but he says early studies show very good results... Seems to localize and Hasson and Wong have over 2 years of data on their patients that had sides on oral and on their topical no sides reported... The pharmacy that Hasson and Wong and Dr. Shapiro use is Farmacia Parati in Itally....

Dr. Shapiro has forwarded my prescript to the pharmacy and they are preparing it now... I will update you when it arrives and how it works... Once I get it Iam done with the oral version....

 

[ERO]

Re-ride, With my low levels, my PCP offered T gel. I was using Axiron and it did nothing but seem like an inconvenience. I hated the application process and felt no change. My doctor had me start at two pumps per day and we'd increase until I felt good. At least he was open to judging my use of T on how I felt versus a standard chart of normal. I eventually quit and moved towards a urologist in hopes of moving to injections. My experience with the urologist wasn't a very good one. I discussed my issues but he required just about every test of my prostate before he would consider prescribing T. After all the testing, he absolutely forgot the reason I came to him to begin with. That pissed me off and I never followed up with him. That led me to Defy. I had blood work done and started T with HCG and Anastrozole at 1mg a day. That protocol was created by Dr. Saya. Well, the side effects almost killed my hair but what was worse was that although my T level was nearly 1100 and my sex drive was through the roof, the ED was also worse. I was told that the AI that was prescribed was way too much and my E levels were tanked leading to extreme ED. After those experiences, I quit cold turkey and haven't been back since. I simply know that at 51, this is not the way I want to live what's likely to be my last 3rd of life. That's my story.

Just curious - not judging - but instead of stopping cold turkey, why not just reduce or eliminate the AI? Tanked E2 causes intractable ED, but that goes away once your E2 rebounds to a good level in a few weeks.

 

[Jackie Treehorn]

That led me to Defy. I had blood work done and started T with HCG and Anastrozole at 1mg a day. That protocol was created by Dr. Saya. Well, the side effects almost killed my hair but what was worse was that although my T level was nearly 1100 and my sex drive was through the roof, the ED was also worse. I was told that the AI that was prescribed was way too much and my E levels were tanked leading to extreme ED. After those experiences, I quit cold turkey and haven't been back since.

Sorry, I'm kind of having a hard time following your story. You're saying that Dr. Saya prescribed you 1mg of Anastrozole daily (a gigantic dose, btw) as a new patient...at the beginning of a brand new protocol...with just your baseline blood work, and no symptoms of high E2? Is that what you're saying?

Also, as ERO alluded to...why not just stop the AI if it tanked your E2, instead of going cold turkey? Makes no sense to crash your HPT axis because you're frustrated. Did you describe your symptoms to Dr. Saya? If you did, then what was his response? Sorry, but your story isn't adding up here. Are you leaving anything out?

 

[Sterling]

Jackie, That's exactly what I'm saying. That was the protocol that was established and I followed. I had no idea my E2 was going to tank. I was following what was prescribed for me. I quit because of accelerated hair loss. Does that add up for you?

 

[Sterling]

ERO, I quit because of accelerated hair loss. I wasn't willing to work on balancing my hormones and find my sweet spot due to the hair loss issue.

 

[Re-Ride]

Please select One from the following list: Hair, health/well being.
Millions make that choice every year. Did you know Skin is In? If you want it all now move to Marin.

I can imagine Dr. Saya prescribing 0.1 but not 1 mg anastrzole daily as a starting regimen.

ERO +1: Stop cold turkey! Sardines are far healthier.

If there is only a 1 in 10 chance that hCG mono for 6 weeks will strengthen and help focus, IMO that is something worth trying.

 

[Sterling]

I will see if I still have the original bottle with the dosage included. As for the other decision, time will tell.

 

[Dr Justin Saya MD]

Hello Fellas, I don't have much time to post on the forums with 4 children at home and the busy practice (although I do keep up to speed and scan periodically). Nelson has created a wonderful forum here and you guys have helped many patients through the complexities of TRT management. In fact, I've found the excelmale members that come through as patients to be some of the most educated of all and often have LISTS of questions pre-formulated from their fruitful discussions on this forum. Keep up the good work!

A forum member brought my attention to this thread, which I felt warranted my attention as it makes what I feel is a serious allegation...that I prescribed anastrozole at a dosage of 1mg DAILY.

Sterling - I believe this may need to be clarified by you as it appears you are mistaken. In fact, of THOUSANDS of patients I have treated I have only prescribed that dosage of anastrozole ONE TIME, and it was not for you. That was a case of a patient who came in to me already taking that dosage with E2 levels STILL elevated and had previously required 2 surgeries for gynecomastia. He was adamant that anything less would cause a recurrence of his gynecomastia so I simply continued his current dosage (and subsequently titrated down slowly as we controlled some of his other E2 factors - alcohol consumption, BF%).

Your previous post from 10/10/2013 titled "Got labs back" states the truth in this matter. That was the date of your initial visit with me (and per my medical records your only visit - never having a follow-up to allow adjustments to your regimen). In that post you CORRECTLY stated that you came to me from another provider and were already on a dosage of anastrozole 1mg BIW, upon initially meeting with you I then DECREASED your anastrozole to 0.5mg BIW due to the dosage your other doctor prescribed bringing your estrogen levels too low. Further, through email communication later that week by proxy through staff we then decided to STOP the anastrozole completely to see how your levels would adjust...once again there was no follow-up scheduled by you after that initial appt to assess and I have only 1 RX in my system for you from 10/10/2013 for anastrozole. If you indeed have a bottle stating anastrozole 1mg daily in MY NAME, PLEASE do forward as I will certainly need to have a word with the pharmacy about a serious error they made.