Misdiagnosed as "Adult ADD" ; baseline labs -- starting TRT

[atlman65]

Hi Guys,


I actually went to a psychiatrist for symptoms of "brain fog / can't focus"; irritability; poor sleep, fatigue, anhedonia, low libido and was dignosed with adult ADHD. Started taking Adderall. This seemed to help some but amphetamines will wake anyone up. While reading an adult ADHD message board I clicked a banner ad for TRT and saw all of my symptoms as symptom of low T. Thinking "what would be more likely at age 50 -- newfound ADHD or low T"? I got tested and had the following results:


Free Testosterone 4.7 ( 7.2-24)
Testosterone 430 (348-1197)
Estradiol 12.9 (7.6-42.6)
HCT 38
Cholesterol 189
PSA 0.4


I thought I would be disqualified by testosterone of 430 but the doc said the free T is what really matters and I would be a perfect candidate. I must have high steroid binding globulin (not measured)


He is starting me out on 2 doses of 250mg HCG on day 1 and 2 followed by 100mg of testosterone-cypionate on day 3 (weekly injections) (I am 5ft 11 in, 168lbs, 15% body fat, vegetarian diet)


I received my first injections of HCG and testosterone in the office and I must say I have felt Euphoric which I know is something that won't last as my body acclimates (unfortunately). Also more hungry and craving more protein than I typically eat. I will get tested and have meds adjusted (including aromatase inhibitor if needed) in October.


What do you guys think. Am I on the right track? Do you think most would have treated based on my low normal total T? From what I have read I am wondering if I should be doing HCG 3 x weekly and / or splitting testosterone to twice weekly. Am I being over / under treated or do you think this is a good start?


Thanks in advance

 

[Vince]

When your first start TRT, for most poeple their appetite does go up and then returns to normal. Your doctors protocol does look okay to me. Only way to know for sure is by labs.

 

[PAUL-E]

Amphetamines/Adderall lower testosterone by increasing cAMP in the local testicle tissue. I believe this also caused me to go threw an abnormal puberty when I was younger. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1909523/

 

[atlman65]

Thanks for the information Paul. I was only diagnosed and started on treatment 2 months ago -- I think I am on the right track with TRT and will be stopping stimulants (Adderall)

 

[PAUL-E]

Thanks for the information Paul. I was only diagnosed and started on treatment 2 months ago -- I think I am on the right track with TRT and will be stopping stimulants (Adderall)

I agree and think it will be beneficial to your health and longevity.

 

[Tommy Wall]

Speed is speed. I don´t think it is the right way to treat overactive or lively kids like they were called in the olden days(nowadays they are called ADHD). And most of them grew up and had normal lives.

 

[Loki]

Is there anything on long term effects of Adderall? A guy in my office pops them like candy and can't live without them. I think he takes 20MG per day... Seems like a heavy dose to me... I tried them once and I did not like the way it made me feel... Amped me up way too much....

 

[johndoesmith]

Is there anything on long term effects of Adderall? A guy in my office pops them like candy and can't live without them. I think he takes 20MG per day... Seems like a heavy dose to me... I tried them once and I did not like the way it made me feel... Amped me up way too much....

20mg per day is not a high dose. Also don't assume he can't live without them = drug addiction. I have narcolepsy, and I can't live without my adderall. I would not classify myself as addicted, nor would I classify most men on this board as addicted to TRT.

I understand there are probably some long term consequences to adderall use, but I see no other way to have a life, and not want to die.

I feel that there is a stigma around amphetamine use for medical reasons, which I wouldn't expect seeing as most men here dislike the stigma against TRT.

 

[Loki]

20mg per day is not a high dose. Also don't assume he can't live without them = drug addiction. I have narcolepsy, and I can't live without my adderall. I would not classify myself as addicted, nor would I classify most men on this board as addicted to TRT.

I understand there are probably some long term consequences to adderall use, but I see no other way to have a life, and not want to die.

I feel that there is a stigma around amphetamine use for medical reasons, which I wouldn't expect seeing as most men here dislike the stigma against TRT.

He stopped taking it once and became very depressed and suicidal.. I'm sure just like TRT there is probably a protocol to stop. Weird thing is when I stopped cold turkey off TRT once I didn't get depressed at all... But when I started 50MG of Clomid 5 days a week, those were the darkest days of my life... Suicidal thoughts for sure...

 

[johndoesmith]

He stopped taking it once and became very depressed and suicidal.. I'm sure just like TRT there is probably a protocol to stop. Weird thing is when I stopped cold turkey off TRT once I didn't get depressed at all... But when I started 50MG of Clomid 5 days a week, those were the darkest days of my life... Suicidal thoughts for sure...

Well it depends on the reason you're taking adderall. I am taking it because my brain cannot achieve the restful stages of sleep a person needs to feel refreshed, and since that will never go away, I will always be tired for the rest of my life.

If I stopped adderall(which I basically do every night, and wake up with very little still circulating in my blood) I would feel like I do in the mornings. I'd be depressed and probably close to suicidal again, but that's like taking away a person's wheel chair. They're not addicted to it, they're dependent upon it.

Since I have an issue where my brain can't regulate sleep, and unlike testosterone where the body CAN make it, there isn't a way of restarting like there is with testosterone.

In essence, adderall is like a wheel chair, it accommodates my lack of refreshing sleep.

 

[atlman65]

Hi Loki,
The treatment of ADHD is very much akin to the treatment of hypogonadism with TRT. The pre frontal cortex in people with ADHD is working too slow. As a result, you have trouble organizing thoughts, concentrating, staying on task etc. The medication targets this area of the brain and makes it work at the same "baseline" as everyone else. (Just like testosterone which brings a guy with low T back into the optimal range is not likely to experience any side effects) Stimulants have been used since the 1950s and have been proven to be very safe and effective when used for this purpose. If your friend has ADHD he probably can't "function" without them but he could go off of his dose and be just fine -- there is no physical addition. There can be a psychological addiction and some mild symptoms (like giving up caffeine) that lasts a few days. The standard adult dose of short acting would be about 10mg twice daily. 60mg is at the higher end. Like with most meds, under the supervision of a doctor the "right" dose is the dose that works and sometimes this exceeds the FDA recommended dose

 

[johndoesmith]

Hi Loki,
The treatment of ADHD is very much akin to the treatment of hypogonadism with TRT. The pre frontal cortex in people with ADHD is working too slow. As a result, you have trouble organizing thoughts, concentrating, staying on task etc. The medication targets this area of the brain and makes it work at the same "baseline" as everyone else. (Just like testosterone which brings a guy with low T back into the optimal range is not likely to experience any side effects) Stimulants have been used since the 1950s and have been proven to be very safe and effective when used for this purpose. If your friend has ADHD he probably can't "function" without them but he could go off of his dose and be just fine -- there is no physical addition. There can be a psychological addiction and some mild symptoms (like giving up caffeine) that lasts a few days. The standard adult dose of short acting would be about 10mg twice daily. 60mg is at the higher end. Like with most meds, under the supervision of a doctor the "right" dose is the dose that works and sometimes this exceeds the FDA recommended dose

I absolutely agree with you, good comparison to TRT. One thing I will mention, is that not everyone using adderall is using it for ADHD. That's probably the largest percentage of people taking it though.

 

[atlman65]

You're absolutely right. When I was in college it was NO DOZ caffeine pills to keep you going. Now its Adderall. Doctors are largely to blame. A prescription should mandate compliance -- after a one month script patients should be looking for a refill in a month (indicating daily use / compliance) and they should be following up on a regular basis. This medication should never be used "as needed" since ADHD doesn't come and go. Anyway, the point of this thread was that the symptoms of ADD in adults can be very similar to Low T. I was told my recent onset irritability and short temper was impulsivity, my "brain fog" was inattention, and that people with ADHD don't sleep well either. Stimulants would help fatigue too! I really think all these symptoms were due to my low T. Most adults with ADD are diagnosed as children and most children display symptoms before 7 years --- we'll see if my symptoms resolve with T alone

 

[DragonBits]

You could have ADD and low T both.

Sure you will feel good at first on TRT, doesn't mean you didn't have ADD.

ADD is more than just brain fog, it's more about impulse control, being easily distracted and not being able to focus, or hyperfocusing to compensate.

As to whether doctor will treat based on total or free T, IMO it's a crap shoot, I would guess if they have to go through insurance they are much more likely to base their decisions on TT. If they don't accept insurance, they then to be more liberal on what levels they treat on.

 

[DragonBits]

You're absolutely right. When I was in college it was NO DOZ caffeine pills to keep you going. Now its Adderall. Doctors are largely to blame. A prescription should mandate compliance -- after a one month script patients should be looking for a refill in a month (indicating daily use / compliance) and they should be following up on a regular basis. This medication should never be used "as needed" since ADHD doesn't come and go. Anyway, the point of this thread was that the symptoms of ADD in adults can be very similar to Low T. I was told my recent onset irritability and short temper was impulsivity, my "brain fog" was inattention, and that people with ADHD don't sleep well either. Stimulants would help fatigue too! I really think all these symptoms were due to my low T. Most adults with ADD are diagnosed as children and most children display symptoms before 7 years --- we'll see if my symptoms resolve with T alone

I have ADD and low T.

When I did take Adderall I didn't think I felt any different, my wife at the time said it made me more civil to talk to and that when I drove a car I didn't keep jerking the wheel / gas / break as often. More civil because I didn't snap at her when I got annoyed. So others noticed a change.

I don't take adderall after I dropped my insurance a long time ago as I didn't want to pay out of pocket, and I am not currently on TRT, but I was going to get on both.


But I can live without either one, it's just more difficult.

 

[bouquetCPA]

I was misdiagnosed with depression and my GP wanted to put me on SSRIs prior to me seeking out a specialist. It turned out that I had hypothyroidism and low-t. I often wonder what kind of roller coaster SSRIs would have put me on if I had listened to the GP...