Movement in a Positive Direction

[crazycanuck]

Well, after thinking that I hit the jackpot with how well things were progressing with the various doctors and referral, getting set up on sub q Test c and Hcg, etc, then hitting the wall on my follow up with the urologist, it appears that things are looking up.

After having the local urologist tell me that Hcg was next level TRT, if my levels got much higher than the 401 ng/dl he would cut my dose as it would be "supra-therapy" and there was no need for any test other then total t, I took matters into my own hands. I fired him as my urologist.

During my early journey (3 months already into TRT) i was lucky enough to be sent to a urologist to set me up with the Sub Q protocols (Dr. Greenspan). After deciding to drop my local urologist, I called and booked an appointment with him, and as luck would have it, as I was previously seen by him, I didn't need a new referral. I met with him and provided him my most recent numbers (545 ng/dl), told him that I am good 75-80% of the time but still get symptoms and explained what the previous urologist said and asked if he would take me on as a patient. He agreed.

He told me that my numbers are good but not great as he likes to get guys into the upper / high normal range. He indicated that he will probably increase my dose (100mg/week split into every 3.5 days) but wants to wait another 3 months to ensure that I am at a stable level and my body has fully adjusted. He is also maintaining me on Hcg (500iu every 3.5 days - day before Test c) and gave me a req for blood work, including estrogen (non sensitive in Canada). He added that the estrogen will be a guesstimate and we will compare with any symptoms.

So, all in all, things are looking up. The Dr is a no nonsense, straight shooter who knows his stuff. Wish he would have increased my dose but can understand where he is coming from.

I should add that my other labs were a bit ugly. LDL and Cholesteral were HIGH, HDL was low and ALT was elevated. All due to not getting to the gym consistently over the last four months. Been daily clean diet wise so I know it is a lifestyle piece that will bring those numbers into check. That and supplementation. Started DIM (100mg daily), Milk Thistle and will be starting NAC to help with LDL and liver.

 

[Nelson Vergel]

I am glad your search and firing a bad doctor led you to one that may be good. Can you share details on your new doctor for Canadian members struggling to find one?

By the way, how elevated was your ALT? Milk thistle has not been proven to work for liver enzymes. You are better off with NAC at 600 mg twice per day and SAMe at 400 mg twice per day. I also think DIM has questionable efficacy to modulate estradiol (that is the test you want: estradiol NOT estrogen).

 

[crazycanuck]

Thanks for the reply Nelson. Btw, I grab a copy of your both and wish my biology and chemistry books from university were written so straight forward.

So yes, he ordered estradiol not estrogen. Late night posting and not paying attention.

As for details about the doctor. Dr Greenspan is a urologist based out of Hamilton, Ontario. He was the first Canadian Dr to examine the use of sub q injections for testosterone back in 2005 I believe. Here's the study title if you want to look it up in detail (STABLE TESTOSTERONE LEVELS ACHIEVED WITH SUBCUTANEOUS TESTOSTERONE INJECTIONS: M.B. Greenspan, C.M. Chang; Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada). The Saudi Med J 2006 study conducted through the Royal Victoria Hospital / McGill in Montreal used his study as a starting point. As I said, he believe that levels should get to the high normal range in TRT without question. He also open to talking about the therapies and his views, particularly if you come in educated (armed with some basic knowledge) on the topic.

The only issue for Canadians, particularly those in the southwestern Ontario area, in trying to get to see him is that you need a referral from you PCP. What usually happens however, is that PCP make referrals to specialists associated with their clinic group. So, you need to advocate for yourself and request the referral to Dr Greenspan, as a specialist in TRT. The drive to see him is well worth it in my opinion.

For the supplements, I have taken Milk Thistle more for the immunity support with the potential spin off for liver function. Knowing that I needed something effect, I went to NAC. My levels aren't extreme, as they are at 63 and the high lab range is 42. I have historically ran high ALT (50) as a result of fatty liver but being hemachromitosis, an increase isn't good in the overal picture.

The DIM is controversial I known but I have also found that it takes away huge sweet cravings after I have been on the, for a bit (3+ weeks).

 

[madman]

Glad to hear CC. I took your advice and spoke with Laurie Rigg from CHIC clinic related to the TruBalance network. I sent her my most recent labs and she looked them over and said Dr. Kiellerman would treat me so she wants to send me a new blood requisition and get everything done again as theirs is extremely thorough and than wants to set up an appointment to see him.

Unfortunately they prefer to start most patient on the compounded test cream even though he does prescribe injections if the patient does not respond well to the topical and agrees that reaching the high/normal range is optimal.


We exchanged many emails as I had so many questions to ask and she seems like a very knowledgeable understanding NP and that my views on being treated for trt are along the same lines as Dr. Kiellerman and she feels he would be a good fit. It is $450 for the first appointment than you see him twice yearly at a cost of $250 each visit.

I just have a hard time with the whole bio-identical hormone thing even though they state trt also. At least with the compounded creams on average most patients are prescribed 50mg-100mg twice daily although everyone is different and would respond to individualized protocols.

She is waiting to hear back from me as I am still some what unsure because I also have to see my new GP in a few weeks and actually bumped into my now retired GP at a walk in clinic and showed him my most recent labs and asked him again for a referral but he said I would have to wait until I see my new GP. After looking at my blood labs he said this seems to be an ongoing issue and asked if I wanted to see an endo/uro and I mentioned Dr.Greenspan and he said he would be a good choice and to ask my new GP for a referral to see him.

So Laurie wants me to do the new blood work and book me to see dr. Kiellerman 3rd week of November but I think I would rather see Greenspan.

When you first went to see Greenspan what levels were your TT/FT at? I am low/normal TT........LifeLabs range 8.4-28.8nmol/L and mine was11.7nmol/L (336ng/dL) and low/normal FT................LifeLabs range 196-679nmol/L and mine was 225nmol/L

I am sure yours were much lower than mine from reading your previous post so not sure how Greenspan would look at my numbers as they are not low but low/normal as I am still in the range?

Do you have any idea how he would view a patient with my levels? In the US LabCorps range is 350-1197 ng/dL a over 100+ points on the low and high end TT range compared to Canada.

Let me know if you think it is worth a shot to try and see Greenspan................a good sign was that he likes to see patients levels in the high/normal range. Take care.

 

[crazycanuck]

When I got out on TRT my numbers had crashed below normal. I think TT was 5.7 nmol/l and free was below as well.

Not sure what the urologist would say about the low numbers. When converted to ng/dl the fall into the range for TRT being an option, according to the nebido conversion scale. I would think if you stress the symptoms with the low numbers, you might have luck. Just remember, the only thing that it costs is time to get in to the urologist.

As for the CHIC, a quick review shows some positive reviews. Don't let the "bio identical" talk scare you. Testosterone regardless of delivery method is bio identical. The phrase refers more to female HRT. The accreditations for the dr attached to the clinic are on parr with other TRT clinics in Norh America. I know for myself that TruBalance would be my fall back if things don't work out with the traditional route, considering you can write it off.

About the cream, I am sure if you stressed concerns about transference they might be open to injections. But, if they are willing to work with you, that's the first part of the battle. Plus you never know, you might luck out and the cream works great for you.