My case.. 28 year old striving for optimal living!

[iEnigma]

Hello all. Let me preface this by saying this is gonna be a long post. I plan on using this thread as my mini journal in my quest for living optimally. Before I start I want to say I'm wow'd by how much information this forum has to offer. I am beyond glad that I've found it. To be honest I've been borderline obsessed reading deep into latter pages just absorbing all the information and searching for answers. Anyways yes thanks to everybody that contributes here it's nice to feel like there's other people out there who suffer similar symptoms and are working together to live optimally. I think that's awesome and inspirational. I get sad when certain threads die and no updates are followed up... I really hope it happens just because the OP was "fixed" hehe. Anyways here we go!

I am a 28 year old male of Asian descent. I'm 5'10" and weigh about 170lbs. I've felt like a mess emotionally recently and physically, and now I really wanna get to the bottom of it all and try to fix it. I've always felt some of the things I've been feeling as of late, but I guess the symptoms have recently been more pronounced. I've always wanted to see a doctor about this stuff, but never had insurance until now. I've since visited one GP (5/22/15), and most recently a urologist today (6/3/15). I found both of these guys via ZocDoc, and so far no complaints; both had stellar reviews. I would, however, like to go to a doctor who really specializes in TRT/hormones/adrenals (I'm NY based if anybody knows anybody good). Depending on how my next few MD visits and labs go, I plan on consulting with Defy as I have read nothing but great things about them here. Hopefully I can get some help here and get myself in the right direction. All comments, criticisms, etc are welcomed. I thank you all in advance.


Here's some of what I've been going through..

- constantly fatigued despite getting adequate sleep (no difficulty sleeping for the most part).. would lay in bed and sleep all day if I could
- feelings of anxiety/nervousness(general, social)
- I feel very awkward around people a lot of times
- can be moody.. can feel borderline depressed at times especially during times of stress
- can't grow a lot of facial hair, don't have aggressive "manlike" tendencies. I swear every guy has more facial hair than me. Every. I can't grow a beard to save my life and I hate it.
- lose concentration very easily / cannot maintain focus. lots of brain fog/lack of mental clarity
- very forgetful
- cannot formulate sentences well / express self clearly .. word salad?!
- very sensitive to light, cold, etc
- get colds/allergies easily. Seemingly always have a runny nose year round
- get hives all over my face/neck after cardio (basketball) that disappear about an hour or two after, depending on the intensity of the cardio. these are actually way more pronounced when I'm at the beach.. I get filled with these hives! I've also dealt with a slight case of vitiligo on the right side of my face a couple of years ago.
- hands are shaky-ish when idle
- don't build muscle easily.. lose it very easily as well
- despite constant working out and eating relatively healthy I seem to have a protruding belly.. especially after eating
- lowered libido recently.. slight ED.. difficulty getting erections at some times
- premature ejaculation.. dealt with this my whole life which sucks big time. I used to spend hours.. days.. reading about how to fix it to no avail.
- very rare morning / night wood
- urologist pointed out today (6/3/15) that my right testicle is smaller than my left, and said that he sees that "infrequently." So I guess that is definitely concerning.


Things that I take...

- multivitamin (optimum nutrition)
- fish oil 1200mg (about 2 per day)
- vitamin d3 (5000units)
- green tea extract
- zinc
- vitamin B complex
- whey protein (usually after working out)
- creatine (post workout as well)
- BCAAs
- preworkout drinks


Clearly I take one too many pills hoping something sticks and that my symptoms will improve.


I've also experimented with DAA (daspartic acid) trying to boost my test levels. It made me feel good for a little while, but it lost its effectiveness quickly.


I also drink I'd say at least once every other week. Just enough to feel nice.. I used to be way worse and get wasted at least once every weekend. I also enjoy partaking in smoking weed. That I also used to do daily. Now that also happens maybe once every other week. I also used to smoke cigarettes daily, but have switched over to vaping. Again, I hate that I do this stuff, but it's just the reality.


I workout roughly 3-4x per week. These days a little less. I do weights + basketball. I've always had a bit of a belly despite all of the working out.
Then again my diet isn't the GREATEST, but I am conscious of it and do attempt to eat semi-healthily.


I know some of the stuff to follow is repeating, but I think it's significant so I'll elaborate.. My libido has definitely been suffering over the years. I used to watch porn daily and masterbate a lot. I've always suffered from pretty severe premature ejaculation and haven't been able to fix it despite years of trying. I'm guessing that has something to do with my anxiety. I rarely get morning wood these days. Used to have a short refractory time with my lady but now I struggle getting myself up for round 2. I even feel myself having difficulty maintaining a strong erection for round 1 to begin with sometimes. Couple that with the quick ejac time and that crushes my confidence even more. Granted I have a great, understanding gf but with my state of mind I'm def afraid of losing her.


Honestly I've always felt these kind of things but I can feel myself getting worse lately. Always worried, always nervous, always stressed. It really affects me and makes me perform less than optimally in everything that I do. I always feel myself wanting to just stay in bed away from the world. Not a great way to live. These days where I feel like everything is wrong and I'm anxious are pretty debilitating and coming around way too often now. I think I need help and really feel something is wrong with me.



Here are my initial labs from the first doctor which were taken on 5/22/15. I also had one tube drawn today by the uro's nurse before I saw him.. He said when I met him that the tube would test for testosterone, and other hormones like LH / FSH which I was so pleased to hear since those seem to be a staple / big deal around here. Can't wait to see how those tests look.. I wanted to ask for other things to be tested (Estradiol sensitive, ACTH-S, DHEA-S, Cortisol salivary, reverse T3, Thyroid antibodies to name a few other seemingly popular ones around these parts) but I didn't get the chance. Maybe he can add them to the tube if I ask him tomorrow? Or maybe I'll just ask him to test those on my follow up visit next week (6/10/15). He also mentioned he was going to send me home with some machine that will measure my erections at night or something? IDK lol. Also mentioned he would do some kinda imaging test on my privates.. I think. We'll see.

I originally thought that maybe I had hypothyroidism, but judging by my labs and how the knowledgable fella Chris around here seems to evaluate other people's Thyroid panels, mine seem to fall under the "good" category.

I feel like i have some sort of adrenal fatigue. I was reading around and thinking of supplementing with something called "Gaia adrenal health". Somebody raved about it here and it has good Amazon reviews. Also thinking about trying DHEA, but I definitely want to see what my level is before I dive into that. Clearly my Testosterone is on the lower end, and I would like to get my balls producing that endogenously rather than diving into TRT. I was thinking maybe clomid and HCG would be a worth start if warranted? What would I do if God forbid I had a pituitary adenoma? Would I be able to recover from that?

Anything else that you guys think could be going on?

Sorry again for the huge post. Thanks to everybody who read it. Again all comments, criticisms, etc are welcomed.

 

[Hammer]

Just a heads up based on personal experience. Before embarking on the TRT path, make sure that you have a sleep study performed to check for sleep apnea as an initial step. If you have no apnea issues, make sure that you get complete blood panels to tell the whole story. I didn't see any estradiol results. Your estrogen levels may be elevated which could be controlled with an aromatase inhibitor. Also, get your pregnenolone level checked which is the primary hormone from which all others are derived. Your cholesterol may not be converting to pregnenolone. Your free test levels are low and may be bound to excess SHBG. Good luck finding a doc that is well versed in hormones. They are not easy to find. I suggest that you read as much on your own as possible while working with a doctor to insure optimal results.

 

[ERO]

Many of us here have found great doctors at Defy Medical and they can do everything via telephone and on-line. Remember, that most doctors are not up to speed on TRT and related issues, whereas Defy specializes in it.

 

[CoastWatcher]

You certainly need to find a doctor who knows hormone replacement thoroughly. It's all too easy to wind up consulting a physician who has all the "correct" credentials, but isn't up to date on how to manage the entire process. I've no relationship with Defy Medical, but have read only first-rate things about them here on the Forum.

 

[iEnigma]

Hey guys. Thanks for the replies. Here's an update.


I had another appointment with the Uro yesterday (06/10/15), and it wasn't anything special. Honestly I only really came for the lab results.


First thing that happened was the doc injected I believe a vasodilator into my penis and did an ultrasound which came out positive and unremarkable. It also gave me a temporarily heavy penis. Lol. He also gave me some "Rigi(?)" machine that's supposed to measure my penis's activity when I go to sleep for one night. I will use it tonight perhaps.


Anyways to the lab results. As can be seen, my total T level was towards the bottom of the acceptable range. Still within range so the doc practically dismissed it. Expected, I guess. Based on this test and my previous one which tested my free T I clearly have low test issues - there's no denying it at this point. Also, my LH is at the very bottom of the acceptable reference range. From what I've gathered this means that I am not primary hypo? Right?! I also don't have high prolactin so from what I gather I may not need a pituitary MRI?


Regardless I think I'm pretty much done with this Uro at this point. I don't believe he and I can work together towards what I'm looking for. He wasn't very receptive to me about my wants. I clearly need more labs. What I'm most interested in is SBHG, Estradiol ultrasensitive, pregnenolone, DHEA... Anything else I need? I was thinking 4 point cortisol test.. Maybe reverse T3, thyroid antibodies?


I think my next step on this journey is to go to Defy medical. I don't think any other doctors will be able to help piece this puzzle together for me. I need people who are specialists. Will they run these tests for me? I don't wanna jump into TRT or anything, I wanna cover every corner before doing that. I think HCG and/or Clomid "restart" sounds like a good plan.


I'm considering buying DHEA and Pregnenolone supplements. Sucks that I don't have the labs for those yet, but from what I've been reading I feel like I'm lacking in those two and that they'd help. I really feel like I have adrenal fatigue symptoms.


So yeah my next plan of action is to go to Defy and go from there. What does everybody think of that?


All comments, questions, criticisms appreciated. Thanks for reading!

 

[Nelson Vergel]

Besides the blood tests you mentioned, I would add DHT since it is highly correlated with libido and erectile function.

Let us know your experience with the RigiScan. Is it this big?



Have you tried daily low dose Cialis? Increasing your T and including HCG could also be options.

The folks at Defy will be able to help.

 

[a_crossfitter]

I am a scientist, Electrical Engineer to be more specific. I cannot believe how some doctors don't think outside the bubble.

In my field, I want to see as much data as possible. One data sample does not paint the whole picture of what is really going on in a very complex system (such as our bodies). I am outraged by the way some medical doctors think. I am here typing FURIOUS.

The ranges provided in each of these blood tests come from many data samples from the general population. I dont know what statistical algorithms they use to arrive at these limits. I cannot believe why they use these limits to blatantly decide whether patient X, who is within the limits, does not merit to use a specific drug.

Why don't they go off of how a patient feels?

I haven't tried Defy Medical, but I have a feeling that their medical professionals will responsibly give you access to FDA approved drugs shall they think you merit sampling/using them if they help your quality of life.

I am glad to have the MD I have because he listens and is receptive too.

I have legitimate low T and I've tried: Adderall, Wellbutrin, Nuvigil, Armour, Synthroid, Testosterone Cypionate, HCG and Clomid.

I ran an experiment on myself and sleeping well has greatly improved my fatigueness; however, it has not raised my T, hence, I was and will be coming back to TRT.

 

[iEnigma]

Hey all.. just an update!

I've since joined Defy Medical and as of 7/8/15, I've been on Clomid 12.5mg every day. I was also taking DHEA 50mg daily. Here are my most recent labs which were done on 8/6/15.

(Tried to add the photo, but I don't have enough posts apparently).

ESTRADIOL 48 (<=39)
DHEA 960 (85-690)
TESTOSTERONE, FREE 178.8 (35-155)
TESTOSTERONE, TOTAL 1257 (250-1100)
SHBH 45 (10-50)

On paper, my values looked pretty good. Objectively felt better as well. My symptoms improved as well. I definitely don't feel like I'm dragging my feet throughout the day.. Don't feel like laying in bed isolated from the world all day. Still have anxiety especially in public settings. A bit moody like I always have been, but the days of despair weren't coming around as often and as hard. Still feel like my mind doesn't think quickly, and also like I don't feel like a real man. Libido and erection quality *SEEMS* a little better... definitely nothing groundbreaking. There may be a placebo effect taking place as well, perhaps. Felt some improvements, but still a ways to go.

After getting these results I had another consult with Dr. John, who then decided to add Anastrozole 0.25mg every 3 days. I inquired about Pregnenolone since I read about it improving anxiety. Dr. John said to take Preg cream 100mg every day. Was going to go through with this, but decided to go with sublingual version initially considering the costs.

So since 8/8/15, I've been on Clomid 12.5mg daily, Micronized DHEA 25mg (decided to half my dosage since my values were high, and I was adding Preg), Pregnenolone 25mg sublingual, and Anastrozole 0.25mg every Tuesday and Friday. I feel okay, but still want more. What I really am longing for is for my brain to be sharper. I feel very forgetful and a slow thinker. Maybe I'm just a dummy and this has nothing to do with testosterone, but I want it haha. I also feel like I need to be more manly. I want to feel in control of situations, I want to be proactive - not reactive.

I am due for labs again soon. Considering my regimen, when do you guys think is the best day and time to get them drawn? What do you guys think of my labs and my symptoms now?

Any other questions or criticisms please send em my way. Look forward to hearing from you all.

 

[CoastWatcher]

It sounds as if you have made significant progress in four months - congratulations. Your decision to seek care through Defy is a sound one. Have patience (easier said than done); there is every reason to hope for continued improvement.

 

[Hammer]

Based on your previous protocol of climid and DHEA, your testosterone levels are a little on the high side so I don't know why you would want them any higher. Your doc is giving you an aromatase inhibitor that should lower your estradiol level which is currently twice what it should be. Based on my experience with pregnenolone cream vs tablets is that the cream is absorbed much more efficiently, at least for me. Pills did virtually nothing for me. I had added 40 mg of pregnenolone and 40 mg of DHEA on a daily basis. It raised my testosterone levels by 50%. I had the blood drawn one week after my testosterone cypianate injection of 0.4cc/week. I felt much more anxious than normal so I backed off of the pregnenolone and DHEA to 3 times per week. Also my sleep was horrible. You have to be careful because sometimes these hormones metabolize in a manner that gives you the direct opposite result that you were looking for! Kepp a journal and update it on a daily basis. I found this approach to work best so that you can identify why and when certain changes occurred. I have lifted weights and ran for 40 years on a regular basis and was always tempted to do steroid cycles but always resisted the temptation. Five years ago I started testosterone therapy due to low thyroid (high TSH 9.5) and low T readings of 310 - 350 range. I had brain fog issues and memory problems. I was in a high stress executive position and needed mental clarity to function in my career. I started testosterone therapy and have been happy with the results. That said, it is a forever decision. Later, I found out that I had sleep apnea. Don't go on testosterone if your levels are at least average for your age. Stay on the cloimid and DHEA if that works for you. By the way, with your somewhat high testosterone levels, you didn't mention your DHT level. If elevated for long periods of time, it can affect the prostate. As far as your feeling of fatigue, have your thyroid tested along with a sleep study to rule out sleep apnea (even at your age)! best of luck!

 

[Hammer]

I just wanted to add that I saw you had your thyroid tested and the numbers looked ok. That said, you mentioned that you had Vitaligo which is an autoimmune disorder that is common in people who have had Hashimotos disease where the thyroid feeds on itself. Have your thyroid antibodies checked to see if you have Hashimotos. The low levels of LH indicate a problem in the HPTA. You will narrow it down eventually but it takes time. I went to an endocrinologist for 3 years before swathing to another doctor that identified the Hashimotos problem within the thyroid. It is amazing how the testosterone and thyroid hormone interplay which can take a while to balance out.

 

[iEnigma]

Hey all. Been awhile since I've posted here. I am now 31 years old, and have been on the same protocol of Clomid 12.5mg every MWF. In the past 3 years I've been coasting along on this, with so-so results. Objectively my #s have been okay, but the subjectives have been quite volatile. My anxiety, depression, mood swings, social anxiety etc actually had bothered me to the point where I started Lexapro in June. Four months passed and it seemed to be working, I was okay, and living a semi-normal life. I thought maybe depression & anxiety were just underlying issues that I have with no cause for them, and ADTs were what I needed all along. However, around October I started to feel like I was relapsing and going deeper into terrible swings into depression & anxiety once again. I am not open to the idea of trying all the ADTs, I'm back to thinking that it's time to focus on my hypogonadism & potential thyroid issues instead.

I have already drawn up bloodwork for Defy Medical, and now am waiting on those results & my next consult. After doing my research, I think that ultimately I am ready to drop the Clomid & jump into a TCyp, HCG, & arimidex protocol. I'm ready to do this for life. Rather stick myself multiple times a week, then allowing myself to live such a poor quality of life.

So here I will continue on my journey to living optimally. Any questions or things that I should be thinking of please let me know. I will be posting my lab results as soon as they populate.

Also, does anybody have experience with the providers at Defy other than Dr. Saya? Scheduling a consult with him would require a minimum 2 week wait, and I kinda sorta really wanna get the ball rolling. Dr. Colker is a provider that they suggested. Any input on that would be great.

Thanks all & HAPPY NEW YEAR!

 

[Vince]

Hey all. Been awhile since I've posted here. I am now 31 years old, and have been on the same protocol of Clomid 12.5mg every MWF. In the past 3 years I've been coasting along on this, with so-so results. Objectively my #s have been okay, but the subjectives have been quite volatile. My anxiety, depression, mood swings, social anxiety etc actually had bothered me to the point where I started Lexapro in June. Four months passed and it seemed to be working, I was okay, and living a semi-normal life. I thought maybe depression & anxiety were just underlying issues that I have with no cause for them, and ADTs were what I needed all along. However, around October I started to feel like I was relapsing and going deeper into terrible swings into depression & anxiety once again. I am not open to the idea of trying all the ADTs, I'm back to thinking that it's time to focus on my hypogonadism & potential thyroid issues instead.

I have already drawn up bloodwork for Defy Medical, and now am waiting on those results & my next consult. After doing my research, I think that ultimately I am ready to drop the Clomid & jump into a TCyp, HCG, & arimidex protocol. I'm ready to do this for life. Rather stick myself multiple times a week, then allowing myself to live such a poor quality of life.

So here I will continue on my journey to living optimally. Any questions or things that I should be thinking of please let me know. I will be posting my lab results as soon as they populate.

Also, does anybody have experience with the providers at Defy other than Dr. Saya? Scheduling a consult with him would require a minimum 2 week wait, and I kinda sorta really wanna get the ball rolling. Dr. Colker is a provider that they suggested. Any input on that would be great.

Thanks all & HAPPY NEW YEAR!

Defy Medical Doctors​

https://www.excelmale.com/forum/showthread.php?13066-Defy-Medical-Doctors

 

[iEnigma]

Lab results are in.
Couple causes for concern. BUN has never been elevated. Not sure what's going on with that, but maybe it means I was dehydrated at the time of the test.

Next issue is my lipid panel is all out of wack. My exercise regimen as well as diet hasn't really changed much at all in the past 6 months. The only thing that has changed is the addition of Lexapro, which I've read may cause people to gain weight. My weight, as far as I know, has not changed. Nothing drastic anyways. I am still relatively fit, I just can't pack muscle or lose stubborn fat in my stomach or love handles. Come to think of it, my physique was definitely much better prior to starting Clomid therapy.

Biggest issue to me is the rise of my TSH level to 3.61. Prior to this test I've been at about the 1.8 range. I have been taking my temps recently and I average around 97.7. When I wake up from sleep it's 96.1. I'm considering doing an iodine replenishment therapy that I learned about in another forum where I take 50mg of iodine daily for a month or so. Also, I intend to get a full thyroid panel workup. Should I do this through defy? Probably not is my guess. I also have issues with vitiligo which I suspect are related to my rising TSH levels. My autoimmune system seems to be messed up.

TT, FT, and SHBG are around where I expected them to be.

Plan: I intend to call Defy and get the next available consult with whomever is available first. It's been an inconsistent 3 years, and it's time to say goodbye to clomid. I intend to ask for it to be d/c'd, and initiate T-Cyp therapy 100mg in 2 split doses per week(q3.5d), and HCG 500 in 2 split doses as well(q3.5d). I intend to put both medications in the same syringe. On pinning days I also plan on taking .25mg of Arimidex, totaling .5mg per week.

Next thing I want to do is taper off my Lexapro. I'm hoping that TRT will help relieve this depression & anxiety. I feel that this medication is disrupting my cholesterol levels.

I also plan on treating my therapy as mentioned above. Do you guys feel that I should go through with the iodine 50mg daily?

I've tried to avoid it, but I think it's time to proceed with TRT. I look forward to getting myself dialed in, and hopefully living a better quality of life. I hope that this thread can not only help me, but help others who have similar cases.

I look forward to all comments, criticisms, suggestions, and more. Thanks for reading!