Not sure what to do next

[Jason Sypolt]

I'm 37 and have primary hypogonadism and have been seeing a urologist for a little over a year now. My initial Total T blood tests came back at 224 and 159, but thyroid function, FSH, LH, etc. were normal.

The urologist seemed a lot more knowledgeable than from the horror stories that I've read on this and other forums, works with me on things like administering my own frequent injections so I can find out what works best within reason, mentioned AI's for managing estrogens, etc., but when I've started exhibiting symptoms and side effects of treatment (high Estradiol only) he tells me that it's beyond his experience and that he isn't comfortable prescribing anything and that I should seek a second opinion. He has even emailed me links to hormone therapy clinics that do testosterone and HGH.

I've tried the following dosages and have given each at least a couple of months to see how effective or not they are:

200mg / every 2 weeks
Of course I feel terrible by the time of next injection

100mg / every 1 week
I didn't like the rollercoaster fluctuations. Total T was 832.

50mg / every 3 days
Physical changes started like losing some weight and gained some muscle tone for pretty much the first time in my life, but it felt like I might as well have been injecting saline as far as mood and sexual function improvements. Total T was 956 and E2 was 32.7

60mg / every 3 days
I definitely felt this, and it was great - until I got really bad symptoms of high E2. Total T was 1059 and E2 was 42.6

40mg / every 3 days
Urologist wanted to try cutting the dosage back, and this is the worst I've ever felt in my life. Some of that was probably from crashing down from such a high level. Total T was 540 and E2 was still elevated at 27. I've read that the low 20's for E2 is optimal for most men.

I'm currently back on 50mg / every 3 days and started taking Anastrozole on my own because I really feel like I don't have another option for that at this point. Things have improved somewhat - I had every symptom in the book for high Estradiol, and they are slowly going away now since starting to take the AI. I had to demand to get the Estradiol blood test and after seeing the 42.6 result, the doc finally acknowledges that there is a problem. His response was to just try cutting back the injection dosage, but that just wasn't effective.

Something else - it seems like this is a problem of needing a waterfall to fill up a bucket so that I can feel any benefits at all. I don't have a lot of lab results since the urologist didn't seem to think they were necessary and I initially didn't know any better. But looking at what I do have, at 100mg of Testosterone Cypionate every week my peak 48 hours after injection was 832ng/dl. The low right before the next injection was 150. Is that right? I thought T Cypionate had a half life of about 7 days. That seems like a pretty fast drop in just 5 days.

Even with frequent injections every 3 days - if I miss an injection (had to go out of town at the last minute), it takes a week to get rid of the fatigue. It just seems like the testosterone leaves my body at a ridiculous rate.

So can anyone offer any advice and/or does anyone have any experience with these hormone therapy clinics? The message that I'm getting from the urologist is that he doesn't want to treat me since he doesn't know how. I live in nowhere western Ohio and there aren't many other options that are close by. The links I was sent were for Evergreen Life and Defy. I seriously think that he got them from a Google search. What sucks is that I have awesome health insurance. If I have to go to one of these clinics then that obviously falls outside of that.

I hope this post makes sense. I thought I had this all figured out up until a few months ago. I'm sort of not sure what to even ask for because I'm still trying to put all of this together and figure out what to do now.

 

[Helboi]

Have you ever had your SHBG tested? That could be the culprit, if it's low. Also, consider splitting your dose into every other day injections. That's what I did and haven't felt better since. You said you missed a dose when traveling out of town? Why? It's easy to take with you anywhere.

 

[Ty1on73]

If your up for it research daily shallow IM injections. I just started (yesterday) after reading thread below. My desire is to get a true steady state T reading and to see if it lowers my elevated E2 w/o using an AI. I've only been on TRT seven months now but the information and experience on this forum in invaluable.


https://www.excelmale.com/forum/sho...ht-on-T-cyp-injection-frequency-and-SC-vs-IM)

 

[Helboi]

If your up for it research daily shallow IM injections.

Might be a good idea. I'd recommend him going to EOD injections for 5-6 weeks first, then maybe to daily if necessary since he's only done every 3.5 days at this point.

 

[CoastWatcher]

Welcome to Excelmale, Jason. I would urge you to consider two points: self-test via Discountedlabs.com in order to correlate your body's objective response to the uneven, subjective, physical symptoms that you are reporting, and - most importantly - find a good doctor who is more confident and skilled in the management of androgen replacement. When testing, wait a minimum of four weeks, no changes, and test for total and free testosterone, estradiol (sensitive, LC, MS/MS), and SHBG. Have blood drawn just prior to an injection, and then evaluate.

You deserve better medical care. No, your doctor isn't the worst that has been described here at EM, but he isn't doing his job (his job is to help you). I can't speak to your financial situation, but to continue to seek sub-par medical care because a benefit plan will pay for it is doing you no favours.

 

[CoastWatcher]

I have injected on a daily basis for nearly a year. It was the best decision I ever made in regard to TRT, it gave me rock-solid, stable lab values. Still, many, many guys achieve the same - or very close to it - on an EOD injection schedule.

 

[Jason Sypolt]

Thanks for the suggestions. I've been reading about the sub-q injections, but keep putting it off so as not to introduce too many new things at once. I already use tiny insulin syringes, so I may as well try that vs IM in my delts which is what I've been doing.

50mg E3D with 0.25mg liquid Anastrozole is about a 3 out of 5 I'd say as far as feeling well. I've been on that for 3 weeks now. Adding in the Anastrozole started to improve things almost immediately. It was seriously bad. My current script is for 60mg E3D, so after testing levels at 50mg to see where I'm at, I want to go back up to 60mg with the Anastrozole and see how that works out. 60mg was 5 out of 5 - I had never felt better in my life until the E2 crept up. All of my bloodwork is in normal range except for E2. The CBC, CMP, lipids, liver - if I can get the E2 under control then I feel like I can eliminate the single problem I'm having. So I'll work in sub-q and more frequent injections.

I guess the biggest thing right now is what to do about a Dr. that will listen and know what he/she is doing. I'm not looking to abuse, but I am looking to feel better - feeling great even. Because it definitely seems possible and otherwise what's the point? I'm seeing the only other urologist in the area next Tuesday. Not really expecting much. My financial situation is ok, it's just that if I can get testing covered under my insurance, then a CBC, CMP, Total T, E2 - all of that is about the cost of a lunch vs what the private labs charge. If I do have to end up going to see a private clinic, are there any that are recommended that work remotely? I see a few on the sidebars of the forum.

Thanks!

 

[Helboi]

If I do have to end up going to see a private clinic, are there any that are recommended that work remotely? I see a few on the sidebars of the forum.

Thanks!

Yep, Defy does. That's who I'm with and I couldn't be happier. I've been with 2 others, and they weren't bad, just not nearly as good as Defy is.

 

[Ty1on73]

Thanks for the suggestions. I've been reading about the sub-q injections, but keep putting it off so as not to introduce too many new things at once. I already use tiny insulin syringes, so I may as well try that vs IM in my delts which is what I've been doing.

50mg E3D with 0.25mg liquid Anastrozole is about a 3 out of 5 I'd say as far as feeling well. I've been on that for 3 weeks now. Adding in the Anastrozole started to improve things almost immediately. It was seriously bad. My current script is for 60mg E3D, so after testing levels at 50mg to see where I'm at, I want to go back up to 60mg with the Anastrozole and see how that works out. 60mg was 5 out of 5 - I had never felt better in my life until the E2 crept up. All of my bloodwork is in normal range except for E2. The CBC, CMP, lipids, liver - if I can get the E2 under control then I feel like I can eliminate the single problem I'm having. So I'll work in sub-q and more frequent injections.

I guess the biggest thing right now is what to do about a Dr. that will listen and know what he/she is doing. I'm not looking to abuse, but I am looking to feel better - feeling great even. Because it definitely seems possible and otherwise what's the point? I'm seeing the only other urologist in the area next Tuesday. Not really expecting much. My financial situation is ok, it's just that if I can get testing covered under my insurance, then a CBC, CMP, Total T, E2 - all of that is about the cost of a lunch vs what the private labs charge. If I do have to end up going to see a private clinic, are there any that are recommended that work remotely? I see a few on the sidebars of the forum.

Thanks!

Sub-q is an option, it seems many, like myself, are doing shallow IM. I was promoting the more frequent dosing aspect to lower E2. I tried sub-q once and had a reaction for the same Test Cyp I had been using for a few weeks and went back to shallow IM using a 28g 1/2" insulin pin. You will find most on here like the 3.5 day dosing approach. I am just trying the daily for a month or so to see how the steady state delivery method effects my e2. Good luck finding a doc I know that is or has been a challenge for us all. Here is a link of how Nelson injects c.2014.


https://www.youtube.com/watch?v=0uXoBb6mkys

 

[Jason Sypolt]

Ah, I mistook or misread "shallow IM" as "sub-q". So it sounds like that's similar to what I'm currently doing by injecting into my delts. I use 29g 1/2", 1/2cc insulin syringes. You feel more from a mosquito bite with a needle that small.

I watched the video and didn't know that HCG improves sex drive. I thought it was only for correcting testicular atrophy. I had a vasectomy 7 years ago, so it's really only the libido that I care about. But now I can talk to a potential Dr. about HCG as well as managing E2 to hopefully get a more complete treatment protocol.

So, I'll see what this new urologist says next week. But I have a feeling that I'll probably have to go private. These doctors want to see clinical research on this stuff and get info from colleagues who have already prescribed it before they will consider it. No one wants to go first. I even offered to sign whatever waiver so that it wouldn't be a problem prescribing "off label", but no dice.

So I have no recourse at the moment for treating these symptoms other than to self-medicate. I can totally see how this ends up driving people to the black market for everything, then they abuse, it's sad. I actually told the last urologist that this morning and I think he felt bad even though he won't budge. He said he will mail me orders for bloodwork for Total T, Free T and E2 every month if I want to go get it checked and said to get a second opinion - basically go somewhere else.

 

[Jason Sypolt]

I decided to save myself time and trouble and got started with Defy Medical. I got my labs done this morning. It was a lot more than what the previous doctors I've seen have ordered. I need to get a required physical from my family doctor next week when he's back in his office. Then hopefully soon I can talk with one of the doctors at Defy who knows how to treat me effectively and we can get things sorted out.

 

[CoastWatcher]

I decided to save myself time and trouble and got started with Defy Medical. I got my labs done this morning. It was a lot more than what the previous doctors I've seen have ordered. I need to get a required physical from my family doctor next week when he's back in his office. Then hopefully soon I can talk with one of the doctors at Defy who knows how to treat me effectively and we can get things sorted out.

Keep us posted - all the best.

 

[ERO]

I decided to save myself time and trouble and got started with Defy Medical. I got my labs done this morning. It was a lot more than what the previous doctors I've seen have ordered. I need to get a required physical from my family doctor next week when he's back in his office. Then hopefully soon I can talk with one of the doctors at Defy who knows how to treat me effectively and we can get things sorted out.

Good move - you will love working with Defy. Also, just as an FYI - you can get a physical at most walk-in urgent care clinics if you don't want to wait for your regular doc. That is what a lot of us here on the forum do.