Opiate abuse and testosterone deficiency

[zojo360]

Very fortunate to have found this great website!! 45 year old male with 15 years of prior opiate abuse. Now clean for 5 years and on TRT since 11/18/2016 due to my poor mistakes with pain pills, methadone and at the end, suboxone. Initially put on the standard dose of 200mgs cyp every two weeks. After feeling great for 3-4 weeks, I suddenly gained about 15 lbs, feeling down, anxiety and an overall "off" feeling. Something is not quite "right" is the best I can describe it. No problems with erections yet libido is weak and there is a change overall since I started. I currently took things into my own hands and administer 50 mgs every 3.5 days of cyp IM as this is the more progressive protocol on this website. Have follow-up appt with endo on 2/17/2017 for blood work. I have contacted her regarding my late changes in feeling and she won't do anything until I see her in February. Have to wait until then and don't want to obsess about it anymore as this is not healthy for me. Any input is very much appreciated. I believe I have high E2 to begin with as my labs of 11/17/2016 appear to show a improper balance/ratio...

PSA,ANTIGEN=0.44ng/ml(range 0.00-3.60)
T4 FREE=0.94ng/dl (range 0.75-2.00)
TESTOSTERONE TOTAL=203ng/dl (range 240-950)
TESTOSTERONE FREE=4.47 (range 4.26-16.4)
another Testosterone total=162ng/dl (range 241-827)
TSH=1.900uIU/ml (range 0.450-5.500)
FSH=5.7mIU/mL (range 2-18)
ESTRADIOL=18.8pg/ml (range ND-39.8)
CORTISOL=18.8ug/dl (range 6-29 @8a.m.)
ACTH=20pg/ml (range 10-60 (a.m. Collection))
LH=3.98mIU/ml (range 2-18)

I also have "hepatic function panel" and "CBC" if those would help??

 

[Vince]

Congratulation on your recovery from opiate addiction. Your protocol of 200mg of T every 2 weeks sucks. You definitely a better TRT doctor.

 

[CoastWatcher]

Welcome to Excelmale. Yes, in regard to your blood work, please post all you have.

Your "standard" dose of testosterone, 200mg every 14 days, is the standard fool's protocol. You aren't the fool - your doctor is. You will never benefit from TRT on such a protocol; smaller, more frequent doses of testosterone will be the ticket to success. Congratulations on recognizing you needed to make changes. We all are our own advocates. Was SHBG not tested? Can you confirm your estradiol was measured via the sensitive test?

We look forward to your complete bloodwork, and - assuming you live in the US - you can self test through Discountedlabs.com. When did you change your protocol? How many weeks?

 

[zojo360]

Thank you Vince, Coastwatcher for taking time to respond.
I'm the type that never accepts the "status quo" on anything these days. Evolution is constant and everywhere especially in the medical sciences. I've been reading this forum since starting TRT, constantly looking to my peers for their personal experiences as that is the best way imo. I changed my injections 10 days ago to the every 3.5 days as this just makes more sense. On every level. Yet as I'm seeing here, without proper blood panels weekly ideally at first, I'm flying almost blind. I will be demanding that my endo test for shbg, prolactin and the more sensitive E2 test as I believe it's high now. At two week intervals of injections before, I felt really good for a bit as I probably hit my personal best ratio to T/E2 then quickly blew past it, now having it way off. It seems if I was already at an 18.8 E2 with a TT of 203, I tend to convert easily?
Living in Chicago and will be seeking alternative professionals

Rest of blood work:
Hepatic Function Panel
Albumin=3.8g/dl...range 3.4-5.0
Total Bilirubin=0.2mg/dl...range 0.0-0.9
Bilirubin, Direct=<0.1... range 0.0-0.3
Alkaline Phosphate u/l=65... range 43-117
AST U/l=10...range 9-37
ALT u/l=17...range 12-65
Total Protein g/dl=6.8...range 6.4-8.2

CBC panel
WBC=6.7...range 3.7-10.4
RBC=4.44...range 4.25-5.56
Hemoglobin g/dl=13.9... range 13.2-16.8
Hematocrit % =41.4... range 39.2-48.8
MCV fl=93.2...range 81.2-96.7
MCH pg=31.3...range 27.5-33.1
MCHC g/dl=33.6... range 32.1-36.1
RDW %=12.4...range 11.5-14.3
Platelets 10*3/ul=294...range 131-340
MPV fl=11.0...range 8.7-12.1

 

[johndoesmith]

Thank you Vince, Coastwatcher for taking time to respond.
I'm the type that never accepts the "status quo" on anything these days. Evolution is constant and everywhere especially in the medical sciences. I've been reading this forum since starting TRT, constantly looking to my peers for their personal experiences as that is the best way imo. I changed my injections 10 days ago to the every 3.5 days as this just makes more sense. On every level. Yet as I'm seeing here, without proper blood panels weekly ideally at first, I'm flying almost blind. I will be demanding that my endo test for shbg, prolactin and the more sensitive E2 test as I believe it's high now. At two week intervals of injections before, I felt really good for a bit as I probably hit my personal best ratio to T/E2 then quickly blew past it, now having it way off. It seems if I was already at an 18.8 E2 with a TT of 203, I tend to convert easily?
Living in Chicago and will be seeking alternative professionals

Rest of blood work:
Hepatic Function Panel
Albumin=3.8g/dl...range 3.4-5.0
Total Bilirubin=0.2mg/dl...range 0.0-0.9
Bilirubin, Direct=<0.1... range 0.0-0.3
Alkaline Phosphate u/l=65... range 43-117
AST U/l=10...range 9-37
ALT u/l=17...range 12-65
Total Protein g/dl=6.8...range 6.4-8.2

CBC panel
WBC=6.7...range 3.7-10.4
RBC=4.44...range 4.25-5.56
Hemoglobin g/dl=13.9... range 13.2-16.8
Hematocrit % =41.4... range 39.2-48.8
MCV fl=93.2...range 81.2-96.7
MCH pg=31.3...range 27.5-33.1
MCHC g/dl=33.6... range 32.1-36.1
RDW %=12.4...range 11.5-14.3
Platelets 10*3/ul=294...range 131-340
MPV fl=11.0...range 8.7-12.1

You have a great attitude, probably is the reason you've been sober for 5 years, the way you're fighting for your health is impressive. You will do well on TRT, with a proper protocol that is!

I do not think anyone needs weekly blood tests, TRT changes should be followed up with labs after 5 weeks minimum. Blood levels will not reach a "Steady state" as it's called in 1 week, so the results will be all different, and essentially meaningless.

Describe your recent symptoms. With high E2 the most concerning is gyno, as past a certain point it's not reversible.

 

[CoastWatcher]

Are you in a position to seek care on a fee-for-service cash basis? I ask because many of the leading physicians in the field of androgen replacement do not participate in insurance plans. Prime Body, a site sponsor, serves a number of our members and they have a presence in Chicago. Defy Medical, the national tele-health practice, serves many EM members and is highly regarded. Nelson has a good friend practicing in Chicago, too.

 

[zojo360]

Thank you johndoesmith for your input and encouragement. Yes, I am absolutely steadfast in my overall recovery, health, wellness and achieving my personal best possible healthy lifestyle no matter what. My experience with opiate abuse was extremely devastating. I lost everything and everyone that mattered. I almost lost myself due to frustration, depression and most likely suffering from serious hormonal issues. To get to your question. Recently, at the time I changed my IM injections, I started to feel anxious. I got bloated some yet also at the same time, I saw, as well as others a marked change in my physique muscular wise. I've always been a bit muscular and it seems to be coming back without a single trip to the gym yet. Just a few sets of push ups to failure EOD. Gyno is already an issue from my teenage years. Not too much yet even a little is psychologically a hindering. Also, just a bit of malaise overall and an ease of becoming emotional, in a easy to get watery eyed way when I am exposed to strong emotions other than anger. At the start of TRT, this was not the case. For a few weeks I felt the best in decades. Perhaps I was overly excited and in good spirits to truly address an underlying issue that kept me from my full potential health wise. The years and years of low testosterone. I do not want to solely focus on this aspect as I have to live a balanced life with no one thing spinning in my mind.

I will be giving TRT my absolute best, be patient as well as it's time to come to full fruition. I didn't get this way overnight and can't expect to feel my best overnight as well.

Gratefull for where I am now...

 

[johndoesmith]

Thank you johndoesmith for your input and encouragement. Yes, I am absolutely steadfast in my overall recovery, health, wellness and achieving my personal best possible healthy lifestyle no matter what. My experience with opiate abuse was extremely devastating. I lost everything and everyone that mattered. I almost lost myself due to frustration, depression and most likely suffering from serious hormonal issues. To get to your question. Recently, at the time I changed my IM injections, I started to feel anxious. I got bloated some yet also at the same time, I saw, as well as others a marked change in my physique muscular wise. I've always been a bit muscular and it seems to be coming back without a single trip to the gym yet. Just a few sets of push ups to failure EOD. Gyno is already an issue from my teenage years. Not too much yet even a little is psychologically a hindering. Also, just a bit of malaise overall and an ease of becoming emotional, in a easy to get watery eyed way when I am exposed to strong emotions other than anger. At the start of TRT, this was not the case. For a few weeks I felt the best in decades. Perhaps I was overly excited and in good spirits to truly address an underlying issue that kept me from my full potential health wise. The years and years of low testosterone. I do not want to solely focus on this aspect as I have to live a balanced life with no one thing spinning in my mind.

I will be giving TRT my absolute best, be patient as well as it's time to come to full fruition. I didn't get this way overnight and can't expect to feel my best overnight as well.

Gratefull for where I am now...

Wow. You have the most incredible attitude of anyone I've ever talked to on a TRT forum. This is all with screwed up hormones, so I can't imagine how you'll be with a proper dialed in protocol.

Do yourself a favor and dive into research. Wikipedia, this forum, google, PUBMED, just keep reading and reading. It'll take you a year to have a solid understanding depending on your science and medicine foundation, as well as your free time. You need to learn this.

 

[Vince]

Nelson's friend in Chicago is Dr Daniel Berger,MD Phone: 773.296.2400

 

[zojo360]

Thank you to everyone who responded, this forum and fellow peers seeking their own optimum personal best in health. This forum is an incredible vast wealth of stories and information all in one place. Vince, I will be calling Dr. Berger this week. I agree with you johndoesmith. Knowledge is absolute power..

 

[Dr Justin Saya MD]

Congrats on your recovery, zojo360!

I've lost friends and family to the horrors of opiate addiction, so it is heartwarming to hear stories of recovery and rebirth such as yours. Best of luck in your future journeys and stay strong!