Secondary vs. Primary (Should protocols be different?)

[Xerxes]

Hi all,
So i have had (as many here have) ups and downs and a bit of a roller coaster ride on my 7+ month TRT journey. Current protocol is 40MG cypionate MWF and very small doses (1/8mg) of arimidex as needed by symptoms.
When my lows are there, my libido and erectile function arr really bad and my anxiety and insomnia come bad. I've been steady on the above protocol since late summer. My most recent blood work from October showed great T numbers, both free and total. E2 was good (maybe lowish, but considering my SHBG and that I was feeling pretty good at the time I figured it was okay for me, but I stopped taking te Arimidex then for a while (probably laid off for a month).

Oct 12 2015
Total 949 range 290-836
free 288 range 30-150
SHBG 16 - range 10-57
e2 14.52-7.02-49.06 (ultra sensitive)
FSH and LH were zero as to be expected.

I finally dug around and found the original numbers my doctor pulled (he had only told me about the total T numbers). These are from 5/1/2015 BEFORE Starting TRT (same ranges as above)



total 289 range 290-836
free 61.65 range 30-150
SHBG 24 - range 10-57
e2 NOT TESTES-7.02-49.06 (ultra sensitive)
FSH 2.6 range 1.5-12.4
LH 2.2 - 1.7-8.6

I had never seen my original LH or FSH numbers. From what I can research that means I am secondary rather than primary (i.e. its my pituitary or hypothalamus rather than my testes). Is this better or worse? Does it require any different protocol? Would a restart be more likely to work for secondary guys?

I am actually going to my primary today at the urging of my wife to see about maybe starting an SSRI (again) to see if that can help with my mental health. She also thinks it might make sense to try a restart or maybe stop the T therapy. The highs and lows in my mental state, anxiety levels, libido, etc. are getting to both of us.

The frustrating part is that there are stretches when I feel like a new man, and then other times when I feel crazy anxious with no libido and just plain awful.

I am going to see my urologist, who is managing my TRT on Jan 19th. I think I might ask him to draw the necessary blood work that DEFY wants and at least have a consult with them.

I am just not show what else they could do for my protocol...NOt sure I want to try HCG b/c I seem to respond so poorly to elevated E2. Any suggestions or insight?

 

[Vince]

I don't believe your protocol should be any different. My concern would be your e2, do you thing it may be too low? What happens when you're off an AI. How do you feel when you're not taking your AI?

 

[CoastWatcher]

A restart, after an extended period of TRT? And your levels were only at 289 when you started?

I presume you've seen this on restart protocols?

https://www.excelmale.com/forum/sho...olics-You-May-Want-to-Read-this-HPTA-protocol

 

[Xerxes]

I've definitely looked at the restart protocol that you've linked and have reviewed Defy's literature on it as well. I'm only 35 and consistency has really eluded me. Started gels in May and they actually lowered my T numbers to 218, then went to two tubes, then shots in mid June and felt ok for a while, but then terrible, then upped dose then really really terrible. That's when I first had my E2 checked and it was 42 on non-sensitive back in August. Got arimidex and took a bit and felt relief and then like 3 weeks later had my E2 tested again and it was 19...and stopped arimidex. Stopped taking until symptoms popped up again....was feeling great for a while...then symptoms would pop up, then i'd take some arimidex... really very small amount 1/8mg or 1/4 mg a week... I think a few times (1x in Oct and 1x in Nove must have gone low, but stopped so quick that I was feeling good again a week.. in fact, better than a long time...

But it's a crazy see-saw with zero consistency. I've on TRT total for 7+ months and shots for 6+ months.

I'm just wondering if a restart and SSRIs might be better than the lifelong inconsistency of TRT.

I have pretty bad anxiety at times and when I am not feeling well on the TRT it ramps up and/or is a symptom of something off with my levels of T or E2 or some other hormone I am ignorant of. Then I start to fixate on the whole thing and ruminate and totally lose confidence of ever getting better. The libido, ED stuff really takes a toll on me psychologically when it's not good.

I know I babble and spew on here sometimes, but I don't many outlets to discuss this stuff. My wife is basically the only person who even knows I am on the TRT.

Maybe I should try the SSRis in conjunction with my TRT and that might help my anxiety and obsessive thoughts. I guess I should also stop playing with the arimidex fire, but it really had made me feel the best I had ever felt on TRT for short periods of time.

Sorry again for the long reply. Just frustrated again. I was feeling pretty damned good right before Christmas, but that week after really took me down the rabbit hole again.

I'll let you guys know how my meeting with my primary goes this afternoon.

 

[BBaller]

Hey Xerxes- I have people close in my life who struggle with anxiety and other mental health issues, and know how tough it can be.

Like many others here, I work with Defy and have had a good experience so far; I don't know what your insurance situation is, or if you'd be able to work with Defy out of pocket. But they have a strong track record of helping guys dial in their protocols, and it might be worthwhile to consider a consultation with them if you're able to. Good luck!

 

[CoastWatcher]

I've definitely looked at the restart protocol that you've linked and have reviewed Defy's literature on it as well. I'm only 35 and consistency has really eluded me. Started gels in May and they actually lowered my T numbers to 218, then went to two tubes, then shots in mid June and felt ok for a while, but then terrible, then upped dose then really really terrible. That's when I first had my E2 checked and it was 42 on non-sensitive back in August. Got arimidex and took a bit and felt relief and then like 3 weeks later had my E2 tested again and it was 19...and stopped arimidex. Stopped taking until symptoms popped up again....was feeling great for a while...then symptoms would pop up, then i'd take some arimidex... really very small amount 1/8mg or 1/4 mg a week... I think a few times (1x in Oct and 1x in Nove must have gone low, but stopped so quick that I was feeling good again a week.. in fact, better than a long time...

But it's a crazy see-saw with zero consistency. I've on TRT total for 7+ months and shots for 6+ months.

I'm just wondering if a restart and SSRIs might be better than the lifelong inconsistency of TRT.

I have pretty bad anxiety at times and when I am not feeling well on the TRT it ramps up and/or is a symptom of something off with my levels of T or E2 or some other hormone I am ignorant of. Then I start to fixate on the whole thing and ruminate and totally lose confidence of ever getting better. The libido, ED stuff really takes a toll on me psychologically when it's not good.

I know I babble and spew on here sometimes, but I don't many outlets to discuss this stuff. My wife is basically the only person who even knows I am on the TRT.

Maybe I should try the SSRis in conjunction with my TRT and that might help my anxiety and obsessive thoughts. I guess I should also stop playing with the arimidex fire, but it really had made me feel the best I had ever felt on TRT for short periods of time.

Sorry again for the long reply. Just frustrated again. I was feeling pretty damned good right before Christmas, but that week after really took me down the rabbit hole again.

I'll let you guys know how my meeting with my primary goes this afternoon.

You never have to apologize for posting here - at any length.

 

[Vettester Chris]

Yes, going by your earlier labs, pretty suffice to say you were "Secondary". If "Primary", you'd see those LH & FSH numbers elevated, and "usually" (not always) it's pretty common to see the baseline testosterone serum to be much lower, like < 100ng/dl type lower.

As far as protocols go, test is test, once you introduce exogenous testosterone to the system (and you have), it will raise the serum levels to the level appropriate to the medication amount (xxmg/week), and that will be the new serum level regardless of being primary or secondary.

The only other variable to that would be HCG, which would have an impact on endogenous production of testosterone "if" you were/are "secondary" (and you are), and testicular function of the leydig cells is functional. That last part will be different with everyone, so it's just important to gauge how HCG impacts the testosterone serum levels after being introduced.

 

[Xerxes]

So primary doc gave me script for buspar to help with the anxiety. He suggested wellbutrin first, but I had tried that and it didn't work (well at first it did and then it pooped out). And he didn't want to try traditional SSRIs b/c of the sexual side effect profile. He didn;t want to do anything with the testosterone until my mental health improved. I'll let you know how it goes. I think I am going to try this buspar and stick to my current protocol but avoid the arimidex. He did take some blood and tested for T and E2, but probably not the sensitive...I have a urologist appt on Jan 18th anf then a follow up with this primary on the 19th. I'll keep you guys updated.