Starting to question my therapy

[Dixonbeaver]

Hi, longtime lurker first time poster

Ive been on TRT therapy for over 6yrs now. I started with Androgel and transitioned to the Cypionate.
It all started with muscle loss, libido issues, and generally feeling like warmed over death. This was all at the ripe age of 34. I am in really good health, normal build, and all around active.
I went to my GP who ran the tests and found my levels were stupid low. Like around 200 low. Without further sleuthing he put me on Androgel. I got a bit of a spike in mood and energy at first then nothing. Probably all in my head. Went back 6mths later and my numbers were lower than before. He chalked it up to me being hairier than a sasquach and doubled the dosage. 6mths later, same. He didnt want to change it up so I found a urologist who seemed on her game. Put me on cypionate and I felt better. Still had libido issues but generally felt better. Numbers were in the 500s at 100mcg per week. Was told all the other numbers were in line and good to go. Over the years the testosterone numbers fell and hovered around 280-300. She felt it was all fine and good. I didn't.
I started having alot of libido issues. She prescibed Viagra. Not a big fan of it.
I started to get a racing heatbeat and severely flucuating blood pressure. I asked her about just getting off of it with a stopping procedure. She wanted to do a step down in dosage and extended time between doses. It was like a roller coaster.
I decided to take a break from it for 3wks. After the first week I was getting morning erections (gone for a few years) and feeling better. Alot better. Then after the second week I felt like dogshit. No erections. No energy. Nothing. Then I started the upswing. Called the doc back and was sternly told to restart or I would shock the system and cause damage.
I feel better off the cypionate but am extremely fearful of going cold turkey. I'm 40 for gods sake. I would like to feel like a normal man after I stop
Is this kind of thing normal? Ive read thru this forum and see all ends of the spectrum. I couldnt care less about bodybuilding or huge muscles. I just want to feel normal.

Sorry for the long post. Thanks for reading it tho!

 

[Nelson Vergel]

Welcome to ExcelMale. You have joined a forum with many men who have gone through your path.

Before we can start chiming in, can you answer the following questions?


1- What medications are you taking?

2- How is your sleep?

3- Is there anything that you would change in your life if you could? (I know this is a very general question)

4- What are your blood pressure, blood sugar and lipids like?

5- How is your intake of alcohol and drugs? (No judgment zone here)

6- How is your energy level through the day?

7- What kind of work do you do?

8- Can you masturbate (alone) and have a strong erection?

9- Do you watch porn more than once per week? (No judgment zone)

10- Do you have access to your latest bloodwork?

 

[Dixonbeaver]

Before we can start chiming in, can you answer the following questions?


1- What medications are you taking?
Just Testosterone Cypianate

2- How is your sleep?
Horrid. Maybe 5hrs a night but interrupted
3- Is there anything that you would change in your life if you could? (I know this is a very general question)
No, generally good
4- What are your blood pressure, blood sugar and lipids like?
Blood pressure has leveled back to normal, sugars are good

5- How is your intake of alcohol and drugs? (No judgment zone here)
None and none. Seriously

6- How is your energy level through the day?
Good
7- What kind of work do you do?
I work at a sewer plant
8- Can you masturbate (alone) and have a strong erection?
Not really consistantly
9- Do you watch porn more than once per week? (No judgment zone)
Rarely. Too busy for that
10- Do you have access to your latest bloodwork?[/QUOTE]
No. I usually get a copy but not the last time. Next visit is August.

 

[Systemlord]

Men typically don't absorb gel well at all, some do in the beginning and levels fade over time. You obviously need injections, now comes the hard part of finding a doctor who knows how to administer TRT and read your blood biomarkers to determine the proper protocol for you, sound hard, it is indeed and insurance doctors don't have the time as they have 30 patients to see in an 8 hour shift.

Going private is the only option for most of us.

 

[Nelson Vergel]

You may not be reaching enough REM sleep.

Here is a study:

DECREASE OF NOCTURNAL PENILE TUMESCENCE DUE TO REM SLEEP
DEPRIVATION IN YOUNG HEALTHY MALES: YOUNG,
HEALTHY...IMPOTENT?

Kamp S., Ott R., Hatzinger M., Knoll T., Juenemann K.P., Alken P., Bross S.
University Hospital, Department of Urology, Mannheim, Germany

INTRODUCTION & OBJECTIVES: To determine the influence of a
disturbance of the physiological sleep pattern on Nocturnal Penile Tumescences
(NPT) in young healthy males and to evaluate the significance of NPT measurement
for the diagnostic of erectile dysfunction under in patient-conditions.

MATERIAL & METHODS: 10 healthy young males, mean age 25.2 years (25-
32) were examined on 3 nights under sleep laboratory conditions. A 12-channel polysomnography was performed to register the sleep stages, NPT were
continuously measured with the RigiScan-device in all three nights. In night 2
we performed additional measurement of vital parameters as heart rate and blood
pressure. In night 3, in addition, sleep was interrupted and blood was drawn via an
i.v.-line every two hours to determine the serum levels of testosterone, FAI (free
androgen index), estradiol, LH, FSH, prolactin, DHEA-S, and SHBG.

RESULTS: We found a significant decrease of REM-sleep in night 3 versus night
1 (8 vs. 17%, p>O.O5) and a significant reduction of the total time length
of erections (50.2 vs. 98.8 min, p>O.O3). Phase 3 and 4 sleep was also decreased,
whereas Sl and S2 sleep was increased. The total number of events was
significantly decreased in night 3 (3.7 vs. 5.5, p>O.O5). The amount of NPT
correlated to REM-sleep decreased from 80% in night 1 to 53% in night 3
(p>O.O3). There was no disturbance of the circadian rhythm and pulsatile
secretion of the measured sexual hormones in this study.

CONCLUSIONS: The disturbance of the physiological sleep pattern leads to a
significant reduction of REM and S3/4 sleep combined with a significant decrease
in the number and total length of nocturnal erections in young healthy adults, with
some showing the pattern similar to patients with erectile dysfunction. Therefore, a
normal sleep pattern is crucial for the evaluation of NPT-measurements in the
diagnostics of erectile dysfunction and a combination with polysomnography should
be performed to exclude the diagnosis of erectile dysfunction in healthy men.

_______________________________


Defining association between sleep apnea syndrome and erectile dysfunction


Abstract

Objectives
To conduct a study using validated sexual function and sleepiness inventories to define whether sleep apnea syndrome (SAS) is associated with erectile dysfunction and whether any correlation exists between the severity of SAS and the severity of erectile dysfunction. Previous work has suggested that sleep disorders are associated with erectile dysfunction.

Methods
Men presenting to a sleep clinic with symptoms consistent with SAS were given the Epworth Sleepiness Scale and an erectile dysfunction risk factor inventory, the International Index of Erectile Function. A database was constructed and statistical analysis conducted to define the correlation between the two entities.

Results
A total of 50 men met the criteria for inclusion. Of the 50 men, 60% had abnormal Epworth Sleepiness Scale scores and 80% of these patients had erectile dysfunction as determined by inventory scores compared with 20% of the men with normal Epworth Sleepiness Scale scores. There were statistically significant differences between men with normal and abnormal sleepiness scores for the total and erectile function domain of the International Index of Erectile Function. The correlation between the severity of the sleepiness and the severity of erectile dysfunction was good (r = −0.80, P = 0.012).

Conclusions
Men presenting with symptoms consistent with SAS have a significant risk of erectile dysfunction, and the correlation between the severity of sleep apnea and the severity of erectile dysfunction is strong.


Reference: Urology. Volume 67, Issue 5, May 2006, Pages 1033-1037

 

[CoastWatcher]

You aren't the first, and will certainly not be the last, man to join Excelmale who has been poorly served by their doctor. It's the rare physician who understands - and has time to treat - men presenting with hypogonadal issues. If you post your lab work we can suggest some areas that you and your current doctor might wish to explore; if you would like help in finding medical care we can offer referrals.

 

[Dixonbeaver]

The sleep issues started a few years ago. Right around the time I started having diminishing returns on the injections.
Since my numbers are low already, is the amount of time for natural rebound shorter? Its been over 2wks since my last dose. My doc isn't going to do any kind of med stopping regimine.

 

[Dixonbeaver]

I'm digging thru my records for my last results.

 

[CoastWatcher]

The sleep issues started a few years ago. Right around the time I started having diminishing returns on the injections.
Since my numbers are low already, is the amount of time for natural rebound shorter? Its been over 2wks since my last dose. My doc isn't going to do any kind of med stopping regimine.

What is that YOU want? Yes, you want to feel "normal," but you presented with bargain-basement testosterone levels at your initial evaluation. You suspend therapy, which is your choice, you will probably achieve those levels again...then what?

Again, if you share your lab values, particularly free testosterone and SHBG, some avenues you may wish to discuss with your doctor may be evident. Or, find a new physician. It doesn't sound as if you're getting the care you deserve.

 

[lexer]

I would adjust the dosage, perhaps 50 mgs every 3.5 days. The dosage is still the same but broken up and highs and lows are greatly diminished.
if are in the 500's, maybe a trip to the 600's will be the “ sweet spot”. One thing some men seem to hyper focus on is the initial burst in energy and libido which eventually levels off. The reason is quite simple, you are going from low levels to much higher levles in a short period of time thus shocking the system in a way. Over time you get used to this feeling and the shock value wears off. That doesnt mean your energy level and libido are lower, you are just now accostomed to higher T levels. What winds up happening is guys then start upping their dosage hoping to re-capture that initial spike. Not a good idea.

 

[Dixonbeaver]

Alright, found my last test results

White blood cell count. 5.8 x10e9/l
Red blood cell count. 5.47 x10e12/l
Hemoglobin. 17.4 g/do
HCT. 48.6%
MCV. 89 fl
MCHC. 35.8 g/dl
Platelet count. 206 x10e9/l
PSA 0.45
Testosterone level. 279 ng/do
Reference on that is 240-1000

That is all the info my doc pulls

 

[Deleted member 16042]

Get yourself a doc that knows what they are doing. Yours doesn't. Basing TRT solely on total testosterone level in terms of labs for sex hormone assessment is missing many basics necessary for good treatment.

Missing free T, estradiol (sensitve LC/MS/MS) and SHBG in particular.

 

[Dixonbeaver]

Yeah, got that feeling a year or so ago. My test numbers never went over 350 from what I remember on any of my results. Ive generally felt the same since starting treatment.
I'm pretty healthy, 5'10" and 170lbs. Could never get a straight answer from any of the docs why my test is soo low. Only thing they've thought was it was a complication from my vasectomy. Problem with that was it was 10yrs earlier with no problems. Ever.

 

[CoastWatcher]

Without SHBG, your doctor is guessing when prescribing your protocol. It's an indispensable element. You deserve better care.

 

[1Draw]

The sleep issues started a few years ago. Right around the time I started having diminishing returns on the injections.
Since my numbers are low already, is the amount of time for natural rebound shorter? Its been over 2wks since my last dose. My doc isn't going to do any kind of med stopping regimine.

I would first have a sleep study done to see if you are suffering from sleep apnea. Poor sleep can hammer your hormones. Next thing I would do is have a full thyroid panel done along with other suggested Testosterone related test. Here is a great link of symptoms of both Low T and low Thyroid and what to test for:

https://www.restartmed.com/thyroid-symptoms-men/

Dr. Childs recommends the regular Estradiol test but, this test is for women. Be sure and request the Estradiol Sensitive, LC/MS/MS.

Good luck and keep us informed!

 

[OMI100]

My MANTRA.....below
I would also download DR Johns papers and power point presentation.
If your DR has not done the test or eval similar to DR. Johns paper, take the paper and give to your DR if you have one that is open minded and open to learning...
********************************
First step is education....
********************************
Cannot tell how much research you have done on TRT.
If not a lot, I recommend you get a few books.
Get a few good books and educate yourself now:
1. Get Nelsons book "Testosterone: A Man's Guide".
2. Get Lee Myer's book "Natural Versus Testosterone Therapy".
3. Get “Testosterone for life - Dr. Abraham Morgentaller “.
4. Get “The Definitive Testosterone Replacement Therapy MANual: How to OptimizeYour Testosterone For Lifelong Health And Happiness” by Jay Campbell.
These books will give you a much better understanding of TRT....
One other forum that has great info that might be useful to you is:
http://www.peaktestosterone.com/
********************************
Dr Saya's Videos on Testosterone Therapy and Side EffectManagement
https://www.excelmale.com/forum/showthread.php?15207-Dr-Saya-s-Videos-on-Testosterone-Therapy-and-Side-Effect-Management
**********************************
Second step might be to have a look at your thyroid and see if any issues there.
********************************
Do some research.
I do like Tiredthyroid as a starting point.
Easy to read sections.
References at the bottom of each section (and NOT from people wearing "tinfoil" hats)
See below:
Basic sources to research Thyroid issues and testing:
******************************************
https://stopthethyroidmadness.com/
Spend time here and get the 2 books, “STTM: The Revised Book” and “STTMII:Authored by Doctors”.
*******************************************
http://www.tiredthyroid.com/
Great simple to understand articles.
Get her book.... “Tired Thyroid: From Hyper to Hypo to Healing—Breaking the TSHRule”, https://read.amazon.com/kp/embed?asi...Channel=system
A lot of clear researched information that is easy toread and understand.
***************************
https://hypothyroidmom.com/
Good info here. Look around.
*************************
https://www.restartmed.com/?s=thyroid
A LOT of good articles and a youtube page.
Spend time here looking around and reading after getting labs back.
************************************
Do you have Hypothyroidism?
The CompleteHypothyroidism User Guide for Patients (2018 Edition)
https://www.restartmed.com/hypothyroidism/
*********************************
Need information on testing....
Read here:
http://www.tiredthyroid.com/what-labs.html
And here:
http://www.tiredthyroid.com/optimal-labs.html
and here:
https://stopthethyroidmadness.com/recommended-labwork/
and here:
https://www.restartmed.com/thyroid-tests/
and here:
https://www.restartmed.com/hormone-testing/
And here:
https://www.restartmed.com/normal-thyroid-levels/
**************************************
Some additional links to read before you receive the books you have already ordered
Go here:
http://www.allthingsmale.com/publications.html
and download:
TRT: Recipe For Success
Print out.
and
HCG Update.
and the TRT Power Point presentation.

Dr. Crisler is one of the "TRT Cutting Edge DR's" here in the states....
Also go here:
http://www.drjohncrisler.com/the-cri...part-deux.html
and also print out the article.
***************************
ALSO look at the videos that are posted on this site. A LOT of great info totake in....
******************************
Now you will have a great reference library and knowledge base to go forward on!

 

[ozraelised]

Hi Dixonbeaver,

fist thing - TRT is taking testosterone and anti estrogen. if you are just taking Testosterone then your estrogen level will go up as well as testosterone is converted. also counting Total testosterone is wrong.
DO YOUR RESEARCH !!!! _ YOU MUST
how much are you taking and how often?
Do full blood test and put them on this site.