Symptoms & next steps

[CoastWatcher]

Thanks Coastwatcher. This has been a real pain to deal with. I'm at this point not sure what to do. I was able to get some updated labs, and I would welcome anyone's opinion on the next steps given all discussion above on symptoms.
Labs: View attachment 3164

You need a capable doctor who can work with you to deal with your issues. I'm not dismissing your concerns, and your labs show you have reason to be concerned in regard to your androgen levels, but we can only point out the areas that do need to be addressed. That doesn't help you because you realize what they are.

If local care that answers your questions and puts you on a road that will lead to good health is not available, I urge you to consider either Defy or Prime Body. You deserve better than what you're receiving.

 

[FreeRangeYeti]

Thanks Coastwatcher. My TT & FT are both on the low end, and LH/FSH being high, which I think means that I'm just not producing. My E2 isn't bad, but my FT/TT are low, so I still might need an AI if I do end up taking something to up the TT/FT. I understand that given my age, a HCG restart is probably not likely to succeed, so is my best option a permanent TRT route? I guess what I am asking is what I should be considering as a next step so I can advocate for myself.

Thanks again everyone

 

[CoastWatcher]

An AI is never called for as a routine part of a TRT protocol when starting therapy. One only initiates Anastrozole when a test of estradiol (using the sensitive, LC, MS/MS, only) indicates your level is elevated, and you have symptoms that can be attributed to the higher level. You take anastrozole for any other reason, or at any other time, you are buying a ticket to misery. Estradiol is not a waste product, it's an important hormone for sexual and general health.

Will a restart work? Well, not if you are dealing with primary hypogonadism. But are you? Your LH and FSH aren't sky high...even more reason to work with an experienced Doctor who will know if a Clomid protocol is even a possibility.

Rather than approach a doctor, any doctor, with what you believe is in your best interest, I'd suggest you approach a doctor with the questions you want answered (the answers will determine for you what is in your best interest). Lead with your concerns abiut a restart - is it possible, if so, what are odds of success? What experience does this doctor have in managing a restart? If not, what about TRT? Ask for details on the types of protocols he/she favours.

What at are your thoughts at this point on doctors/locating one?

 

[Vince]

FreeRange, I think you're making the right decision going with Defy. That's what I had to do, I saw three doctors in my area and visited two Clinic before deciding on Defy. I didn't want to start TRT with out proper treatment. There are other good TRT doctors but hard to find.

 

[FreeRangeYeti]

My experience so far has been limited to doctors within my HMO. I pay upwards of $600/month for medical insurance for my kids and I, and with other costs, fitting in out of pocket (telemedicine) on top that is regular and recurring as a cost is extremely difficult. That said, I have had no success working inside my insurance. The response has been either apathy and outright negativity at the worst case or a desire to help without any knowledge or ability to do so at the best. I have had to literally sit down and make the doctors order the tests so that I can try to understand what is going on. My urologist and PCP have less knowledge than I do, and I admit I am pretty limited in terms of understanding how this all works. I have been completely unable to find anyone inside my HMO that will work with me. I've made appointments and had them cancelled by 4 endocrinologists in my area because my labs are not outside the 3 sigma deviations of the test population, so they won't even see me and discuss symptoms.

My next step is to meet with one of my urologists' partners on 3/1, and failing a positive outcome from that, telemedicine through Defy since the Primebody location near me has had mixed reviews.

 

[FreeRangeYeti]

Thanks Vince! I am going to contact them to see about average costs so I can try to fit this into my budget. If my diagnosis is to start any type of recurring treatment, I need to be able to keep it going since I will be worse off than when I started if I have to stop!

Again, I appreciate the help and guidance. Been rough sledding lately

 

[isos266]

Hope you find what is causing your issues. Rooting for ya dude

 

[FreeRangeYeti]

Update - Met with a TRT doc / urologist through my HMO. We reviewed my last labs which were just:
TT - 363
FT - 6.24
E2 - 42

He said I'm not a candidate for TRT because my last labs for total t were 363, 392, 440. He prescribed 1MG Anastrozole/Day and recheck labs in 4 weeks follow-up in 6 weeks. From what I have read this is a super high dose of Anastrozole! Is this right?

I have had gyno from puberty, had it surgically removed only to have it come right back, but this does seems like it will bottom out my E2, right?

 

[Dr Justin Saya MD]

Update - Met with a TRT doc / urologist through my HMO. We reviewed my last labs which were just:
TT - 363
FT - 6.24
E2 - 42

He said I'm not a candidate for TRT because my last labs for total t were 363, 392, 440. He prescribed 1MG Anastrozole/Day and recheck labs in 4 weeks follow-up in 6 weeks. From what I have read this is a super high dose of Anastrozole! Is this right?

I have had gyno from puberty, had it surgically removed only to have it come right back, but this does seems like it will bottom out my E2, right?

Probably wasn't the sensitive E2 assay? 1 mg of anastrozole per day with those levels and when you're not on TRT will make you worse than prior - absolutely guaranteed . Take no more than 0.25 mg twice weekly to start out.

 

[CoastWatcher]

Update - Met with a TRT doc / urologist through my HMO. We reviewed my last labs which were just:
TT - 363
FT - 6.24
E2 - 42

He said I'm not a candidate for TRT because my last labs for total t were 363, 392, 440. He prescribed 1MG Anastrozole/Day and recheck labs in 4 weeks follow-up in 6 weeks. From what I have read this is a super high dose of Anastrozole! Is this right?

I have had gyno from puberty, had it surgically removed only to have it come right back, but this does seems like it will bottom out my E2, right?

I really feel your frustration. You deserve much better care...please proceed with caution.

 

[FreeRangeYeti]

Thank you Dr. Saya!
He had my labs and read them to me. I also received these from him:
ESTROGENS,SERUM FRACTIONATED 01/25/2017 08:20Description Result Flags RangeESTRADIOL,SERUM 22.0 N 10.0-42.0ESTRONE BY TANDEM MASS SPECTO 20.2 N 9.0-36.0TOTAL ESTROGENS(REF) 42.2 N 19.0-69.0

I still wasn't sure he was doing the right test, so I paid for my own on discount labs and got this reading back today from last friday:
Testosterone,Free and Total


Testosterone, Serum 440 ng/dL 348 - 1197 01


Comment:


Adult male reference interval is based on a population of lean males


up to 40 years old.


Free Testosterone(Direct) 9.7 pg/mL 8.7 - 25.1 02


Estradiol, Sensitive 26.3 pg/mL 8.0 - 35.0 02


This test was developed and its performance characteristics


determined by LabCorp. It has not been cleared by the Food and


Drug Administration.


Methodology: Liquid chromatography tandem mass spectrometry(LC/MS/MS)

 

[Dr Justin Saya MD]

Thank you Dr. Saya!
He had my labs and read them to me. I also received these from him:
ESTROGENS,SERUM FRACTIONATED 01/25/2017 08:20Description Result Flags RangeESTRADIOL,SERUM 22.0 N 10.0-42.0ESTRONE BY TANDEM MASS SPECTO 20.2 N 9.0-36.0TOTAL ESTROGENS(REF) 42.2 N 19.0-69.0

I still wasn't sure he was doing the right test, so I paid for my own on discount labs and got this reading back today from last friday:
Testosterone,Free and Total


Testosterone, Serum 440 ng/dL 348 - 1197 01


Comment:


Adult male reference interval is based on a population of lean males


up to 40 years old.


Free Testosterone(Direct) 9.7 pg/mL 8.7 - 25.1 02


Estradiol, Sensitive 26.3 pg/mL 8.0 - 35.0 02


This test was developed and its performance characteristics


determined by LabCorp. It has not been cleared by the Food and


Drug Administration.


Methodology: Liquid chromatography tandem mass spectrometry(LC/MS/MS)

With those levels you shouldn't take anastrozole at all, let alone 1mg per day, especially when not on TRT.

 

[johnt]

@FreeRangeYeti In my opinion, all the advice you are getting about going to Defy or a doctor that is experienced in TRT is the way to go. Excelmale is an awesome site for information but I would also highly recommend reading some books on the subject all of which are an easy read. Highly recommend Jay Campbells book The Definitive Testosterone Replacement Therapy Manual, Nelson Vergel's Testosterone A Man's Guide, Dr. Crisler's Testosterone Replacement Therapy A Recipe For Success, and Testosteron For Life by Abraham Morgentaler.

 

[FreeRangeYeti]

@johnt
Thanks for the reply. The first couple books I read on the subject before I even found this site were Nelson & Jay's books from the searches I did on Amazon. After that, I read Thor Training and Master Your T by Christopher Walker and all the articles on Anabolicmen.com to try to improve my testosterone naturally. I've reduced my body fat by 5%, and I'm managing to hold onto some muscle. I've literally tried everything from diet, to training, to supplementation (L-Dopa, Zinc, D3, Boron, Choline, anything with research that shows a deficiency could tank your test), and my blood tests and symptoms confirm that it hasn't improved, and I'm about out of options.

My last hope was this doc in my HMO who was supposed to be a Urology specialist that I waited 2 months to see. I admit I was pretty excited following the visit. He listened, took notes, and offered some options, and prescribed the Anastrozole. I asked about the dosage, and he confirmed for me it was a safe and well tolerated dose based on my sensitive E2 test that could help with Gyno and freeing up some more test. Imagine my shock when I picked up the prescription for 1MG/Day! My first thought was this has to be wrong. I logged into the medical system (I can look at my charts from the office visit), and he only took two sentences of notes, did not transcribe most of my symptoms, and made a judgment based on total test levels alone, even though they are in the bottom 15% of the range. What a joke. I'm going to call back tomorrow and try to confirm if this is all an error. Otherwise I am done.

I'm going to contact Defy again. I still have the original intake form, and I am going to go through the no cost consultation offered and go from there. At the very least, I will have an educated opinion to set against the other things I've gone through.

 

[johndoesmith]

@johnt
Thanks for the reply. The first couple books I read on the subject before I even found this site were Nelson & Jay's books from the searches I did on Amazon. After that, I read Thor Training and Master Your T by Christopher Walker and all the articles on Anabolicmen.com to try to improve my testosterone naturally. I've reduced my body fat by 5%, and I'm managing to hold onto some muscle. I've literally tried everything from diet, to training, to supplementation (L-Dopa, Zinc, D3, Boron, Choline, anything with research that shows a deficiency could tank your test), and my blood tests and symptoms confirm that it hasn't improved, and I'm about out of options.

My last hope was this doc in my HMO who was supposed to be a Urology specialist that I waited 2 months to see. I admit I was pretty excited following the visit. He listened, took notes, and offered some options, and prescribed the Anastrozole. I asked about the dosage, and he confirmed for me it was a safe and well tolerated dose based on my sensitive E2 test that could help with Gyno and freeing up some more test. Imagine my shock when I picked up the prescription for 1MG/Day! My first thought was this has to be wrong. I logged into the medical system (I can look at my charts from the office visit), and he only took two sentences of notes, did not transcribe most of my symptoms, and made a judgment based on total test levels alone, even though they are in the bottom 15% of the range. What a joke. I'm going to call back tomorrow and try to confirm if this is all an error. Otherwise I am done.

I'm going to contact Defy again. I still have the original intake form, and I am going to go through the no cost consultation offered and go from there. At the very least, I will have an educated opinion to set against the other things I've gone through.

Been there before.

Just to let you know the no cost consult isn't a Dr consult, it's more or less speaking to a non medical staff on the phone. You still have to pay for your initial consult. I was a bit confused myself.

I wouldn't say that AI will "free up test" really. It will, but the amounts are insignificant and tiny.

 

[Vince Carter]

NO one knows your money situation but defy, out-of-pocket, is absolutely the most affordable route to go.
Check your insurance coverage for something called a "Lab Card" or other lab services...in my case this "lab Card" pays 100% of my labs, no ded/no copay thru Quest. Defy writes me a script for the tests I want and I walk in to Quest and they bill my insurance...saves me a TON of $$$$$$

 

[FreeRangeYeti]

Update:
I ended up talking with the urologist and took the anastrozole for 5 days. I was completely miserable, joints a wreck, and forget about libido. I stopped taking it, ripped the doctor for being a complete moron, and started looking elsewhere. Took about 3 weeks for my joints to stop aching after I stopped the AI.

Fast forward 3 weeks, and I ended up meeting w/Dr. John Crisler. He did a physical exam and reviewed the copious amount of blood work I had accumulated and started me on TRT (60mg twice/week), HCG (100iu/day), and Anastrozole (.5mg w/test injection). After waiting a couple weeks to receive my meds, I have taken the first two test injections as scheduled, and began the AI & HCG. Since I started the AI, my elbows have been aching. My libido is still way down from the previous Urologist back in March. I honestly haven't felt like myself since then. I am hoping that this gets better soon.

 

[CoastWatcher]

Update:
I ended up talking with the urologist and took the anastrozole for 5 days. I was completely miserable, joints a wreck, and forget about libido. I stopped taking it, ripped the doctor for being a complete moron, and started looking elsewhere. Took about 3 weeks for my joints to stop aching after I stopped the AI.

Fast forward 3 weeks, and I ended up meeting w/Dr. John Crisler. He did a physical exam and reviewed the copious amount of blood work I had accumulated and started me on TRT (60mg twice/week), HCG (100iu/day), and Anastrozole (.5mg w/test injection). After waiting a couple weeks to receive my meds, I have taken the first two test injections as scheduled, and began the AI & HCG. Since I started the AI, my elbows have been aching. My libido is still way down from the previous Urologist back in March. I honestly haven't felt like myself since then. I am hoping that this gets better soon.

Dr. Crisler's certainly one of the doctors who has done so much to make TRT a sensible option for so many men. I do hope you're able to handle what seems like a steep dose of AI. Keep us posted.

 

[growing4skin]

I already take Choline Bitartrate, boron, zinc, and I have read that saw palmetto, pygeum, and grape seed extract could help. Should I start taking these?

Hi Guys! This is my first time to post on this forum and I'm new to TRT - 5 months now. Recently I found out that Saw Palmetto will raise testosterone levels, but it does so by blocking 5 alpha reductase, which converts testosterone into the more potent DHT. I've stopped taking the Saw Palmetto because I feel that DHT is a better way to engage the testosterone pathway - even if I lose a few more hairs because of the increased DHT levels.