TRT and Gout questions

[FLmale]

In the wee hours on Valentines day morning I woke to a surprise and no, it was not what I was I hoping for... It was my big toe aching like someone had hit it with a red hot poker. Long story short, I have Gout and can't for the life of me figure out what triggered it. ​I eat pretty clean, not too much sugar or fast foods. May have 2 beers at dinner once a week or may go a month and not have a beer; no liquor, wine or illegal drugs. I'm 5'11" and 190lbs, I am in the gym 5-days a week, probably >20% body fat, not skinny but can see my abs. Kidney function is good but not great. I'm in my early 50's and have a sibling that has had gout. I do a lot of running, box jumps, squats and what not in the gym so I do bang my feet up more then average so there is that.

I have been on TRT for several years with good results. About 12 months ago HCG @ 40 Units 2x weekly was added to my protocol of Testosterone Cypionate 200MG/ML @ .2ML 2x weekly. That worked well but my Free T was lower and my SHBG higher then my Dr. liked so in January he increased the Testosterone Cypionate 200MG/ML to .4ML 2x weekly, HCG @ 50 Units 2x weekly and added Stinging Nettle Root Extract 250mg x2 daily in an attempt to lower SHBG. I only started taking the SNR about two weeks ago.

Prior to January adjustment my test results.


DHEA-Sulfate
242.0 NORMAL
Reference Range: 71.6-375.4 ug/dL

Luteinizing Hormone(LH), S
0.1 LOW
Reference Range: 1.7-8.6 mIU/mL


Sex Horm Binding Glob, Serum
65.0NORMAL
Reference Range: 19.3-76.4 nmol/L

Testosterone,Free and Total
Testosterone, Serum
431 NORMAL
Reference Range: 264-916 ng/dL


Free Testosterone(Direct)
7.6 NORMAL

Uric Acid, Serum
5.3 NORMAL

All other blood work results were NORMAL, I don't have any test results since then except for Uric Acid, Serum which was taken during the gout flare and it was 5.7

My gut feeling is that my gout episode may have been caused by dehydration, I have read that HCG and Nettle Root are both diuretics. I do drink a lot of H2o and include BCAA's in post-workout but I am going to drink even more H2o going forward. I am also going to work on a converting to a mostly plant based whole food diet as I feel it will be a good fit for me.

Any thoughts on what I should do?

Leave Testosterone and HCG dosage as is?
Cut out Nettle Root?
Reduce Nettle Root?
Cut back to former levels on Testosterone and HCG?
Cut back to former level on HCH and leave Testosterone at .4?

Any other words of wisdom?

Anyone unfamiliar with gout can go here for more information. https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897

 

[blackebob]

You posted your T protocol as the same before and after your Dr. adjusted your dosage, 80mg 2 times a week. How much HCG are your taking? Did you mean 400iu 2x a week, or are you taking only 80iu total for the week? What size syringe do you use for the HCG and where do you pull to?

 

[FLmale]

@ blackebob,

I corrected my original post to clear it up.

To summarize, prior to increase I was:

Testosterone Cypionate 200MG/ML @ .2ML 2x weekly
HCG @ 40 Units 2x weekly

After increase I am:

Testosterone Cypionate 200MG/ML @ .4ML 2x weekly
HCG @ 50 Units 2x weekly
Added Stinging Nettle Root Extract 250mg x3 daily
I only started taking the Nettle Root about two weeks ago.

HCG syringe is 31 gauge 5/16" and inject in belly fat alternating sides.

 

[blackebob]

If you added SNR and the gout popped up two weeks later I would cut out the SNR. It is the last thing you changed and the easiest to check. See what happens after two weeks.

Why did you start taking it?

 

[FLmale]

The Stinging Nettle Root can reduce SHBG in some people.

Thank you for your input.

 

[blackebob]

So, I googled lowering SHBG, and the link I hit, I already do most of it. The Boron I make my self out of mule team soap, and the magnesium I make myself out of one part water, and one part epsom salt. Bring the water to a boil, pour in the salt, and wait a few seconds. Turn it off, let cool, and put in a pump spray bottle. Actually as Vince says if he could only have one supplement it would be Magnesium. I am curios if you make a mag spray, or even just a compress and put on your toe to see what happens. When I get mysterious pains I spray some mag on it and voila, a lot of times it goes away.
My SHBG runs around mid 20.

https://www.anabolicmen.com/how-to-lower-shbg-naturally/

I know some natural cures work, I mean people been around a long time. Big pharma has not been running everything since Noah, eh. I use a lot of stuff from this web site. I believe in the apple cider vinegar. Take from it what you want, but at least give it a look.

https://www.life-saving-naturalcures-and-naturalremedies.com/natural-remedies-for-gout-best.html

Power just went out so for my battery to last, Blah, blah blah...

 

[Pauly_P]

I had gout before TRT, and basically mine was caused by dehydration mixed with having one or two unfiltered wheat beers. Or any of the unfiltered craft type beers. So if you were dehydrated on V day night, had a couple of beers that could be what triggered it. My uric acid also tested in the normal range. I'm a runner and cycle, and I got on allopurinol to protect my joints more than anything.

I don't know about SNR, but I do know a bit about gout.

 

[jp]

I had gout before starting TRT. I would get flare ups every couple of months. Since starting TRT about 7 months ago the flare ups have increased to almost every two weeks. I've cleaned up my diet. Drink at least a gallon of water a day. I haven't touched alcohol in almost 3 years. I was a heavy drinker for quite a few years and really believe that's why I now have gout. The only thing I can see as the cause to the increase in flare up coincides with starting TRT. I've tried numerous natural remedies with no success. The only thing that helps now is that I take Indomethacin when I feel a flare up coming on. 2-3 pills stops the attack and I'm usually pain free within 24 hours.

 

[Nelson Vergel]

Sci Rep. 2017 May 18;7(1):2087. doi: 10.1038/s41598-017-02392-x.

Serum Uric Acid Is Associated with Erectile Dysfunction: A Population-Based Cross-Sectional Study in Chinese Men

Gao F1, Jiang B2, Cang Z2, Wang N2, Han B2, Li Q2, Chen Y2, Chen Y2, Xia F2, Zhai H2, Chen C2, Lu M2, Meng Y2, Lu Y3, Shen Z4.

Abstract
The role that serum uric acid (UA) plays in the pathophysiological development of erectile dysfunction (ED) is controversial. We aimed to screen the factors related with ED, and to examine the association between serum UA and ED. Our data were derived from a cross-sectional Survey on Prevalence in East China for Metabolic Diseases and Risk Factors study in 2014-2015. Questionnaire of International Index of Erectile Dysfunction-5 was used for assessment of ED. Data were collected in three general communities respectively. A total of 1365 men were enrolled with an overall mean age 55.5 ± 10.8 years (range: 20-83 years). The prevalence of ED was 62.4% (51.4% standardized) in the population. Males with ED were older, and more prone to have a higher follicle-stimulating hormone, luteinizing hormone, sex hormone-binding globulin, glycated hemoglobin, fasting plasma glucose levels and lower free androgen index (FAI), UA levels, and more likely to have diabetes and elevated blood pressure compared with those without ED. Age and UA were independent influencing factors for ED. Besides, UA was positively correlated with FAI after adjustment for age. In conclusion, our study demonstrated the protective role that UA might play in development of ED.

 

[MrFrost]

If you added SNR and the gout popped up two weeks later I would cut out the SNR. It is the last thing you changed and the easiest to check. See what happens after two weeks.

Why did you start taking it?

What is SNR

 

[Melody68]

There's a hereditary disposition to it; your sibling also had it which is a strong indicator.

Some people get it, some don't.

 

[Nelson Vergel]

Stinging nettle root has been used for hundreds of years to treat painful muscles and joints, eczema, arthritis, gout, and anemia[1][4]. The root of the stinging nettle is used to treat mictional difficulties associated with benign prostatic hyperplasia (BPH), while the leaves are used to treat arthritis, rheumatism, and allergic rhinitis[1]. Stinging nettle leaves contain a wide range of chemical components, including flavonoids, phenolic compounds, organic acids, vitamins, and minerals, as well as tannins, volatile compounds and fatty acids, polysaccharides, isolectins, sterols, terpenes, and proteins[2]. These components contribute to the plant's antiproliferative, anti-inflammatory, antioxidant, analgesic, anti-infectious, hypotensive, and antiulcer characteristics[1].

Specifically regarding gout, stinging nettle has been shown to effectively treat the condition, relieve muscle aches and minimize the symptoms of arthritis[2]. Gout occurs when uric acid accumulates and crystallizes in and around the joints, producing inflammation and agonizing pain[3]. Stinging nettles can help eliminate excess uric acid and alleviate certain symptoms of the condition[3]. Brewing a cup of stinging nettle tea is the most typical technique to relieve gout-inflamed joints[3].

Stinging nettle root is also used widely in Europe to treat BPH. Studies in people suggest that stinging nettle, in combination with other herbs (especially saw palmetto), may be effective at relieving symptoms such as reduced urinary flow, incomplete emptying of the bladder, post urination dripping, and the constant urge to urinate[1]. These symptoms are caused by the enlarged prostate gland pressing on the urethra (the tube that empties urine from the bladder)[1]. Some studies suggest that stinging nettle is comparable to finasteride (a medication commonly prescribed for BPH) in slowing the progression of the disease, but unlike finasteride, the herb does not decrease prostate size[1]. Scientists aren't sure why nettle root reduces symptoms. It may be because it contains chemicals that affect hormones (including testosterone and estrogen), or because it acts directly on prostate cells[1].

In summary, stinging nettle root has been used for centuries to treat painful muscles and joints, including gout and BPH. The root contains chemicals that may affect hormones and prostate cells, contributing to its effectiveness in treating BPH symptoms. Brewing a cup of stinging nettle tea is a common technique to relieve gout-inflamed joints and eliminate excess uric acid.

Citations:
[1] Stinging nettle Information | Mount Sinai - New York
[2] Nutritional and pharmacological importance of stinging nettle (Urtica dioica L.): A review
[3] 16 Benefits of Stinging Nettle (Plus 7 Side Effects)
[4] The medicinal uses of Urtia dioica (stinging nettle) range from treatment of allergies, prostate health, bleeding, gout, urniary tract infections, finger nail health and many more- Medicinal Uses
[5] Benefits of Nettle Tea

 

[Nelson Vergel]

What was your last uric acid test result?

 

[Nelson Vergel]

Testosterone therapy has been observed to elevate serum uric acid levels, which may increase the risk of gout[5]. A study of 1899 men found that low testosterone levels were significantly associated with an increased risk of hyperuricemia, a precursor to gout[2]. This suggests that testosterone therapy may be a risk factor for gout, although further research is needed to confirm these findings. It is also important to note that hormonal influences, such as estrogen therapy, can affect plasma uric acid and urinary uric acid levels, which may contribute to the development of acute attacks of gout[1]. Therefore, it is crucial to consider the potential hormonal impacts on uric acid metabolism when evaluating gout risk and treatment options.

Citations:
[1] Hormonal Aspects of Gouty Patients
[2] The Association between Serum Testosterone and Hyperuricemia in Males
[3] The Potential Effect of Aberrant Testosterone Levels on Common Diseases: A Mendelian Randomization Study
[4] Exploration of the association between serum uric acid and testosterone in adult males: NHANES 2011–2016 - Han - Translational Andrology and Urology
[5] Testosterone replacement elevates the serum uric acid levels in patients with female to male gender identity disorder