Setting Expectations

Low testosterone issues, impacts on health & marriage, treatments, etc.
justsomeguy
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Setting Expectations

Postby justsomeguy » Sat Feb 06, 2016 4:02 pm

[OG Note: This is a "sticky" thread. Please don't delete.]

Never in a million years thought I'd lose my HD but it seems to have happened. I'm a fairly fit 47 yr old with 15% body fat who exercises regularly but just got diagnosed with low T (250). Urologist this past Wednesday started a "test course" of T injections, starting with "200mg" according to the notes. He plans on doing bloodwork in 2 weeks followed by another injection, and then assess in 1 month. He said it's entirely possible the T will do nothing. What's worse is over the past several weeks I'm now experiencing DE, unable to finish about half the time. Doc said IF the T is effective I should feel it by 2 days after the injection. I don't feel a difference yet :(

Can anyone tell me if there's any hope for the T working since I don't feel it yet? I'm also concerned the doc said he'd take me off of T in one month if I don't feel relief: "why put something in your body if it's not helping you?". What's confusing is that I thought having higher T is also important for other health reasons, and not solely for sexual function.

Last question: is the 200mg high/medium/low dosage? Curious what his strategy is.

Thanks so much for any insights

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Re: Setting Expectations

Postby SquarePants » Sun Feb 07, 2016 7:07 pm

250 is definitely low and should be treated. It’s not just a sexual performance issue. There are many health consequences related to low testosterone.

If you have low body fat, then you may also have low estrogen levels as well, which is also bad for your health. I’ve been on testosterone replacement therapy for a number of years, and I’ve noticed delayed ejaculation when my estrogen levels were low.

Don’t worry if you don’t feel anything by day two. I could be wrong, but based on what I’ve read so far, your doctor doesn’t seem to be very knowledgeable about testosterone replacement therapy. If so, then I’d recommend two options: 1) Learn as much as you can, and use your knowledge to influence your treatment with your doctor, or 2) Find another doctor who knows what he’s doing.

For learning about replacement therapy, there are a variety of sources on the internet. Some are more reliable than others, though, some are very good. I highly recommend the following book: “Testosterone Replacement Therapy: A Recipe for Success,” by John Crisler.

Is your doctor monitoring anything else because total testosterone? He should definitely be monitoring estrogen (estradiol) levels and a number of other things.

A 200 mg injection every two weeks is a terrible idea, and any doctor knowledgeable about testosterone replacement therapy would know better. 200 mg in a single dose is pretty high. You’ll probably briefly feel a little better for a while, and by the end of your two weeks, you’ll likely feel terrible. The high dose will cause a spike in testosterone, which will result in high conversion of testosterone into estrogen. Since your levels are low, that might not be too bad for you, at least for the first injection. However, it will also slow down your own production of testosterone, so that by the end of the two weeks, your levels may be even lower than before. Injections should be no fewer than once a week. I’m taking a 70 mg injection twice a week.

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Re: Setting Expectations

Postby spiritfire777 » Sat Feb 13, 2016 7:21 pm

squarepants... this is what my hubbys doc has done too.. but I also know if we tell him we went to 100 per week and why we did, he would be fine with what works for us... Hubby will prolly start on the 2oo per week.. but go to the 100 per week after the initial.. His doc says there is no absorbtion probs with the shots... and the gels are not working.. so.. this is gonna be a way to go... at least for now... ( his T level was 189 at last count.. )

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Re: Setting Expectations

Postby Nvr2Late » Tue Feb 16, 2016 8:27 am

It's also a known fact that higher, less frequent T injections cause MORE conversion to estradiol than smaller, more frequent ones. I second the Crisler book.
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Re: Setting Expectations

Postby justsomeguy » Fri Feb 19, 2016 3:09 pm

Ok so 2 weeks after the 200mg shot of Cypionate my T went from 243 (54 pg/mL free, 147 bioavailable) to 384 (94pg/mL free, 250 bioavailable). Estradiol from <20 to now 24 pg/mL (but a previous sample earlier in Jan. also gave a reading of 24 pg/mL). I then got another 200mg. He plans to do labs again in 2 weeks and then start me on Testopel. Got the book but haven't read it yet.

Any thoughts on Testopel pellets or anything else here?

Thank you!!

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Re: Setting Expectations

Postby Nvr2Late » Sat Feb 20, 2016 11:42 am

Dr Crisler is a fan of gels first, then injections and not at all of Testopel, in that order.
The pellets worked ok for us, but there is an unevenness to the way they release T, and now that I know more, I don't think they are best. One of my doctors still thinks they are the bomb, though. So you'll get differing opinions.

They are EXPENSIVE in men, and much bigger deal as you have to have multiples (I think DH got 8 at one time) and one cost me $275. They last about 3-6 months and it's a minor surgical procedure to have them implanted.
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Re: Setting Expectations

Postby be64 » Sun Mar 06, 2016 4:49 pm

I think the likely best course of action would be 100-200mg per week divided into two injections. It should be noted that it can take as long as twelve weeks after starting for testosterone to reach its upper level. It can also take up to a year to notice all the positive effects of testosterone replacement. Low testosterone can cause testosterone receptors to down regulate therefore even with an increase in testosterone the effects may not be noticed right away because the testosterone receptors need to become up regulated in order for the testosterone to be effective.

I believe the goal should be to have a trough level, the lowest level just before injection, that is in the upper fourth of the range.

While it is not always possible, I think the best thing you could do is find another doctor who knows more about testosterone replacement. When I started having hormone issues I went to twelve different doctors before I got to the one I have now.
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Re: Setting Expectations

Postby Unfulfilled » Sun Mar 06, 2016 6:18 pm

Be64,

Please explain a bit more about your statement where the rule of thumb is to inject for I assume subQ when the blood test is in the UPPER 1/4 (75% of the range).

Are you saying this because it takes so long for the T to transition to usable T (half life). So that by the time it is available for use by your body, your levels will will be lower in the range than The upper 1/4?

If you are injecting twice a week, is the "trough" really that noticeable? It would semi like the long half life of the T and the frequent injection would keep the blood levels fairly constant?

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Re: Setting Expectations

Postby be64 » Sun Mar 06, 2016 6:51 pm

When you are not on testosterone replacement testosterone it checked first thing in the morning to catch the highest level. For some reason when you are on TRT doctors check your testosterone level just prior to injection which would be your lowest level. The ideal goal when on TRT is generally to have a low level just prior to injection which is in the upper fourth of the range.

I don't know what the daily fluctuation of natural testosterone production is but the idea behind checking the low point is to make sure your level doesn't drop too low before the next injection.

With twice weekly or more frequent injections the trough and peak are likely not noticible, which is the point of frequent injections.
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Update

Postby justsomeguy » Wed Apr 20, 2016 4:48 pm

Blood test last week, 1 month after 12 Testopel pellets installed, shows me at:

T: 816
T % free: 2.6%, 214 pg/mL
SHBG: 20 nmol/L
T BIOAVAILABLE: 570 ng/dL

From the numbers I'm thinking I should be a raging horn dog, although with my wife's awakening we do something nearly every day. I have still experienced several times where I simply could not finish. Low sensitivity some times.

Q: 5 weeks in from pellet insertion should I be at equilibrium or do I need to give it more time to fully get back to 100%?

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Re: Setting Expectations

Postby txtwindad » Wed Apr 20, 2016 5:07 pm

Didn't they test your estrogen level?
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Re: Setting Expectations

Postby justsomeguy » Sun Apr 24, 2016 1:53 pm

Estrogen was not tested this time. Last night was a total disaster. She tried oral & I just wasn't feeling it. She suggested PIV and for the first time ever totally lost erection, could not penetrate. Feels like I'm getting worse... :(

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Re: Setting Expectations

Postby SquarePants » Sun Apr 24, 2016 4:38 pm

If your doctor isn't checking your estrogen levels, he has no business administering testosterone therapy. Increased testosterone levels will cause an increase in estrogen levels. I would demand to have my estrogen levels checked, and then request a prescription for Arimidex if your levels are too high. Meanwhile, you might consider searching for another doctor as a backup. If your estrogen levels are high, your performance isn't going to improve until your pellets wear off and both the testosterone and estrogen levels go down.

Meanwhile, you might be able to decrease your estrogen levels with 50 mg of zinc. I'd give the doctor a call and request the lab for Estradiol (ultra sensitive). Did you get your labs at Quest Diagnosics or Labcorp, or somewhere else?

I'll recommend again the following book: “Testosterone Replacement Therapy: A Recipe for Success,” by John Crisler.

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Re: Setting Expectations

Postby spiritfire777 » Tue May 17, 2016 1:22 pm

also we found out to late that before you use T shots.. you should have your heart tested... can cause heart failure if you aren't ok there... or if your artieries are clogged up, it seems to make it worse.. :(

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How high Estradiol is too high?

Postby justsomeguy » Fri Jun 10, 2016 12:17 pm

Again rather symptomatic with my Testopel :(

Blood work from 2 days ago:

ESTRADIOL: 33 pg/mL (last checked 2/17, value was 24)

Testosterone: 612 (last checked 4/13, value was 816)

T bioavailable: 373 (last checked 4/13, value was 570)

Sad the T therapy was only marginally effective, and only for 6-8 weeks. Any thoughts where to go from here?

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Re: How high Estradiol is too high?

Postby SquarePants » Fri Jun 10, 2016 2:12 pm

33 isn't too bad. One doctor I had suggested 20-30 as optimum, but another doctor seemed to the think that 20-40 was okay. I've seen elsewhere someone suggesting 18-28 as being optimum.

Your optimum level will depend on your sex hormone binding globulin (SHBG) levels. Higher levels of SHBG will raise what is optimum for you. SHBG will bind with both testosterone and estrogen and permanently keep them from interacting with your body. Your bioavailable testosterone doesn't look too bad. My levels tend to bounce between 250-550, though my total testosterone hovers around 700-900.

My doctor suggests that patients can try zinc supplements for mildly elevated estradiol. You might consider trying it. The recommended dose is 50 mg per day.

What symptoms are you currently having? Many of us would recommend self-administered injections once or twice a week. Subcutaneous injections only require a small needle into the fat, and are easy to do. Some people have mild allergic reactions which cause soreness, but aren't serious. I don't know anyone who liked pellets.

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Re: How high Estradiol is too high?

Postby justsomeguy » Fri Jun 10, 2016 6:16 pm

My SHBG is 25, previously 20. Symptoms are low drive, inability to finish about 40% of the time, and weak O's when I can. My refractory period has increased substantially from just 18 months ago (24 hours min as opposed to an hour or two).

For as yet unknown reasons my (young) doc doesn't prescribe sub-q injections. He likes pellets. At least my insurance covers pellets. Not sure if it would cover sub-q (but I'd be happy to try sub-q if I could). I see him on Monday. Have a feeling he's going to point to psychological cause if my numbers aren't "bad" :roll:

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Re: How high Estradiol is too high?

Postby justsomeguy » Sun Jun 12, 2016 4:59 pm

Any thoughts before I go in to see my doc?

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Re: How high Estradiol is too high?

Postby SquarePants » Sun Jun 12, 2016 6:08 pm

Was that estradiol level of 24 from before your testosterone therapy?

I'd be tempted to ask for two things: 1. Self-administered subq injections twice a week, and 2. A small dose of Arimidex (maybe 0.25 mg once a week or every other week). The smallest pill size is 1 mg, but you can break it into quarters. Injectable testosterone is fairy cheap, typically $25-$60/ month. You can shop around your local pharmacies for the best pricing if you have to pay out of pocket.

If he rejects the Arimidex, then consider 50mg/day zinc.

Also, do you have DHT values from your lab work?

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Re: How high Estradiol is too high?

Postby justsomeguy » Tue Jun 14, 2016 10:19 am

Hi SP - thanks for all your help :)

My Estradiol was "<20" on 1/29/16 prior to any TRT. On 2/17/16 after 1 month of bi-monthy IM injections it rose to 24 and then on 6/8/6 is rose again to 33. Testopel procedure was on 3/16. I don't see any DHT in labs. Only various T, SHBG, Estradiol, and Hematocrit.

Doc was not opposed to prescribing self-administered IM injections instead of Testopel. Said subQ is "unproven" in the science and would not be covered by insurance. He gave me Cialis samples to try, advising breaking a 5mg tablet in half taking 30 minutes prior to sex. I'm not having problems with erections (which he knows) but said that might help sensitivity. He also prescribed another drug to experiment with: cyproheptadine (4 mg) 3-4 hours prior to activity. Also prescribed terbutaline in case of emergency (yikes!).

Should I be a little spooked by the potential for side effects?


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