Setting Expectations

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

Postby justsomeguy » Mon Sep 05, 2016 2:19 pm

This was from 8/9/2016. I don't know whether this was ultra-sensitive or not.

Estradiol 25 pg/mL

Reference Ranges (pg/mL):
Males: <=42 pg/mL
Menstruating Females:
Follicular Phase: 27-122 pg/mL
Mid Luteal Phase: 49-291 pg/mL
Luteal Phase: 95-433 pg/mL
Post Menopause: <41 pg/mL

ledgemoor
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Re: Setting Expectations

Postby ledgemoor » Tue Sep 06, 2016 5:18 am

JustSomeGuy:

First of all, I am so glad your wife is not only alive but will recover. The couple that got me interested in cycling are big roadies. Recently she was in an accident where a motorcyclist wiped out. She avoided the motorcycle but in the process got in front of the rider. He slammed into her, making splinters of her carbon frame and breaking her collar bone or shoulder. It wouldn't heal, so they had to remove something. She is still fully functional and riding again thank God. The motorcyclist barely had a scratch on him.

I take my chances with trees and cross-country mountain biking. The trees are supposed to be stationary, but they still hit my handlebars occasionally :lol:

Also sorry to hear that the testosterone therapy isn't going will. After three weeks at an increased dose, you should notice some improvement. Certainly it shouldn't be getting worse. Your estrodial looks in range. I'm sure SquarePants or someone who has had problems with estrogen will be along and give you the final word on that. It's possible to have too little estrogen and suffer ED as a result (again, yours doesn't look low either based on the range).

My thoughts at this point is that your typical urologist isn't equipped to handle a difficult hormone case. Most of the time, prescribe testosterone, and problem solved. They aren't equipped to handle anything more difficult. You need someone who specializes in hormones. Check out a4m.com. Click on Directory and make a few calls. Their certification is rigorous. Also, a doctor who specializes in treating women would be a good bet. Women are more complicated, and bHRT doctors who treat women are used to dealing with difficult cases. Our doctor is a gyn. Made for some interesting moments, sitting in the gyn's office with a bunch of women, and the receptionist says "Mr. Moore, the doctor will see you now" :lol:

There are also guys here on TMB that deal via phone/web with doctors specializing in men's testosterone issues. They would probably be good too, seeing it is a specialty and not a sideline for them.

Are you taking zinc, copper, DIM (estrogen management). Also, vitamin D. I have heard of several guys who take care of their ED issues with fish oil. I suspect it was nothing but vitamin D deficiency. It is so prevalent that our doctor no longer tests for it (a rather expensive test), he just tells people to take 5000 IU/day. My brown wife takes 10,000 IU/day. She can feel it if she only takes 5000. We live in the deep South btw. We don't sunbathe and all of my cycling is in the woods, but we do get out and get some sun, and are rather tanned.

And I guess that being a serious cyclist, you know about proper saddle selection etc. to avoid nerve damage. Not a problem for mountain bikers since we are up and down so much.

Praying for you and your wife. Wow, glad that wasn't worse.
Everything you ever wanted in life is just outside your comfort zone (Jamie Lee Curtis)

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SquarePants
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Re: Setting Expectations

Postby SquarePants » Tue Sep 06, 2016 8:08 am

25 would be good for Estradiol. However, I have 2 comments:

1. That reading was before your dose was increased from 100 mg/wk to 150 mg/wk. Your E2 levels almost certainly increased noticeably after increasing your dose. You commented that you felt worse after increasing your dose. High E2 will block the positive effects of increased testosterone. If your E2 was borderline high at 100, then I'd bet that you'd be much too high at 150. If I remember correctly, your SHBG level was on somewhat low, would would mean that you probably wouldn't tolerate high E2 very well.

2. If that level of 25 was from an insensitive lab, I have read from multiple sources that the values can differ significantly from the "sensitive" measurement. If I remember correctly, the non-sensitive lab often measures about 10 points higher than the sensitive lab when E2 levels are near 20.

justsomeguy
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Re: Setting Expectations

Postby justsomeguy » Tue Sep 06, 2016 8:53 am

ledgemoor:

As for supplements I am taking a daily multi-vitamin (with 1000 IU vit D) and also a 1400mg fish oil. My doc advised the multi-vit and I started the fish oil maybe 6 weeks ago based upon a recommendation I saw here on TMB. I'm rather tan at the moment and so my guess is I'm not Vit D deficient, at least not right now. I live in a place notorious for Vit D deficiencies during the winters tho.

I am starting to wonder about my saddle tho. It's a rock-hard fizik with a deep center channel (supposedly to provide nerve bundle protection) but I definitely feel it for maybe the first 10 miles before it goes a bit numb (or at least my legs/lungs start complaining louder than my crotch :roll: ). In a recent fitting at my LBS they didn't have anything optimal for me in terms of saddles. My doc does think there may be a correlation, and said he doesn't see how my cycling would NOT be having an impact, and he's seen other cyclists with "issues". Gave me the option to see a specialist for such nerve issues. Might be time to take him up on that offer.

SquarePants:

Perhaps the lab can tell me which one has been ordered. Next draw is tomorrow.

Thanks all :)

ledgemoor
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Re: Setting Expectations

Postby ledgemoor » Tue Sep 06, 2016 9:56 am

You could still be low in vitamin d. If you weren't cycling in the sun a lot I would say you definitely are. You can be tanned and still be low in D. In fact, the tan works against your vit d production. I've read that anywhere north of Atlanta you could spend all day outside in the nude in the winter, you would not get enough D. The test is < $100, so given your situation....

On the saddle, are you numb in your perineal area for most of the ride? Not good. My understanding is that a hard saddle may be uncomfortable and give you a sore butt, but that in itself isn't an issue for ED. You just don't want numbness. Too SOFT a saddle will pinch nerves/cut off ciurculation etc. and cause numbness. The cutout is good, but will still make you numb if too wide or too narrow.

I guess you wear a chamois too? I ride a hard saddle but wear a roadie's shorts & jersey. I never get the least bit numb. Too sore to sit down perhaps, but not numb.

Anyway, you gotta find a saddle that fits. Go to another dealer. Have you been Ass-O-Metered? (yes mods, that's the proper name for the device). Our LBS will measure you, then let you try the saddle for a few days and exchange it if per chance it doesn't work for you. I've heard that Terry, which started out with women's seats only then expanded into mens' seats, make a good range of comfortable saddles. I'm not aware of them making lightweight racing saddles tho.

https://www.youtube.com/watch?v=zMbZ2Q8VqOo
Everything you ever wanted in life is just outside your comfort zone (Jamie Lee Curtis)

justsomeguy
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Re: Setting Expectations

Postby justsomeguy » Tue Sep 06, 2016 10:11 am

I'm going to ask (beg?) my doc to give me both a sensitive E test as well as Vit D. We'll see how that goes.

I have been Ass-O-Metered :lol: In fact, my LBS has a state-of-the-art realtime pressure mapping system that they used during my fitting to distribute the pressure points towards the back of the saddle and reduce them. But further improvements might be had via a new saddle. Edit: I definitely always wear bib shorts with a chamois. Perhaps problematically, I wear cheap Chinese knockoffs (perhaps sub-standard padding) since the real (good) ones are so bloody pricey ($200 retail - ouch!! :shock: )

Here's my full detail from 8/9:

TESTOSTERONE ADULT MALE 438 ng/dL
TESTOSTERONE PERCENTAGE FREE 2.3 %
TESTOSTERONE FREE CALUCLATION 102 pg/mL
SEX HORMONE BINDING GLOBULIN 22 nmol/L
TESTOSTERONE BIOAVAILABLE 272 ng/dL

Note: this draw was on a Tuesday but I had forgotten to stick myself on the day before. I received the IM immediately after this draw.

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Re: Setting Expectations

Postby Unfulfilled » Tue Sep 06, 2016 10:32 am

Wow, your numbers are almost identical mine. But my Dr.mtold me my numbers are not low enough to be covered by insurance.

I'm turning 50 soon but my levels are that of a 60 year old man. Don't know how the Dr can call that "normal".

I'm in a catch 22. If I start out of pocket HRT, then I would assume my numbers will get better and I'd never get the insurance to help pay. Also my current sex drive is much lower and seems to better match my wife's drive. So I really don't have much incentive to increase my sex drive and just be frustrated all the time with the lack of sex.

On the other hand, I am tired of not being able to lose weight and being so fatigued when I do hardly any physical work by the end of the day.

Not sure what I should do. Currently no decision is my decision. If I wait another 6 months, at the rate my levels were declining, I will be out the bottom of the normal ranges by then. Maybe then The insurance will pay. I went from 440 total T to 404, and free T from 10.4 to 8.0 in 10 months. The last test was May 2016. They never tested for estriodal either time.

I do all the other things recommended for diet and exercise. Except I do not weight lift and frankly do not want to buy the equipment or pay to join a gym. Besides, I just do not like weight lifting. I swim 3 days a week though.

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Re: Setting Expectations

Postby justsomeguy » Tue Sep 06, 2016 12:41 pm

Unfulfilled:

Those numbers follow 4 months of pellets and then a month of weekly T injections. My T first started in the 200's and I'm 47. Although the T therapy hasn't been the magic pill I'd hoped for in the sexual department I do definitely notice a higher level of alertness & energy. Since I quantify my cycling (as many cycling nerds do) I can see it's had a direct impact in improving my strength & speed on the bike (definitely digging that!).

I know what you mean about a wife's drive. For YEARS I prayed that the Lord would reduce my drive b/c it was so much higher than my wife's and that made me miserable (so I thought). Well here I am, God granted my prayer, and I dislike that even more. In my case, in the Lord's providence earlier this year my wife abandoned all refusing and gatekeeping. The irony isn't lost on me...

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Re: Setting Expectations

Postby justsomeguy » Tue Sep 06, 2016 12:57 pm

I had emailed my doc. His reply:

Our estradiol is not sensitive. There is no standardized or acceptable value in and of itself for estradiol but more in connection with ration compared to total testosterone. I have put an order in to check this.

I can check your Vitamin D levels but generally, this is not recommended unless you have some symptoms. If it is off, I will have you follow-up with your primary MD.

So, you will have Testosterone, Estrogen, PSA, Hematocrit, and Vit D drawn on you and the orders are in for this.

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Re: Setting Expectations

Postby Unfulfilled » Tue Sep 06, 2016 3:36 pm

I too prayed for lower libido and I also got it.m but in my case so far from that aspect it has worked out.

I suspect all the endocrine disrupting chemicals in our environment(fire retardants on furniture and bedding) and in our food (pesticides and herbicides) is causing higher estrogen levels in both men and women. Leaving men with ED and fatigue and leaving women with a significantly higher odds of breast cancer.

And what to we see in society? More and more men With T levels falling, WD and high rates of breast cancer in Women.

Hummmm. What a surprise!

So the prime symptom of low vitamin d is fatigue. And a prime symptom of low T is fatigue. Nope you don't have any symptoms to call for the need of vitamin D.

I'm the north part of the USA, after about mod September to mid May no matter how much sun exposure you get, you make no vitamin D from sun exposure. The sun is at too low of an angle and in the winter you're covered up anyhow. also if you where sunscreen, you also won't make much vitamin D.

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Re: Setting Expectations

Postby be64 » Wed Sep 07, 2016 7:49 pm

I was at a steady testosterone dose for a long time having the greatest sex of my life then suddenly a couple months ago my sex life crashed. Despite using Cialis daily I had significant ED and difficulty reaching orgasm with very little penis sensitivity. It was time to have my hormone levels checked so my doctor ordered the tests. It came back that my total testosterone was 1250 and free T was over the top as well. My estradiol was 33 which while in the range is higher than optimal. I increased my Arimidex dose and my sexual ability gradually came back. A couple days ago I had the second or third most intense sex of my life. Whether or not it was the estradiol that caused the problem I can't say for sure but I would guess that in your case and mine it is the problem.
The secret to having everything is believing you already do!

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Re: Setting Expectations

Postby justsomeguy » Wed Sep 07, 2016 9:07 pm

be64: may I ask, are you under the care of a local doc or are you using something like Defy Medical?

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Re: Setting Expectations

Postby be64 » Wed Sep 07, 2016 9:35 pm

I am being treated by a combination of my regular doctor and an endochrinologist. I mostly am treated by my regular doctor but the endo sort of oversees it. I see him only once per year and test once in between. He also monitors my ferritin level since I have hemochromatosis. I've seen a young urologist who is new to the area who is quite sex positive. We have discussed hormone replacement and I may switch all my sex hormone stuff over to him if he will agree to let me do things how I do and not interfere with what I consider appropriate treatment. If he doesn't like how I do things I'll stick with who I'm already with.
The secret to having everything is believing you already do!

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Re: Setting Expectations

Postby justsomeguy » Sat Sep 10, 2016 8:49 am

Problem identified: lab on 9/8:

TESTOSTERONE: >1500 ng/dL
T % FREE: >2.7%
T FREE CALC: >410 pg/mL
SHBG: 24 nmol/L
T BIOAVAILABLE: >1094 ng/dL

Estradiol: 118 pg/mL :shock:

Just for kicks, my Vit. D was 45 ng/mL (smack middle of normal)

Looks like we overshot my T dose just a wee bit? :roll:

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be64
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Re: Setting Expectations

Postby be64 » Sat Sep 10, 2016 9:43 am

Yes, that estradiol is extremely high. I'm surprised you weren't having a lot more symptoms.

What T dose have you been using and what frequency of injection?

Something to remember is that with frequent injections the trough level will be higher than on less frequent injections. So for example if you were at 150mg per week divided into three doses your trough levels may be over the high end of the range, but with that same dose given only once a week your trough level may only be near the top of the range. Therefore with frequent injection I don't worry if it is a little over the top of the range.

I should also ask at what point in relation to your injections was this blood test done. If done soon after instead of just before injection the results will be higher.
The secret to having everything is believing you already do!

justsomeguy
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Re: Setting Expectations

Postby justsomeguy » Sat Sep 10, 2016 10:37 am

T dose was bumped up to 150mg a month prior. IM injection (once weekly) was received on the Monday before.

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be64
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Re: Setting Expectations

Postby be64 » Sat Sep 10, 2016 9:04 pm

By this you mean you are injecting 150mg per week in one weekly injection? I still don't understand when the blood was drawn in relation to the injection.
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Re: Setting Expectations

Postby justsomeguy » Sat Sep 10, 2016 10:14 pm

be64 wrote:By this you mean you are injecting 150mg per week in one weekly injection?


Yes. I may have bumped it to 160 or so.

I still don't understand when the blood was drawn in relation to the injection.


The blood draw was 3 days after the injection

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be64
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Re: Setting Expectations

Postby be64 » Sat Sep 10, 2016 10:58 pm

Testosterone peaks within the first few days after injection therefore your result is likely more of a peak level than trough level. If it had been tested the day of injection before injection then you'd have the trough level. The doctors I've been to always want to monitor the trough level. So long as the trough level is within the normal range they are happy with it.
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Re: Setting Expectations

Postby justsomeguy » Wed Sep 14, 2016 8:06 pm

Saw my doc today. He said there's "no way" my higher E caused any of my recent issues. He said it's all about the T/E ratio, and in my case my ratio was massively high on the T side. So much so that he said T therapy "might not do all that much for me" :shock:

In the end he just knocked my dose down to 120 and labs in 3 weeks. He did mention a willingness to have me be his first sub-q patient if things stabilize on the new dosage.


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