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Old 06-05-2009, 09:40 PM   #1
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hoosier_guy HB User
I need advice, I am not responding to Testosterone Replacement Therapy

I for the longest time thought I had ADD. I couldn’t concentrate nor focus on anything. I had no drive to do much and I always felt down and had no energy. I have been 100 lbs overweight being 6’1 and 290. I did get down to 255lbs but that didn’t last very long (maybe 3 mos then went back up)

So my Dr ordered some blood tests as part of my yearly physical and snuck a Testosterone Test to see if that would provide my lack of general interest.

I got a call with the following results…

4/13/09

TESTOS FREE/TOT ADU
TESTOSTERONE, % F 2.4
Reference range: 1.6 to 2.9
Unit: %

TOT TESTOSTERONE 176
Reference range: 400 to 1080
Unit: ng/dl
(NOTE)
REFERENCE INTERVAL: Testosterone, Adult Male

Tanner Stage IV 165 – 854 ng/dl
Tanner Stage V 194 – 783 ng/dl

To convert to nmol/L, multiply ng/dL by 0.0347
FREE TESTOSTERONE 42
Reference range: 47 to 244
Unit: pg/ml
(NOTE)
REFERENCE INTERVAL: Testosterone, Free

Tanner Stage IV 35 – 169 pg/mL
Tanner Stage V 41 – 239 pg/mL

The concentration of Free Testosterone is derived from
a mathematical expression based on the constant for the
binding of testosterone to sex hormone binding globulin.

SEX HORMONE BIND GLO 16
Reference range: 11 to 80
Unit: nmol/L



Needless to say my levels were extremely low and she felt the need to put me on testosterone replacement therapy so after discussing the different methods I decided to do the injections in my arm. While somewhat painful it was quick and easy. After playing the waiting game with my insurance they approved it and...

On May 4th I received my 1st 200mg/mL injection of Testosterone Cypionate. These injections were to be repeated every other week at 200mg/mL each.

2 weeks later (5/18/09) I got my 2nd injection and I didn’t really feel a whole lot different.

2 weeks after that (6/2/09) I showed up for by blood work to see if the injections were helping me and to receive my 3rd injection after they drew my blood. They took the lab work, gave me the injection and I went on my way.

Well I got my results today from the Dr’s.

Not good.

6/02/09

TESTOS FREE/TOT ADU
TESTOSTERONE, % F 2.4
Reference range: 1.6 to 2.9
Unit: %

TOT TESTOSTERONE 122
Reference range: 400 to 1080
Unit: ng/dl
(NOTE)
REFERENCE INTERVAL: Testosterone, Adult Male

Tanner Stage IV 165 – 854 ng/dl
Tanner Stage V 194 – 783 ng/dl

To convert to nmol/L, multiply ng/dL by 0.0347
FREE TESTOSTERONE 29
Reference range: 47 to 244
Unit: pg/ml
(NOTE)
REFERENCE INTERVAL: Testosterone, Free

Tanner Stage IV 35 – 169 pg/mL
Tanner Stage V 41 – 239 pg/mL

The concentration of Free Testosterone is derived from
a mathematical expression based on the constant for the
binding of testosterone to sex hormone binding globulin.

SEX HORMONE BIND GLO 16
Reference range: 11 to 80
Unit: nmol/L


My testosterone level decreased and I was so downed by it and utterly confused. The Dr wants to give me 200mg/mL per week for 6 weeks then test for levels.

How can I receive the T Cypionate injections and have them do nothing much less my T level decrease?

Has this happened to anyone?

 
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Old 06-08-2009, 08:22 PM   #2
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Re: I need advice, I am not responding to Testosterone Replacement Therapy

I saw the Dr today and she told me that I needed to be patient with my treatment and not to worry, it will get up there (my T-levels). She felts that I just started and I need to give it some time.

I asked her if she did a blood test for estrogen levels would it help figure out my issue with low-T and she said that even if she got a result that said I had high estrogen, she wouldn't know what to do with it. So I guess that means that test even if high, would serve no purpose.

I get tested for T-levels in 6 weeks so I hope the T-Cyp will actually work now.

 
Old 06-16-2009, 06:45 AM   #3
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Re: I need advice, I am not responding to Testosterone Replacement Therapy

estrogen E2 should be tested. If your are growing boobs, it is probably very high.
E2 level should be in the lower middle of its range.

The T may be converted to E2. Do 100mg injections once a week. That your help reduce the t to E2 conversion.
Get a prescription for Arimidex. It greatly reduces the T to e2 conversion. You only need 1/2 a tablet 2 or 3 times a week.

Take the two OTC pills called DIM each day. They will help lower the existing natural E2.

 
Old 04-29-2011, 04:36 PM   #4
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buddahcall HB User
Re: I need advice, I am not responding to Testosterone Replacement Therapy

Hi, I am pretty new to this myself, I just started replacement therapy, and my problem was the estrogen level as well, the replacement therapy alone will cause increased estrogen conversion, so yesterday was my second visit, I am taking 200 T a week, and didn't feel much on just that but yesterday I was also given HCG and en estrogen blocker, the same one listed above that I take one pill every 3-4 days, The HCG also gives you a boost by stimulating your body to produce its own T, I Have been married for 10 years and lets just say last night was like our honeymoon again, beyond that I have more energy today than I have in a very long time. They call it the Testosterone Trifecta, I hope this helps.

 
Old 08-15-2011, 08:25 PM   #5
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onxanax HB User
Re: I need advice, I am not responding to Testosterone Replacement Therapy

It's possible the supplementation of the T has shut down your own natural production of T. Very common from what I read.

So essentially if that is the case youre only getting the supplemented T and may need to increase accordingly until you're at your desired level.

About the E2- if your doctor wouldn't know what to do about it if the number was high- you need a new doctor.

There are estrogen blockers (typically prescribed for breast cancer patients) that lower your E2 levels.

There may be other ways to reduce the conversion from T to E2 but if your doctor doesn't know you need a better doc.

 
Old 08-25-2011, 08:10 AM   #6
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BingeGuy HB User
Re: I need advice, I am not responding to Testosterone Replacement Therapy

im not an endocrinologist but i do have some personal background history on anabolic steroids. for one test cypionate has one of the longer half lives of most test esters anywhere from 8-12 days so i can see why the 200mg shots were given every 2 weeks. but it will also take longer for you to feel the effects of this type of test. also i agree with JinL... when testosterone levels rise so do estrogen. arimidex is a good option (it will also decrease water retention cause by increased estrogen, which will help with your appearance since you said you are overweight). nolvadex is an option if you are experiencing gyno, man boobs. talk to your doc about switching you to test enanthate and maybe putting you on an oral steroid such as anavar or something that has low androgenic properties.

 
Old 01-23-2012, 01:05 PM   #7
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Youthful55Guy HB User
Re: I need advice, I am not responding to Testosterone Replacement Therapy

My advice is that you probably need a new doctor, one with experience in TRT. I've just strated TRT myself, but I've spent countless hours researching this. After just one discussion with my family doctor, I new that I needed to get myself to a specialty clinic. I found one about 35 miles away and am happy to make the drive once per week to get treatment from a specialist.

First off, as pointed out by one of the earlier replys, T-Cyp has a half life in the body of about 7 days. The general consensus that I found in the literature is that a lower dose of 100 to 150 mg once per week is the best way to go, although there are some clinics putting guys on 50 mg twice per week, but in my oppionon that's a lot of injections into the muscle.

When you take supplemental T (no matter the form or route of delivery), you shut down your natural production of T. After about 10-12 days you are going to have a serious drop in T below theraputic levels and you have no self-produced T (endogenous in medical terms) to fall back on because you've shut that production down. So if you test two weeks after your last injection, you could have lower T levels than before you started.

Regarding E2, when you raise your T levels, some of it will be converted to either E2 or DHT. You want to minmize the E2 and probably just accept the higher DHT. DHT is important for labido and that sence of wellbeing. The downside is loss of hair if you are geneticaly inclined to it. In my oppinion having my life back is more important that losing a little more hair.

Getting back to the E2, you should be on an anti-estorgen. The typical drug/dosage is Arimidex 0.25 to 0.5 mg twice a week. This is off-label usage of the drug and much lower than that used to treat breast cancer (generally 1 mg/day), so you'll need to cut pills in half and fight with your insurance company. But it is important to control E2 when on TRT because elevated E2 will cause elevated levels of Sex Hoemone Binding Globulin (SHBG) which will bind up the T and lower your Free-T levels, and it's the Free-T that important because it is the bioactive form.

The program I'm on is 100 mg T-cyp once per week and 0.5 mg Arimidex twice per week. I could feel the effect of my first injection of T-cyp about 8 hours after the first injection and the brain fog was completely gone after 24 hours. My Free-T was very low to begin with (8.2 pg/ml) but my Total-T was completely normal (mid-600's). My E2 was on the high side of normal.

After four week of this treatment, the plan is to adjust the T-cyp to get Free-T into the target range (>20 pg/ml range) and then add in 200 IU HCG twice per week (self-injections sub-Q) on the two days preceeding the T injection to bump it up squarely into the target range (closer to 100-200 pg/ml). Target E2 levels are 20-30 pg/ml).

The HCG will prevent testicular atrophy (which WILL happen if you don't get HCG) and boost the T levels toward the end of the weekly cycle and help prevent the emotional crash that can happen at the end of a weekly cycle. HCG is also suppose to stimulate important steroid pathways in the adrenals that are responsible for part of that sense of wellbeing I lost before all this happened.

 
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Old 02-17-2012, 11:41 AM   #8
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Re: I need advice, I am not responding to Testosterone Replacement Therapy

Youthfull, I have recently started hormone replacement therapy as my T levels were 6.6 (190 in U.S. measurements) - extremely fatigued and suffering major depression. I started injections a couple of months ago and so far each injection has done the opposite, and made my low T symptoms worse, to the point that i took 3 weeks off work and after 2 days back my Dr has put me on sick leave for a week.

I am using the testosterone gel (Testogel), and a cream that is only available in Australia called Androforte. With the injections my prostrate enlarged and I am now been tested for a potential prostrate problem.

I would recommend that you use the gels or creams available in your country, even though they need to be applied daily, it is better than having injections that don't work or make you worse.

My own research has indicated that in some men the the injections seem to change from T to estrogen, which I am sure that is causing my problems. I am in bed for about 15 hours a day at the moment and have hundreds of $ in T injections at home that I can't use.

Talk to your Dr about the estrogen issue, and try the creams - they take longer but do work. Don't take tablets unless you want to destroy your liver.

 
Old 02-18-2012, 10:18 AM   #9
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Re: I need advice, I am not responding to Testosterone Replacement Therapy

Quote:
Originally Posted by adlis View Post
Youthfull, I have recently started hormone replacement therapy as my T levels were 6.6 (190 in U.S. measurements) - extremely fatigued and suffering major depression. I started injections a couple of months ago and so far each injection has done the opposite, and made my low T symptoms worse, to the point that i took 3 weeks off work and after 2 days back my Dr has put me on sick leave for a week.

I am using the testosterone gel (Testogel), and a cream that is only available in Australia called Androforte. With the injections my prostrate enlarged and I am now been tested for a potential prostrate problem.

I would recommend that you use the gels or creams available in your country, even though they need to be applied daily, it is better than having injections that don't work or make you worse.

My own research has indicated that in some men the the injections seem to change from T to estrogen, which I am sure that is causing my problems. I am in bed for about 15 hours a day at the moment and have hundreds of $ in T injections at home that I can't use.

Talk to your Dr about the estrogen issue, and try the creams - they take longer but do work. Don't take tablets unless you want to destroy your liver.
THanks for the suggestion Adlis. I think you pointed to the problem that you faced with the injections and that I do not experience, and that is your E level. This absolutely needs to be controlled, even with the topical products, E can still get out of control for some individuals if they happen to have high aromatase activity in their fat cells, this is my case.

My E was 32 pg/ml prior to TRT and that was driving up my sex hormone binding globulin (SGBG) production. Even though the E was within the upper end of what's considered "normal" for my age, it was just too high and that drove up the SHBG and that bound up all of my T making it non-bioavalable.

When I started TRT I also started taking Anastrozole at (0.5 mg 2X weekly) and that brought my E down to a very healthy 17.7 pg/ml. My total T level was good to begin with (618 ng/dL) and when up slightly with TRT to a healthy 770 ng/dL, but more importantly we brought the E down and that brought the SHBG down we think (not yet retested that). However, it explains my very rapid repsonse to the first injection (within 24 hours), I was probably responding to the Anastozole as much or more than I was responding to the T-cyp injection.

Were you taking weekly injections or less frequent? If you take weekly injections, they do not need to give you as much to keep you within range so your E level does not go as high as the less frequent injection schedule. It's also important to know what type of T injection they were giving you. In your country I believe the new T-und is available and that has a much longer half life than the T-cyp which is most commonly used in the USA, so less frequent injection with T-Und will keep you in the zone much better than more frequen injection of T-cyp.

Also, I recommend that you also know you E levels and not just guess that was the problem. Your doctor should include this as a regular monitoring test. As you drive up the T even with the gel you will also drive up the E. Even if you are within the "normal" ranges, the eperts in TRT are recommending that you keep it with 15 to 20 (at the most) pg/ml. Anasrozole will do that for you. It is also important not to goo too low too as you need some SHBG (stimulated by E) to serve as a reservior for the T. When it goes too low, you'll need to increase T because it gets metabolized and excreted fater but that may cause DHT conversion issues by going too high and contribute to you BPH.

Finally, going back to E, there is really good evidence that it's not the DHT that is causing you prostate issues, but rather the ratio of EHT. So by controlling the E, you treat the BPH.

 
Old 02-18-2012, 03:01 PM   #10
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Re: I need advice, I am not responding to Testosterone Replacement Therapy

Youthful,

Thanks for the advice, and I will certainly speak with my doctor when I see him tomorrow. I will post the outcome which may help others too.

regards

Adlis

 
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