DHT - Agel Issue

[kelkel]

Men,

Been on agel about a year or so now and doing well as the regulars here know. My PCP ignored E as did Endo. Now with Euro who's with it. I see him next week. All testing done 24 hrs after application of 6 pumps 1.62%. Here's the issue:

BW 9/13/11 Labcorp

Bio T w/o SHGB: 699
Bio T, S: 364 range 95-285
Bio T %: 52.1
T serum: 712
Free T: 17.3 range 7.2 - 24.0
E Sensitive: < 3 range 3-70 WTF

No baseline E done with prior docs (begged to no avail) and was on 1.5mg adex prior to above test. Happy with results except for E, obviously.

So............

Reduced adex to .25 x 3 per week

BW 11/29/11 Labcorp

Bio T w/o SHGB: 511
Bio T, S: 235
Bio T%: 45.9
T Serum: 485
Free T: 8.7
E Sensitive: 5 (again, WTF)
DHT: 131 ng/dl, range 30-85

I requested a DHT level with the above to see if it was high and playing a part in my E suppression. Here is a good read on DHT for those not familiar. http://www.bodybuilding.com/fun/reform8.htm. After reading that link I'll add I've got a full head of hair and that really is a third leg.

So, we know that agel can contribute to a DHT level increase but I'm also wondering if I'm just naturally high in that area. But without a pre-agel BW I can't really know for sure. After discussions with GD the thinking is that reducing the AI probably led to increased aromatization, therefore lower T levels. Or is it just a fluke and other environmental / physiological factors played a part in the lowered T levels on that day in my so called life.

When it comes to the abnormally low E level and sides, I don't really think I suffer from any. I've got a little pain in one knee and an elbow but I beat myself to death and still train very heavy so that's not abnormal for me. Everything else stands up when requested.

GD and I have a course of action but I would like to hear from you guys if you have the time.

Thanks in advance!

[bass]

LOL! no wonder you can't gain weight, your e2 is in the tank! don't know much about DHT, I'll let the other chime in. besides e2 there is a big drop in your totals, that can't be just from adjusting AI! did you adjust your test does as well? maybe its time to switch to injections!

[kelkel]

Expected that from you sir! Only change was AI reduction.

[Vettester]

Kelkel, you mentioned that you were on 1.5mg of Adex before the first panel. Was that 1.5mg/wk? Broken up 3 x .5mg? I got a theory, but I want to make sure what your dosage was first?

[kelkel]

Correct. .5 M-W-F prior to first BW

[Vettester]

To me it sounds like the 1.5mg was too much, which in turn resulted in your E2 crashing. The problem (IMO) is that you went on a maintenance dose of Adex; using .25 x 3/wk. A maintenance dose is good when you're dialed in, let's say 25 is your ideal E2 number, but a maintenance dose is not good when the E2 is elevated, or in your case when it's at rock bottom.

I would suggest coming off the Adex completely for a few weeks and let the estrogen rebound take its course, which in turn will allow the aromization process to also take its course. Once it gets back up you can take the needed maintenance dose to sustain your number range. In the estrogen rebound process, it is quite normal to see the nipples and breast tissue get very sensitive, as the receptors will be getting hit quite hard. This usually starts to happen after 2 to 3 weeks. I would invest in some Nolvadex (liquid or tabs) & plan a small amount of 20mg/day to combat this.

Just some other thoughts to consider.

[Vettester]

And yes, unfortunately this is info is from past experience.

[kelkel]

That is a consideration. When I was first hit with the low number I did take 1 week off then went back on with half the original dose for about 11 weeks until re-testing. I would have thought it would have jumped up more than 2 points in that amount of time. Right now I'm still leaning toward DHT but I'm not sure. Thanks Vetteman, you may be right. I see Drmagic lurking, maybe he'll chime in.....please

[Vettester]

Kelkel, curious, are you experiencing the sides that usually go along with low E2? I swear, I could barely walk up the stairs because me knee joints were so sore! Plus libido was in the tank. Amazing how quick that came back around

[Vettester]

That is a consideration. When I was first hit with the low number I did take 1 week off then went back on with half the original dose for about 11 weeks until re-testing. I would have thought it would have jumped up more than 2 points in that amount of time. Right now I'm still leaning toward DHT but I'm not sure. Thanks Vetteman, you may be right. I see Drmagic lurking, maybe he'll chime in.....please

Yes, it's just a thought to consider. It would be good to hear Drmagic's thoughts indeed.

My rationale is that you jumped back on to your maintenance dose too soon, therefore sustaining a low level by not allowing further aromatization.

[kelkel]

One knee and one elbow occasionally hurts but overall I feel good. I'm no kid but I still train very heavy so whether it's E related or weight related or a combo, I just don't know. that high dht level just haunts me and pulls me in that direction as the culprit.

[Drmagic]

Men,

Been on agel about a year or so now and doing well as the regulars here know. My PCP ignored E as did Endo. Now with Euro who's with it. I see him next week. All testing done 24 hrs after application of 6 pumps 1.62%. Here's the issue:

BW 9/13/11 Labcorp

Bio T w/o SHGB: 699
Bio T, S: 364 range 95-285
Bio T %: 52.1
T serum: 712
Free T: 17.3 range 7.2 - 24.0
E Sensitive: < 3 range 3-70 WTF

No baseline E done with prior docs (begged to no avail) and was on 1.5mg adex prior to above test. Happy with results except for E, obviously.

So............

Reduced adex to .25 x 3 per week

BW 11/29/11 Labcorp

Bio T w/o SHGB: 511
Bio T, S: 235
Bio T%: 45.9
T Serum: 485
Free T: 8.7
E Sensitive: 5 (again, WTF)
DHT: 131 ng/dl, range 30-85

I requested a DHT level with the above to see if it was high and playing a part in my E suppression. Here is a good read on DHT for those not familiar. http://www.bodybuilding.com/fun/reform8.htm. After reading that link I'll add I've got a full head of hair and that really is a third leg.

So, we know that agel can contribute to a DHT level increase but I'm also wondering if I'm just naturally high in that area. But without a pre-agel BW I can't really know for sure. After discussions with GD the thinking is that reducing the AI probably led to increased aromatization, therefore lower T levels. Or is it just a fluke and other environmental / physiological factors played a part in the lowered T levels on that day in my so called life.

When it comes to the abnormally low E level and sides, I don't really think I suffer from any. I've got a little pain in one knee and an elbow but I beat myself to death and still train very heavy so that's not abnormal for me. Everything else stands up when requested.

GD and I have a course of action but I would like to hear from you guys if you have the time.

Thanks in advance!

Agel and other topicals create more DHT because 5-alpha-reductase is very active in hair follicles so you almost always see higher DHT levels with them, Your change in levels are out of proportion to just changing your AI, topical absorption varies between individuals but also on different parts of your body. If we all checked our levels every day you would see changes based on many variables -stress, nutrition, exercise or lack of, gut health, etc etc etc. Your AI dose was high to begin with and may still be to high for just a topical, I rarely find a need for them with topical use unless a patient is a hyper-absorber and is able to obtain high levels on just topicals. You could have naturally high numbers also. Adding some saw palmetto can help some, medications for this come with risks -impotence is the big one if you drive DHT to low. Low estrogen can also come with many health issues - symptoms are the least of your worries when estrogen stays below normal.

[bass]

geeeeeeeeeeeeeeez, get off the AI kel!

[kelkel]

Doc, so do you think a good course of action would be to take some time off of the AI and then re-institute it as stated by Vetteman or just plain come off? My nips were def sensitive and adding the AI eliminated that. I definitly want to rectify this problem with both E level and DHT. I know some people naturally run high with DHT but I don't really know if mines too high for me? I've read about some of the OTC supps for high DHT and don't really want to go that route. So, if I convert easily via the 5 a-r enzyme I don't think the reduction in AI will make that much of a difference if I'm still on my current dose of topical? Thoughts? My thoughts are to just switch to injections to alleviate the problem?

[Drmagic]

I don't put everyone on test on an AI, some people simply don't need it. We get to caught up with numbers, we have this, "ideal," number for estradiol but if a patient has no symptoms at all there is no reason to take someone from 40 to 30 to chase a number. test is the same, If a patient is feeling great at 650 - 700 and metabolites are in check, no reason to push them to 1000. I do have a 70 year old who lives at 1000 and feels like a rock star so everyone is different. In your case it doesn't look like you are aromatizing at all so no reason to block that process further. I have not seen great results with agel but I would bet if you switched to injections you would see your estradiol go up and your DHT would go down. I'd like to see your DHT levels 2 weeks after stopping the agel, that would tell you if you have a naturally high level. I do like saw palmetto to lower DHT a little. I'd go with the injections and be done with it, keep us posted.

[sirupate]

Like kelkel, I'm on the agel and taking a bit of adex as a precaution on E2 getting out of hand (but don't know my E2 numbers). Lately...last 6 weeks or so, I've been achy in my hand joints and was thinking this was simply arthritis. (56 yrs. old...lots of work with my hands) Now I'm not so sure. The achy hands did come on all of the sudden. Think I'll drop the adex for a few weeks and see how my hands feel then. Perhaps I am driving E2 too low, given that I am back on the gel and not the injections any longer.

Libido still good, however.

Note that based on above post from DrMagic...when I was on injections, my libido just died. Completely. Even my wife commented on this. My theory is that on injections, I was not making enough DHT. I could be one of those that does better on the gel because of the DHT issue.

[kelkel]

Thanks for responding Sirupate! Was hoping more Gel users would. I just feel like I'm between a rock and a hard place here. I know I'm nip sensitive from aas use (last time 1989.) Plus when starting agel had big time sensitivity until the AI. When I took the week off AI before reducing dosage I felt nip issues. Therefore started the AI on what was thought to be an appropriate dosage. Then cutting it in half only moved me up from a 3 to a 5 E level over an 11 week period which shocked me as I was expecting much more.

So, I either have to go cold turkey on the ai for a bit and re-test, during which time I'm sure it will come up some while my T levels come down due to more aromatization (hence the rock/hard place). But this course of action won't effect my high DHT level. Maybe it is time to give the shots a go and see how it goes. Was just hoping to delay it as long as possible....aarghhhh!

Like kelkel, I'm on the agel and taking a bit of adex as a precaution on E2 getting out of hand (but don't know my E2 numbers). Lately...last 6 weeks or so, I've been achy in my hand joints and was thinking this was simply arthritis. (56 yrs. old...lots of work with my hands) Now I'm not so sure. The achy hands did come on all of the sudden. Think I'll drop the adex for a few weeks and see how my hands feel then. Perhaps I am driving E2 too low, given that I am back on the gel and not the injections any longer.

Libido still good, however.

Note that based on above post from DrMagic...when I was on injections, my libido just died. Completely. Even my wife commented on this. My theory is that on injections, I was not making enough DHT. I could be one of those that does better on the gel because of the DHT issue.

[steroid.com 1]

I don't put everyone on test on an AI, some people simply don't need it. We get to caught up with numbers, we have this, "ideal," number for estradiol but if a patient has no symptoms at all there is no reason to take someone from 40 to 30 to chase a number. test is the same, If a patient is feeling great at 650 - 700 and metabolites are in check, no reason to push them to 1000. I do have a 70 year old who lives at 1000 and feels like a rock star so everyone is different. In your case it doesn't look like you are aromatizing at all so no reason to block that process further. I have not seen great results with agel but I would bet if you switched to injections you would see your estradiol go up and your DHT would go down. I'd like to see your DHT levels 2 weeks after stopping the agel, that would tell you if you have a naturally high level. I do like saw palmetto to lower DHT a little. I'd go with the injections and be done with it, keep us posted.

Agree with this point 100% Doc.

What we discussed kel.

It's time!

[lvs]

Kel,

have you been on shots before? sorry if I missed it but what was your baseline E2 numbers before you started AI? IMHO, if you are looking for a push to go on shots, I think this might be it, if you are trying to avoid them because you prefer agel, then what do you have to loose by stopping the AI cold turkey other than some nipple sensitivity and some time and checking if the E2 & DHT numbers improve?

[kelkel]

Ivs, have not been on shots before. No baseline due to pcp as well as endo didn't belive in it. Now with a euro who's "with it" and is willing to help how I see fit. Those are my first two E tests ever and first DHT test as well. Yes, I'm going to cold turkey the AI and see my doc next Friday. Agreed it's time for a change I guess! Grrrrrrrrr. Didn't want to do this yet.....

[sirupate]

Ivs, have not been on shots before. No baseline due to pcp as well as endo didn't belive in it. Now with a euro who's "with it" and is willing to help how I see fit. Those are my first two E tests ever and first DHT test as well. Yes, I'm going to cold turkey the AI and see my doc next Friday. Agreed it's time for a change I guess! Grrrrrrrrr. Didn't want to do this yet.....

Send me your excess gel....lol! If your new doctor agrees, try the injections for 6-9 months to see if that is better. Injecting is pretty easy and probably less expensive than the gel (less expensive co-pays). We are all different and need to find out what works best for each of us. I was expecting to feel a lot better with the injections based upon what is said here by others. That just didn't happen for me, but might for you. Glad you have a doctor who understands the TRT process better now.

[kelkel]

Thanks Sirupate and I would if I could! Doc will let me choose my weapon, so to speak, and I think it will probably just solve both issues at the same time. Think I'd rather be like the 70 yr old drmagic referred to!!

[bass]

Like kelkel, I'm on the agel and taking a bit of adex as a precaution on E2 getting out of hand (but don't know my E2 numbers). Lately...last 6 weeks or so, I've been achy in my hand joints and was thinking this was simply arthritis. (56 yrs. old...lots of work with my hands) Now I'm not so sure. The achy hands did come on all of the sudden. Think I'll drop the adex for a few weeks and see how my hands feel then. Perhaps I am driving E2 too low, given that I am back on the gel and not the injections any longer.

Libido still good, however.

Note that based on above post from DrMagic...when I was on injections, my libido just died. Completely. Even my wife commented on this. My theory is that on injections, I was not making enough DHT. I could be one of those that does better on the gel because of the DHT issue.

sounds like high e2! were you taking AI when you were on injections?

[sirupate]

sounds like high e2! were you taking AI when you were on injections?

I am pretty sure I was using liquidex when I was injecting. No E2 bloodwork though, so kind of blindly experimenting based upon the rules of thumb we talk about here.

[Ryanmcd]

Not sure why everyone is pushing the shots so hard, I did the gel and the shots and feel MUCH better on the gel and even Dr Crisler told me I would prob feel better on the gel. Also my E2 was 6 I added in 250IU HCG E0D and now at 24 and feel great. Everyone one is different and I think most just do shots because everyone else tells them to, for me I want to feel good and happy and this combo is the ticket for me. If you can try both I did and now back to the gel.

[kelkel]

Heard and understood. I've tried to avoid the shots as long as possible just with my predicament is seems to be the best recourse for me. Time will tell though! Personally I've had no issues with gel other than the now high dht.

[kelkel]

Update. Saw my euro on Friday. Literally gave him a typed page of requested prescriptions: cyp, two diff syringe sizes, diff HCG script for compounding instead of the 10,000 unit size which is a waste for me, Nolvadex , more preg/dhea at stronger dose and a script for more BW which he allows me to add to if I choose. He wrote the cyp for 200mg per week so I have some wiggle room but I plan on only doing 60 x 2. Awesome Doc to see! He likes being challenged and was surprisingly up on DHT and agreed totally in switching over to injections and my intended protocol!

So, new protocol starts tomorrow! Finally, I think I was losing vascularity.

[steroid.com 1]

Excellent kel!

Let us know how your first injection goes and how you feel over time!

Great stuff my friend

[OutLaw8.5]

THat's exciting to hear! Be anxious to see how it goes for you!

[kelkel]

Will do. Injections will be no problem. Old memories from a time long, long ago. You don't forget.

[bass]

Update. Saw my euro on Friday. Literally gave him a typed page of requested prescriptions: cyp, two diff syringe sizes, diff HCG script for compounding instead of the 10,000 unit size which is a waste for me, Nolvadex , more preg/dhea at stronger dose and a script for more BW which he allows me to add to if I choose. He wrote the cyp for 200mg per week so I have some wiggle room but I plan on only doing 60 x 2. Awesome Doc to see! He likes being challenged and was surprisingly up on DHT and agreed totally in switching over to injections and my intended protocol!

So, new protocol starts tomorrow! Finally, I think I was losing vascularity.

LOL, as if that is a real issue! great news Kel, i'll be reading your updates to see how it all works out for you. i am sure you'll be pleased!

[Vettester]

^^ x2 - Definitely subscribed here!! I'll be awaiting to hear the good news. Also, good job with stimulating your doctor's need to be challenged!

[kelkel]

Bloodwork Update:

This is my last BW on gel:
BW 11/29/11 Labcorp

Bio T w/o SHGB: 511
Bio T, S: 235
Bio T%: 45.9
T Serum: 485
Free T: 8.7
E Sensitive: 5 (again, WTF)
DHT: 131 ng/dl, range 30-85

I've now been on an injection protocol for 3 weeks of 60mg cyp every 3.5 days. HCG has not changed at 250units x 3. Stopped the AI about 4 weeks ago now to allow estrogen to rebound and added Nolvadex 20mg per day for the past 3 weeks.

Current BW 1/5/12 three days after 60mg injection:
T, Serum total: 1386 Range 348-1197
% Free T Dialysis: 2.0 Range 1.5 - 3.2
Free T, Serum: 277 Range 52-280
Bio T %: 52.6
Bio T, s: 729 Range 95-285

DHT: 75 Range 30-85 (this is a drop of 56 since starting injections from transdermals)
E Sensitive: 15 Range 3-70 (up from 3, then 5)

Knee and elbow pain are virtually gone. My god that is a nice feeling. It's amazing what type of joint pain you just adapt to. I also find it's an impressive drop in my DHT level. It showed just how much the transdermals elevated that particular level. It would have been real nice to have that baseline DHT level prior to initiation of TRT.

[Ryanmcd]

Do you think it's the higher E2 or lower DHT that makes you feel better? I know when my E2 gets low I get dry skin and sore knees.

[sirupate]

Kel...very interesting your lab changes since you began injecting. Glad the joint pain is going away for you. How is your libido doing now that you are injecting? My theory (for me) was that when I was injecting, I wasn't converting enough test. to DHT and had a libido crash. Generally, I have felt better on the gel.

I see a Uro in 4 weeks. Hope he is as cool as is yours. My endo and PCP just were not getting the job done.

[kelkel]

Higher E2. Comparatively my elbow and knee feel like new. Nice! I'm actually surprised it did not rise higher.

[lvs]

kel,

Your numbers are looking so much better and only after 3-weeks and the best part of it is you can feel a positive difference. I have recently switched to injections myself on my 4th week and feeling better as well but I think more gradual than your improvements. I guess you will be sticking with injections?

[kelkel]

sirupate. Amazing difference in joints. Libido seemed to tank initially but seems fine now. I will be very curious where my dht level is after more bw in a few months.

Kel...very interesting your lab changes since you began injecting. Glad the joint pain is going away for you. How is your libido doing now that you are injecting? My theory (for me) was that when I was injecting, I wasn't converting enough test. to DHT and had a libido crash. Generally, I have felt better on the gel.

I see a Uro in 4 weeks. Hope he is as cool as is yours. My endo and PCP just were not getting the job done.

Ivs, yes, happy so far and I will be sticking with injections. When is your next BW?

[lvs]

My next bloodwork in less than 2-weeks. Really curious how my numbers are going to look. 200mg cyp every week.

sirupate. Amazing difference in joints. Libido seemed to tank initially but seems fine now. I will be very curious where my dht level is after more bw in a few months.





Ivs, yes, happy so far and I will be sticking with injections. When is your next BW?

[Vettester]

Looks like the switch to injections was the trick to balance out some of the 5A-R DHT conversion. Your E2 still needs to come up a bit (and it will), just be patient. By now, you should be past the estrogen rebound symptoms; mostly pertaining to the sensitive nipples. I would personally go off of the Nolvadex at this point and let your protocol take its shape. If anything, taper down to 10mg for a few days, see if there's any sensitivity, then put it away.

Just for grins, did your team by chance run some LH/FSH labs? I'm curious just from a speculative standpoint if the Nolvadex provided any increase in GnRH; possibly increasing LH levels during the therapy period? Everyone metabolizes differently, but at first glance your testosterone numbers looked pretty high in comparison to the amount of medication in your protocol. A SERM like Nolvadex does have the potential to stimulate GnRH production within the HPTA, but again, it's just some thoughts of curiosity on my end.

With everything going on, especially your E2 and DHT, I would look to do more labs again; possibly 6 to 8 weeks. It looks like you're on the right track, and it's GREAT that you are feeling better. I suspect you will feel even better as your E2 gets into the 20's!