My doc thinks TRT, good idea?

[ZenFitness]

Little background, I'm 36 years old, in great shape, 6' 3", body fat in the 8 - 10% range, and about 205 lbs. I stay active, lift weights, etc. About a month ago I suddenly noticed some bedroom performance problems with my wife (and I mean suddenly, truly overnight), so I went to a urologist and had myself checked out. Turns out I'm low T - here are the results:

(results from LabCorp)
Total T: 212, normal range 348 - 1197 (for some reason the free T and % free T has the note "quantity was not sufficient for analysis", don't know if that means not enough blood or not enough free T)
LH: 3.4, normal range 1.7 - 8.6
FSH: 3.0, normal range 1.5 - 12.4
Estradiol: 18.5, normal range 7.6 - 42.6
PSA: 0.6, normal range 0.0 - 4.0
Prolactin: 7.7, normal range 7.0 - 15.2

Shortly before the issues cropped up, I switched up my exercise routine to do some gym classes with my wife that are basically HIIT with weights for about an hour to an hour and fifteen minutes each. I also think I was under-eating at about 2000 - 2500 calories a day while working out 3 - 4 times a week in these classes. Top it off with generalized anxiety, some depression, insomnia, and the fact that my T test was at about 3:45 in the afternoon... so I think this represents bottom of the barrel for me.

FWIW, my mom had her thyroid removed due to hyper/hypothyroidism (can't remember which), and my sister had cushings from a brain tumor on her pituitary gland (very high cortisol). My dad has all the signs of low T forever now, but I'm not sure if he is or not.

I've been trying to keep a lid on freaking out about this as I'm only 36 and feel a little freakish that I may need TRT.

My follow up visit was yesterday, and I balked at using Testim as I have two little girls (4 yo and 6 yo). I told my urologist that I wanted to try the "natural" route - eat more, go back to lifting heavy weights, and start some supplements (I went with a zinc supplement (25 mg picolinate), PrimalJax, and some mood balancing herbs including rhodiola rosea and l-theanine). My urologist recommended DHEA, but I a little skeptical of it due to the fact that it can increase estrogen. I plan to cycle what I'm taking for four weeks on, two weeks off, and I'm scheduled for another T blood test at 8:30 in the morning in a month. My doctor said he wasn't hopeful but that he liked my approach.

I'm going to my GP today for a physical and plan to talk to him about this and get the whole panel done. Hopefully he can do a thyroid check as well.

At any rate, I'm looking for some input as I'm feeling like I'm way in the statistical minority, and at age 36 I'm wondering why in the world I'd have these issues. Any input/advice would be appreciated... thanks!

[zaggahamma]

...................

[sirupate]

Does sound like you are doing everything right...much better habits than mine. If on your second bloodwork, your test. levels are about as low, I'd consider TRT. It can make a world of difference...and has for most of us here. I'm sceptical of the natural route to raise your levels, as is the urologist.

[steroid.com 1]

The sudden onset of lose of libido is not symptomatic of low testosterone. While low libido is a symptom of low testosterone it doesn't generally present as a "sudden onset".

The lose of libido associated with low testosterone levels is a more gradual decline and not something that happens overnight.

You have low testosterone levels and do you know why?

Were you diagnosed properly? Are you Primary or Secondary Hypogonadal?

Your LH/FSH assays are slightly suppressed but nothing out of the ordinary.

Supplements, in this case, are a waste of money IMO. If there were any successful natural supplements that can increase androgen levels someone would be very rich right now...and don't believe the advertising hype about these supplements...they don't work for the purposes you need.

You also stated: "Top it off with generalized anxiety, some depression, insomnia..." These are hallmark symptoms of low testosterone along with a host of other things.

Giving your family history I would suggest getting a more thorough and accurate assessment and diagnosis.

I truly believe you will feel much better when you first know what's wrong with you and why your testosterone serum levels are so low and get put on the correct repla***ent protocol.

[ZenFitness]

Thanks gdevine. I absolutely 100% agree... I mentioned yesterday in my follow-up visit to my urologist that I was curious as to why my testosterone is low so that I treat the cause and not the symptoms. His response was that everything looked normal and I wasn't producing enough testosterone... however, all these tests are Greek to me so I don't know exactly how to determine that for myself.

I will be at my GP today for my yearly physical... any specifics you would recommend I ask that would move things toward a more accurate assessment/diagnosis?

[steroid.com 1]

Read the sticky on Finding a TRT Doc by kel and print out the blood work you need. Ask your Doc for these and don't take NO for an answer.

I'd love to see your Thyroid panels.

Hypogonadism and be caused by Hypothyroidism...

[kelkel]

Good baseline BW is where you start. Post up everything if you can!

[ZenFitness]

Thanks again guys.

After further thought and discussion with my GP, I had my thyroid, etc., tested. Provided they come back normal, I expect to probably go on the subdermal pellets. Any thoughts?

[HRTstudent]

if you're up for reading before making a big choice like going on TRT I recommend Testosterone for Life by Dr Morgentaler... it's a very easy read and really sets you up for basic success in your journey. Plus, the guy is an MD from Harvard so it should carry some more weight and set you at ease that it's based on science.

[kelkel]

Thoughts, yes. Depending on your upcoming results and if they come back just low, it might be wise to see what some ancillary therapy may do for you before you jump on TRT. Maybe HCG & Nolvadex, clomid, etc. Worth a shot before you take that leap IMO.

When it comes to pellets they do not seem to be the weapon of choice here. Even Crisler does not really like them. His comment was something to the effect of "Maybe if your going away to climb Mt. Everest" but otherwise not his preference. To each his own and if it works, so be it. One member here is just now maybe a month into pellets. Do a search here and you can probably find it. It also has a lovely video of how they insert them. "Ouch, to say the least.

[ZenFitness]

Okay, overall blood results came back (non-T tests, just thyroid, etc.)

T4, Free (Direct) 1.62 (ref range 0.82 - 1.77)
TSH 3.29 (ref range 0.45 - 4.5)
Triiodothronine 3.0 (ref range 2.0 - 4.4)

I have high HDL (92) and high range of LDL (97). The result is my cholesterol is slightly elevated (203 total, 199 being the top of the range), but I have family history of high cholosterol. My HDL is really high due to HIIT training (my hypothesis).

AST (liver) is 44 which is above the upper end of the range at 40, but the doc said they don't worry unless it is three times that (I probably had a drink or two the night before and aggro'd it)

Glucose is all normal, but I have trace ketones in my blood (not sure what that means, the doc didn't reference it)

Everything else came in as normal. I'm scheduled for the pellets in two days - I know it is a big step, but having total T at 212 (esp. given that T has such a wide ref range of 340 - 1200) makes me think it is sensible.

I also had a ultrasound on my thyroid as I have a 9mm nodule on one of the lobes... I think I have actually felt it for a long time. Just got that back yesterday and haven't heard yet if the doc wants to biopsy.

Any other thoughts? Input is appreciated... this is a big thing to step into, and I want to be sure I'm not stepping in front of a train.

[zaggahamma]

Okay, overall blood results came back (non-T tests, just thyroid, etc.)

T4, Free (Direct) 1.62 (ref range 0.82 - 1.77)
TSH 3.29 (ref range 0.45 - 4.5)
Triiodothronine 3.0 (ref range 2.0 - 4.4)

I have high HDL (92)WOW and high range of LDL (97)WHO SAYS THIS IS HIGH. The result is my cholesterol is slightly elevated (203 total, 199 being the top of the range), but I have family history of high cholosterol. My HDL is really high due to HIIT training (my hypothesis).

AST (liver) is 44 which is above the upper end of the range at 40, but the doc said they don't worry unless it is three times that (I probably had a drink or two the night before and aggro'd it)

Glucose is all normal, but I have trace ketones in my blood (not sure what that means, the doc didn't reference it)

Everything else came in as normal. I'm scheduled for the pellets in two days - I know it is a big step, but having total T at 212 (esp. given that T has such a wide ref range of 340 - 1200) makes me think it is sensible.

I also had a ultrasound on my thyroid as I have a 9mm nodule on one of the lobes... I think I have actually felt it for a long time. Just got that back yesterday and haven't heard yet if the doc wants to biopsy.

Any other thoughts? Input is appreciated... this is a big thing to step into, and I want to be sure I'm not stepping in front of a train.

Never seen hdl that good

and never heard under 100 was high for ldl

bump

[ZenFitness]

Just got back from my pellet implantation. 12 pellets for me.

The procedure was quick and painless. The numbing shots caused me to jerk a bit in my leg but it was a stimulus response (like hitting your knee to test reflex). The doc inserted them in my upper semi-outer thigh about 3-4 inches below my right butt cheek as my butt/hip area is all bone and muscle (he said this was a better spot for comfort given my build).

I should also note that I am an extremely squeamish person... I can barely look at my blood draws at the doc without the blood draining from my face. Getting better at that, but take that FWIW in light of the procedure. For a squeamish person, this was a cakewalk.

Maybe I should start a "pelletized II" thread? I'll keep y'all posted, followup BW in four weeks.

Side note - my GP wasn't concerned about the nodules on my thyroid. 10% of the population has them, and they typically don't biopsy unless 1 - 3 cm. I will re-ultrasound in a year... I told him that I think I've felt at least one of them in my throat for years and years now.

Also curious how soon testicle atrophy sets in... I know it varies, but if it's gonna happen I'd like to know when to look out for it.

[ZenFitness]

One more question... I'm going to stop the *supposed* T-boosting supplements (the PrimalJax) as per direction from my doctor now that I am on TRT, but I do like the L-Theanine and rhodiola rosea and its effect on my mood. Does anyone know any reason not to take either of these while on TRT?

[ZenFitness]

I had the pellets in on June 7th, and the TRT has made an enormous difference for me in terms of mood and libido. I will have my first follow-up blood draw on July 7th (1 month from the implants). So far I feel great.

[steroid.com 1]

Excellent!

Get your BW and post all here complete with ranges.

Happy for you man

[ZenFitness]

BW this Thursday.

So far so good up until yesterday... great libido, etc. Last night the wifey decided she wanted to vape a little pot, so we did - not something we do on a daily basis, but maybe once every week/two weeks. She smokes cigarettes, and I had a couple (which I will do with drinking/pot occasionally)... unfortunately, when we went at it afterwards, my wood would only get to about 80 - 85% and wouldn't hold that easy. She was able to work it and things went through intercourse from there, but I could tell it still wasn't 100% most of the time. Frustrating that my body didn't do its own thing. My wife and I were arguing due to some stress in her life yesterday and I was relatively pissed all day, so that could certainly contribute as well. Since about a week in on TRT, I have had zero problems in this department until yesterday. I've been at TRT almost a month now.

I am taking vitamins (multi, zinc, and fish oil) plus Theanine Serene and Ambien CR in the evenings and eating well, working out, etc. (in fact, I think I may be starting to put on more muscle and notice a difference in the amount of weight I'm able to successfully lift). I do still wake up most evenings in the middle of the night to take a leak, and I can't sleep much past 6 - 6:30 AM or so (although we have young kids, they may be waking me up from noise).

Anyways, didn't sleep last night as a result of stressing over the semi-ED and woke up feeling like crap. Now I'm feeling like I'm doubting everything and can sense the psychological effects of ED fear eating at my well-being.

So my question is this... it seems like the TRT kicked in initially and I felt like a rockstar for a few weeks and my body followed suit. Today I'm starting to doubt all of that due to last night... is this typical, and is a one-off semi-ED episode like this nothing to worry about? Semi-ED was the reason I got tested for low T in the first place... any shared experiences appreciated. Thinking I should quit the occasional pot use, although I'm not sure how much once a week/once every other week affects T, erections, and anything else.

[lovbyts]

Need to get your E2 levels check, you may be high since the pellets may be peaking. I am also squeamish when it come to needles but I would take doing weekly self injections like I do over pellets any day. You will probably need an AI of some type to get your E2 (estrogen) levels under control.

[ZenFitness]

Thanks for the input...

How difficult is it typically to get E2 levels down?

I've been re-thinking the injections, and I may try to switch to them over the pellets when these wear out. Do most docs start with injections once a week or once every two weeks? Also, do you develop a bunch of needle scars where you inject? The latter is not a big concern - just curious.

Also, from what I've read, it seems like injections tend to cause one to roller-coaster a bit... is this true?

Thanks!

[MrManGuy84]

Feeling good early on in TRT and then crashing is not unusual.

What is happening is that in the beginning, you are adding on to the T you already have. Then after a while, your body sees the level you are at and stops making its own, so you go back down, in some cases even lower than where you started. Once you hit that point it should just be a simple matter of raising up the dosage again. It won't drop anymore after that.

It's a pity you weren't able to get the bloodwork while you were feeling good so you know what you need to aim for. However your upcoming bloodwork should be able to shed some light on where you're at, so that's good.

High E2 is another possibility, but I would suspect it's just the usual crash.

If it IS high E2, it's usually as simple as just taking a pill to drive it down. No big deal. The tricky part is having a doctor who knows the right test to run and is willing to prescribe a pill if needed (it is an off-label use so less knowledgeable docs may freak out about it).

Did you ever test your prolactin? With your family history it would be wise to rule out pituitary tumor.

As for the deal with injections, they can cause the roller-coaster. Some people notice it more than others. If it's not working, usually it's just a matter of getting an injection more often (like every week instead of every two weeks). Some people even go more frequently than that, but I haven't heard many people struggling with the weekly injections.

Of course it's also just one day. It may be nothing, or the pot, or the stress. Regardless the fact that you've responded to therapy is really promising and from here on out it should just be tweaks here and there to keep you there.

[ZenFitness]

Thanks for the input, that is very helpful. Yes, my first BW included prolactin:

Prolactin: 7.7, normal range 7.0 - 15.2

As a side note, I've felt emotionally more stable and much better overall over the past couple of days. I started taking rhodiola rosea in the mornings again... that may be helping to contribute to this. I'll post back on the BW when it is done.

[ZenFitness]

Still waiting on my BW results, should be in later this week

Since my last post, I've had 50/50 on being erect when desired vs. having the Mrs. have to work it up. At thirty-six and a half years old, I'm feeling I may be a bit young for this to be an issue. Then again maybe I'm just overthinking it.

At any rate, it is becoming a psychological issue and an obsession for me. When I first started this whole TRT investigation (a few months ago), my doc gave me a sample of Cialis to try just to see that it is an option. I took 10 mg doses (cutting the 20 mg sample pills in half), and I definitely had no erection issues whatsoever (this was even with low T). I was *almost* at the point of having flagpole results just thinking the word sex. Almost like I was 19... good stuff.

As a result, I'm debating about going on Cialis as a regular regimen. I definitely feel a little young to even think to need it at 36.5 years old, but hey, if it works, it works.

I have a few questions:

1. Does anyone take Cialis regularly, and, if so, how much/often?

2. Is there an alternative, or should I wait for BW instead?

3. Is there a place to get Cialis without a prescription? I'm starting to hate my urologist's office as I have to pay a $50 copay to even ask stupid questions that a 2 min. phone call would answer.

Thanks!

[kelkel]

Cialis is an excellent drug for many reasons beyond erectile issues. It is a nitric oxide booster and helps with BPH as well.
Read this: http://www.fda.gov/NewsEvents/Newsro.../ucm274642.htm

Most insurances cover it. Mine does for two a day actually.

[steroid.com 1]

Below in bold:

"At any rate, it is becoming a psychological issue and an obsession for me..."
This is one of the top 3 for erectile dysfunction in men just so you know. The more you obsess over it the worst it can and will get. Performance anxiety is and can be a real problem for men when there is no other pathological or clinical indication.

So what to do...?


I have a few questions:

1. Does anyone take Cialis regularly, and, if so, how much/often?
I take a 5mg of Tadalafil (Cialis) twice a day; once before bed (wake with nice erections) and then 12 hours later. Cialis/Tadalafil have it over the other PDE5-I's in that it has a significantly longer half life (like 18 hours vs 4 to 6 respectively) so the drug serum levels are high almost all the time making sex on demand a much easier proposition then say Viagra or LaVitra.

2. Is there an alternative, or should I wait for BW instead?
I also add in 1mg of Doxazosin to the Tadalafil protocol (Doxazosin has a 14 hour half life as well). Doxazosin is an Alpha Blocker (AB) and in short it relaxes the smooth muscles in men. The Corpora Cavernosa in a mans penis is made up of smooth muscle tissue. When the tissue relaxes (through a very complex chemical/physiological process) when a man is sexually stimulated an erection occurs. There also must be the presences of increased Nitric Oxide (NO2) and this happens with the use of the PDE5-I (Tadalafil). So the combination of both the PDE5-I and the AB both work synergistically to provide a man with the ability to get an excellent erection almost any time.

You may also want to consider trying PT-141.
Description: Bremelanotide (PT-141) is a generic term for a new medication which has shown promise in effectively treating sexual dysfunction in men (erectile dysfunction or impotence) as well as sexual dysfunction in women (sexual arousal disorder). It was developed from Melanotan 2 (MT-II), which is researched as a sunless tanning agent. PT-141 is a metabolite of MT-II that lacks the C-terminal amide function-stripping away tanning properties.

Associated Links:
http://melanotanhq.com
http://melanotanhq.com/bremelanotide...g1429/#msg1429

It can be purchased at a number of Research Peptide Sites:
Our sponsor: http://www.ar-r.com/peptides/ipt-141-10mg.html
or
http://www.tanresearch.com/pt-141

How to use:
http://www.youtube.com/watch?v=kpQSxbf4ZM8

I tried PT-141 for the first time last week when on vacation and all I can say that it's the real deal and it lived up to all the claims. Not only does it work synergistically with Tadalafil/Doxazosin mix but it created a sexual desire in me that was almost to much to bare...I kid you not! I can't get into all the pharmacological dynamics of PT-141 here, the links above and Google can do that for you, but if you're looking to increase your sexual desire to almost teenage levels AND enhance erections this is worth a test.

I injected SQ 125iu (a small dose) on Friday night and sex with the wife Saturday morning was freaking insane. What's more, when we were done I got another impressive erection just 15 minutes after and I had to take care of it in the shower myself...it was crazy. Then on Sunday my libido was so high that any women I looked at gave me an instant erection. I still felt some effects into Monday!

3. Is there a place to get Cialis without a prescription?
There are number of online and very legit over seas Pharmacies where you can get generic Tadalafil and Doxazosin at very good prices....trust me I know PM me and I will help you out.

I'm starting to hate my urologist's office as I have to pay a $50 copay to even ask stupid questions that a 2 min. phone call would answer.

You don't need to always call you Doc or see him for a lot of questions many of us here can help you with. Try that first...

[ZenFitness]

Turns out my insurance covers six Cialis pills per month regardless of strength, so my doc prescribed 6 20mg. This gives me 12 10mg pills.

Any advice on how to take these? The sample said about 30 minutes before sex, etc., but if I want to try and take them regularly, it would be nice to know a good approach. Maybe every third day or so?

Also, is there any advantage to getting Cialis for daily use in lieu of these pills?

Thanks!

EDIT: gdevine, I just saw your post after posting this... thanks for the info! I will send you a PM

So what to do...?

That's what I'm trying to figure out right now... get myself over the mental hump. Cialis seems to overcome any psychological issues I ran into when I tried it, and these issues aren't running deep... yet!

PT-141 looks interesting, but I see on the sponsor's site that it is "not for human consumption". I'd like to try it but will probably give the Cialis and potentially the Doxazosin a shot first. I will research the Doxazosin, but I expect there are no long term repercussions for taking these (i.e. taking them at 36 won't negate their effect at 50, etc.)?

As always, you guys around here are the best and full of great info

[ZenFitness]

gdevine, I think I PM'd you... I don't see an option for private message. I only see an option for "send email". Please let me know if it was not received. I seem to have trouble viewing my profile and others' profiles as well.

Thanks!

[steroid.com 1]

Zen - Sent you a referral via email to my online pharmacy.

Daily use of Cialis is much better for you...see kel's link.

PT 141 is the real thing...go read the links I posted above...Research Sites are safe.

[Brazensol]

Zen - Sent you a referral via email to my online pharmacy.

Daily use of Cialis is much better for you...see kel's link.

PT 141 is the real thing...go read the links I posted above...Research Sites are safe.

Do you think the effect would still be strong without the Doxazosin? Also, were the orgasms stronger or just the desire to have sex?

[steroid.com 1]

Tadalafil + Doxazosin = Great erection results but no libido boost.

Tadalafil + PT 141 = Great erections, great libido, insane desire and great orgasms (don't need Dox but it's an added bonus)

Read the PT 141 forum link here on dosage and experiences: http://melanotanhq.com/bremelanotide...d-experiences/

[ZenFitness]

Is there any difference between the Cialis daily use and regular Cialis? It looks like there isn't, but I thought I'd ask.

[steroid.com 1]

Is there any difference between the Cialis daily use and regular Cialis? It looks like there isn't, but I thought I'd ask.

Daily dosage is 2.5mg to 10mg daily.

[ZenFitness]

I got to thinking and have read around to confirm that test and E2 levels seem to spike on pellets on the first blood test. The lab that my urologist uses says 7.6 - 42.6 is the E2 range. I'm guessing that if I'm way up then that may be my ED problem - would this be accurate? I was rockin' and rollin' for a few weeks and then "wah-wah", the problems started. Either the E2 will subside or I can get an AI for a bit, but I'm guessing this may be the culprit.

Any thoughts on this?

[Brazensol]

Tadalafil + Doxazosin = Great erection results but no libido boost.

Tadalafil + PT 141 = Great erections, great libido, insane desire and great orgasms (don't need Dox but it's an added bonus)

Read the PT 141 forum link here on dosage and experiences: http://melanotanhq.com/bremelanotide...d-experiences/

Thanks for the link! I had not found that one yet. I have got to give this stuff a try.

[Brazensol]

Is dostinex and Cabergoline the same thing? If so, is it prescription only?

Where did you get the pt-141 if I am allowed to ask?

[steroid.com 1]

Is dostinex and Cabergoline the same thing? If so, is it prescription only?

Where did you get the pt-141 if I am allowed to ask?

Doxazosin (Cardura): Alpha Blocker
Dostinex (Cabergoline) : Dopamine Receptor Agonist

Both need a scrip but can be purchased via online pharmacies without.

PT-141 Can be purchased on most peptide research sites.

Our sponsor ar-r sells it so check them out first.

I bought from one of the first PT 141 research sites that's been around a long time: www.tanresearch.com

Throw in some Tadalafil and LOOK OUT

Read the experiences link above...

[kelkel]

I got to thinking and have read around to confirm that test and E2 levels seem to spike on pellets on the first blood test. The lab that my urologist uses says 7.6 - 42.6 is the E2 range. I'm guessing that if I'm way up then that may be my ED problem - would this be accurate? I was rockin' and rollin' for a few weeks and then "wah-wah", the problems started. Either the E2 will subside or I can get an AI for a bit, but I'm guessing this may be the culprit.

Any thoughts on this?

Agree Zen. High E and low E present the same symptoms..

[ZenFitness]

Thanks kel. Coincidentally (or not), I recalled this morning that I started taking rhodiola rosea (500 mg) in the morning around the time the trouble started. I stopped this AM and can notice my libido is stronger an had my first thought-induced erection - haven't had one of those in a while, about as long as I've been taking rhodiola rosea. This could just be placebo but I'm def staying away from rhodiola rosea from now on.

Still waiting on my BW

[ZenFitness]

Just got my results over the phone - they will be mailing them to me:

Total testosterone: 613, range 348 - 1197 ng/dl
Free testosterone: 11.3, range 8 - 25
Estradiol: 11.5, range 7.6 - 42.6 pg/mL
Prostate: 0.7, range 0.0 - 4.0 ng/mL
Prolactin: 10.9, 4.0 - 15.2 ng/mL

Guess the E2 is not a problem. However, had great sex this afternoon, no erection issues whatsoever. I don't know what my deal is these days, but I'm feeling much more hopeful today.

I am thinking about switching to injections after these pellets wear off because I think a little bit higher T would be better. I'm also wondering if my free T should be higher.

[ZenFitness]

Also, someone mentioned that vit D can help with free test... Is there a particular type/amount that works best?

[HealthyMan]

Zen,

My tests are very similar to your when you first posted your results, 205 on the Total and 5.9 on the Free. I am scheduled to see my Doctor soon to discuss the results. It's good to see positive results for you!!