New Member Intro, TRT, AI questions and such.

[TheSpoonyBard]

I'm reposting this in the (hopefully)correct forum as advised by another very helpful member. Sorry if it looks confusing but I wanted to put all the relevant info in this thread and the forum doesn't allow linking. So here is what I originally posted over there:

Originally Posted by Myself:
"Hello guys and girls. I'm a new member here and am beginning to become very serious about recovering lost/atrophied muscle from spinal injury, stomach surgery, and getting into the prime shape of my life. This is my 2nd thread here on the forums. My first was my intro thread with my basics and some questions also. I posted the link but it wouldn't allow it, so basics: 32 yrs old, 2 kids, married, 172lbs, 10% body fat, spinal surgery w/ injury resulting in wasted left calf and shin muscles, huge weight gain, and a bunch of time away from the gym, stomach surgery in 2010 to comabt weight gain from back injury(lost 173 lbs, and tons of muscle mass). Was very depressed and had no real care for anything in life anymore and was diag'ed with Low T last month. My question is regarding Low T, AI's, and the effect of anabolics on people with LowT. I've read a few places that certain beans don't adversely affect estrogen levels such as Masteron . Being a man in his early 30's with low testosterone , you can see why this is important to me, lol. My other question is I believe I could talk my doc into upping my dose of test, I'm currently on 1 50mg tube of transdermal Testim/daily, I believe it to be very wise to seek an increase in dose and let the insurance pay for it? I am also feeling confident that she would bite on an AI as well. What is the best/most effective AI? Arimidex , Aromasin ? Thanks for looking and thanks for all comments and ideas."

Originally Posted by kelkel:
"First, welcome and sorry for your dilemma. Yes, certain anabolics will not aromatize. But remember, estrogen is a needed element in a mans body and you need balance, homeostasis for all things to work correctly. Arguably your E2 on a sensitive assay should run between 20-30 consistently for overall health, but this is subjective and should be based on how you feel, not just the number as we are all different. Most people on transdermals do not need an AI. When it comes to an AI, you need to base it off proper blood work with the previously stated sensitive Estrogen Assay. Your much better off it you can continue your TRT without an AI if at all possible.

What is best as an AI? Subjective once again but if you visit the TRT Forum, which quite honestly is where this post should be, you'll find most use Arimidex . Now, if you've only been on TRT a month it is way to soon to consider adding to it. This takes time to settle in and adjust dosages via BW. I would doubt you've even had follow up BW at this point. If you can, post pre and post BW in the TRT forum as we review BW there all the time. Also take a look at the Finding a TRT Physician Sticky for proper follow-up bloodwork and make sure your doc gets the correct ones done. Be sure to include vit D as most are low. If your not supplementing now I'd suggest starting. Vit D will allow more free T for your body to use.

I don't think you stated, but exactly what caused the low T? Are you primary or secondary hypogonadal?

Remember to copy this to a thread in the TRT forum....

Kel"

Originally Posted by Myself:
"Woah! This is such an informative reply. I know they say that internet forums shouldn't be used as a substitute for a "qualified physician" but jesus man, you've asked and answered more questions than my doc has in a single reply than my doc has in my last 2 appts. I want to apologize in advance for any ignorance on my part(for there is sure to be an overabundance). I believe that I am secondary hypogonnadal because the doc thinks there may be pituitary issues that I'm awaiting results on. I've also requested a semen analysis as well to be sure that I'm not primarily hypogonadic(is that a word, lol?). I feel like the doc should be ordering these tests, not me. Anyways, Total T: 132, Free T: 34, Estriadol I believe was 50 or 51 pg/ml, I believe, without the figure in front of me here at work. The T numbers I'm fairly certain are accurate by memory because the doc calls at first and says: "Your levels are a little on the low side." I'm thinking to myself, "a LITTLE on the LOW side?!" And after our last appt she admits to me that my levels are "really low" and not just "a little on the low side." I'm also concerned that the Estriadol test may have been administered for a female patient not male. I've read that it is a common lab mistake, plus I don't exactly have the most faith in my Dr's office and the competency of the lab techs at the hospital lab they use. I'll have to double check that the correct testing procedures were used and ordered. Thanks for the reply Kel it goes a long way for me. It seems that you have to be your own advocate for everything nowadays...I will post this in the TRT forum also. Once again, I apologize for not posting in the correct section, and I hate being the annoying noob anywhere "

Thanks for looking and thanks for all of the input.

[kelkel]

Hey, as stated, welcome. We've all been in your shoes one way or the other. You will find that most doc's don't really understand TRT and if you find one that really does, it's priceless. I went through three to find the correct one and it can be a struggle for sure.

Now, you need to obtain copies of all your blood work and start a file. They are yours, you paid for them. Call your lab and fill out the HIPAA Form to begin getting future copies and check on how to get older ones if your doc's office won't copy you (they should.) You need to see all BW BEFORE you see your doctor. This allows you to analyze (post it here) and prepare questions for your doc. AND, you should already know the answer to the question before you ask it. If the doc's response is not what you expected be prepared to further the conversation. Write them down, take them with you. Nothing worse than leaving then realizing you forgot to ask an important question. Remember he works for you and as you already stated, you are your best advocate. Self-education is the key and this place is a great start.

Ok, your doc thinks a pituitary issue which I'm sure he's basing off your BW. This is why we need you to post it here with ranges when possible for us to review. LH/FSH are your main indicators here. Low LH/FSH + low T = secondary hypo. High LH/FSH + low T = primary hypo. The only way to be sure is an MRI. Is this the results your waiting on? Also needed is a full thyroid panel, not just TSH. Hypothyroid can cause hypogonadism so it needs to be looked at. Basically, you need to find the cause!

Begin reading all the stickies at the top of the forum. They will answer a lot of questions you have and really give you a good start.

Again, good luck and welcome. Others will chime in but weekends can sometimes be a bit slower...

[juice2012]

Kel knows his stuff. My vitamin D was low (20) at the same time as having low T so now I'm taking 50,000 IU Vitamin D supplements once a week.

[kelkel]

Juice you went with Drisdol I presume?

[kelkel]

Bump for the new member. I'd like him to get some other opinions as well.

[Brazensol]

This question is probably more for me but if the OP is in the same boat it will also help him. Kelkel, you stated that hypothyroid can lead to hypogonadism and I have read this several times as well. Would getting the thyroid hormones under control reverse my low T IF it were caused by the hypothyroid issue? Or has that train already left the station and I will need both thyroid (armour) replacement and testosterone replacement for life?

[TheSpoonyBard]

Would getting the thyroid hormones under control reverse my low T IF it were caused by the hypothyroid issue? Or has that train already left the station and I will need both thyroid (armour) replacement and testosterone replacement for life?

I was curious to know the answer to this as well. I'm going in for blood work on Wednesday of this week. Anything specific I should ask to have tested(beyond full thyroid panel) that may be a smoking gun moreso than perhaps the "usual suspects" to help point my doc in the proper direction to nail down a root cause of the Low T issue? I mean, I know that she IS a doctor and knows what she's talking about, but again she's no endocrinologist either. I'm just going to come out and ask the question that's on my mind as well, and brace myself to get flamed by the fairer sex that may stumble across this thread, so here goes: Should I be seeing a male doctor instead of a female because it seems that male docs may have a more firm grasp on the happs of low T vs a female doc because well, they ARE men and tend to have a bit more real world experience when it comes to testosterone ..

[Brazensol]

I don't think gender is the issue when it comes to finding a doctor who is knowledgable in trt. It's just flat out hard to find a good doctor. And don't expect an endocrinologist to know all that much either (although they should) unless, perhaps, you have diabetes. I think Krelkrel recommended you get a full thyroid panel and that is good advice so ask her about that. Also verify which E2 test she gave you. I doubt she would even know that hypthyroid can lead to low t so asking her if fixing hypothyroid would fix low t will probably only get you a 'deer in the headlights' response.

[TheSpoonyBard]

Any thoughts on hCG and it's uses to stimulate the increase of T? I'm mainly interested in hCG for its uses as an HPGA anti-shutdown agent. I've looked(very briefly)into the possibility of testicular atrophy, and am unsure how long it takes to start seeing the effects of the aforementioned malady? So much info. My head hurts.

[kelkel]

Yes, if hypothyroidism is the only issue then fixing that can cure the hypogonadism.

Read this: http://www.ncbi.nlm.nih.gov/pubmed/15142373

Read GDevines sticky thread on HCG . All your Q's will be answered.