Question for Vettester

[Kwn]

Hello, I am new to this forum. I have read that you have low SHBG. Could you please educate me what protocol you are using to get around it? My SHBG is 9, I am struggling with TRT. Any help will be greatly appreciated.

[Kwn]

Sorry that I had to post it as a thread. I wanted to send a PM, but for some reason I cannot do it.

[Vettester]

Hello, I am new to this forum. I have read that you have low SHBG. Could you please educate me what protocol you are using to get around it? My SHBG is 9, I am struggling with TRT. Any help will be greatly appreciated.

Welcome to the forum, glad you have joined. You are correct, I have low SHBG. I am a carrier for hemochromatosis, and my liver function isn't exactly optimal ... Too much ferritin, not enough SHBG, etc. Not knowing anything about you, I'd advise to at least get all the CBC and metabolic labs to ensure things are in order with your liver and other organs.

As far as my "normal" protocol ...
Test Cyp 50mg x 2/wk (down from 60mg) SubQ
HCG 250 iu x 3/wk
Pregnenolone cream 25mg/day
DHEA Keto 7 at 50mg/day
Vitamin D3. 20,000iu x 2 injected with Cypionate . (Still tinkering with this)
B12 methylcobalamin & L-Carnitine injected with HCG (only 2x though) 250mcg /1,000mg
No AI for me with the sub Q protocol.

As you probably know, low SHBG usually will mean higher free and bio available testosterone . For this fact, I currently try to aim for the 650 to 700ng/dl serum range. My free test is usually at 3.2/3.3%, so 21 to 24ng/dl, which works pretty good for me.

So, for me, I don't aim to get around it, I just work with it. What issues are you having? How long have you been working with your program and what is your goal? I'll gladly help, but you will get a variety of responses if another thread is created at some point that involves the other members.

[Kwn]

Here is my story:

in March 2012 I lost erections and libido, quite literally overnite. Urologist measured TT=147. Upon conversation with him, I decided to lose weight (40 yo, 225 lb, 5 foot 7). So I went on a low-carb diet, and after 5 weeks lost around 20 lbs. And all of the sudden my sex life came back. But three months later, I gradually lost libido again, and orgasmic sensation. I could have sex, ejaculate, but no feeling. I measured again, TT=122. I decided to go with Testopel. Implanted 14 pellets in January 2013, and 5 days later got a MAJOR panic attack. I lived with periodic panic attacks for 5-6 weeks, and then they went away. I started to feel weak orgasms, by far not what it used to be. But libido did not come back. Numerous measurements showed that on Testopel I was pretty stable (which makes sense) at TT=450+/-20, and E2=38.

So in May I signed up for HRT clinic. They made comprehensive panel:

LIPID PANEL
CHOLESTEROL, TOTAL 178 125-200 mg/dL
HDL CHOLESTEROL 46 > OR = 40 mg/dL
TRIGLYCERIDES 157 H <150 mg/dL
LDL-CHOLESTEROL 101 <130 mg/dL (calc)
CHOL/HDLC RATIO 3.9 < OR = 5.0 (calc)
NON HDL CHOLESTEROL 132 mg/dL (calc)
CARDIO CRP(R) 1.6 mg/L

COMPREHENSIVE METABOLIC PANEL
GLUCOSE 91 65-99 mg/dL Fasting reference interval
UREA NITROGEN (BUN) 20 7-25 mg/dL
CREATININE 1.13 0.60-1.35 mg/dL
eGFR NON-AFR. AMERICAN 81 > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO NOT APPLICABLE 6-22 (calc)
SODIUM 141 135-146 mmol/L
POTASSIUM 4.6 3.5-5.3 mmol/L
CHLORIDE 106 98-110 mmol/L
CARBON DIOXIDE 26 19-30 mmol/L
CALCIUM 10.0 8.6-10.3 mg/dL
PROTEIN, TOTAL 7.3 6.1-8.1 g/dL
ALBUMIN 5.0 3.6-5.1 g/dL
GLOBULIN 2.3 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 2.2 1.0-2.5 (calc)
BILIRUBIN, TOTAL 0.6 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 67 40-115 U/L
AST 16 10-40 U/L
ALT 20 9-60 U/L
HEMOGLOBIN A1c 5.8 H <5.7 % of total Hgb.
VITAMIN D, 25 OH, TOTAL 25 L 30-100 ng/mL
VITAMIN D, 25 OH, D3 25 ng/mL
VITAMIN D, 25 OH, D2 <4 ng/mL
TSH 1.71 0.40-4.50 mIU/L
T4, FREE 1.2 0.8-1.8 ng/dL
T3, FREE 3.2 2.3-4.2 pg/mL
TESTOSTERONE , FREE 128.3 46.0-224.0 pg/mL
TESTOSTERONE,BIOAVAILABLE 297.2 110.0-575.0 ng/dL
SEX HORMONE BINDING GLOBULIN 9 L 10-50 nmol/L
ALBUMIN,SERUM 5.1 3.6-5.1 g/dL
DIHYDROTESTOSTERONE, EZ LC/MS/MS 14 L 16-79 ng/dL

CBC (INCLUDES DIFF/PLT)
WHITE BLOOD CELL COUNT 5.2 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.77 4.20-5.80 Million/uL
HEMOGLOBIN 16.4 13.2-17.1 g/dL
HEMATOCRIT 51.7 H 38.5-50.0 %
MCV 89.6 80.0-100.0 fL
MCH 28.4 27.0-33.0 pg
MCHC 31.7 L 32.0-36.0 g/dL
RDW 14.7 11.0-15.0 %
PLATELET COUNT 220 140-400 Thousand/uL
ABSOLUTE NEUTROPHILS 3245 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 1492 850-3900 cells/uL
ABSOLUTE MONOCYTES 322 200-950 cells/uL
ABSOLUTE EOSINOPHILS 120 15-500 cells/uL
ABSOLUTE BASOPHILS 21 0-200 cells/uL
NEUTROPHILS 62.4 %
LYMPHOCYTES 28.7 %
MONOCYTES 6.2 %
EOSINOPHILS 2.3 %
BASOPHILS 0.4 %
DHEA SULFATE 321 45-345 mcg/dL
INSULIN 13 <23 uIU/mL
LH <0.2 L 1.5-9.3 mIU/mL
PROLACTIN 13.0 2.0-18.0 ng/mL
PSA, TOTAL 1.0 < OR = 4.0 ng/mL
E2 Sensitive = 38

In June my TT started to fall (Testopel was wearing off). I was placed by HRT doctor on 500 IU of HCG and 0.5 mg Arimidex E3D. Three weeks later I measured TT=480, E2=7. I crashed estrogen. I asked doctor to write a script for cypionate . Clearly my TT was not high, and I was thinking this is a source of problems (including E2, which was 38 - high, or 7 - low). So I went on E3D protocol on 7/17/2013:
day 1 = 300 IU HCG
day 2 = 50 mg cypionate IM+0.25 Arimidex
day 3 = nothing

It did raise my TT to 912 in 3 weeks, but E2 was at most 14. I went off arimidex, and in a week I was back at E2=41. So I went back on 0.25 Arimidex E3D. The latest measure a week ago gave me TT=555 and E2=11. I believe my HCG is losing its potency (its been 2 months, you are supposed to discard it after 60 days). So today I started new HCG bottle. I have no idea where my TT is right now, or E2.

MAIN POINT:
I still have weak-to-no orgasms, and zero sex drive. Libido never returned. I read on forums (including this) one that low SHBG may be responsible for that. There are a low of guys with low SHBG struggling to observe TRT benefits.

I talked to several guys with low SHBG. They indicated that found the solution by using propionate . Apparently the explanation lies in the fact that prop is fast released into blood stream, cyp is slowly released ester. So prop spikes your blood concentration quickly, and expresses biological action. After this it is quickly removed from blood, apparently, but the benefits are observed. Then blood concentration drops, and the picture repeats with next injection. I do not know if this makes sense or not but apparently it works for some people really well.

So here is my question to you (and whoever else can contribute, fine gentlemen):
being low SHBG man, do you observe typical TRT benefits (elevated energy, good mood, libido, erections, orgasms) with your protocol, and given that you have low SHBG?
If so, how long did it take you to start feeling the difference? I am on HCG+cypionate for 5.5 weeks by now, no results so far.

Any advise/insight/suggestion are more than welcome.

Thank you for your help.

[Joseph956]

I know this thread is about something different but were those bloods from before trt? Your hematocrit looks a little high if so.. Could be the reason for some of your libido issues (circulation) and overall just shitty feelings.

[Kwn]

Yes, HCT is elevated. I donated blood, got it into 45 in May. Went for another donation last week. I seriously doubt libido and HCT are related.

My issues is - all successful TRT cases sound like "first two-three weeks I did not feel much different, then I noticed elevated mood, and more energy, and after that my libido started to improve". I am looking at week 6, and nothing even close to that happens. Something is not right...

I suspect it is low SHBG, since it seems to be the issue with men complaining about now effect from TRT. This is why I am asking Vettester (and anyone else) - how did you guys make TRT work under low SHBG conditions. If this, in fact, is the reason.

By the way - 2 days ago I stopped taking Arimidex , and started to make sub-q cypionate injections.

To be honest, I am not super crazy how my HRT doctor handles this case. I am given a relative freedom to do adjustments, without being too specific on his part. For example, I crashed E2, and emailed him what to do. His response - take Adex less frequently. I know that. Should there be more guidance from him considering I have no experience dialing in TRT. Also, all labs - I buy myself though private md labs dot com. Obviously I am paying for them out of pocket.

[Kwn]

Bump. Any inputs from respected community?

[Vettester]

Kwn, there's a lot of variables to getting a protocol balanced. Don't get too frustrated, and stay committed.

IMO, I think your libido is E2 and 'prolactin' related. Although prolactin at 13ng is showing in range, it would be good to see < 8. Mine crept up over 10ng at one point the first time I added some deca . Trust me, it was a deal breaker. A little caber or prami will work as a dopamine agonist, and it makes a HUGE difference. Rule out of course that you don't have a prolactinoma related tumor or any other pathology.

I'm glad you switched to SubQ. You should be able to manage your E2 much more efficiently going this route. Low SHBG has never been a libido factor for me, but other variables have been. Make sure you're confident with how you are mixing and storing your HCG . I can tell you with authority from the nutometer that HCG starts to lose its potency as early as 46 to 48 days. If it's not handled with care, reconstituted properly, and stored right, it can be less than beneficial.

[Kwn]

Vette, thank you for reply. I was thinking along similar lines. I seem to over-respond to Arimidex . If I do not take it my E2 goes up to 40. If I start 0.25 mg E3D, it drops into 10. I get off Arimidex - and a week later it is 40 again.

On Prolactin - since I am in range I seriously doubt doctor will be willing to prescribe it. Also, deca is not even an "official medication", is it? Does it exist in doctor's world? I am sorry for being so naive, I just never dealt with it before.

Also, are cabergoline or deca permanent medications to maintain prolactin low? Or can you lower prolactin and get off them, and prolactin stays in check? I have no idea why prolactin is high, I had putuitary MRI, came back normal.

[Kwn]

plus, also, the way I understand it, dopamine is great neurotransmitter, it creates good mood, energy, libido, arousal, and orgasms. Prolactin is man-hating bitch, it pretty much negates all dopamin's good things. Testosterone and estrogen determine balance of neurotransmitters in brain, with dopamine being increased by testosterone, and prolacting defined by estrogen. So if your estrogen is high - prolactin dominance, no libido. Therefore, to balance neurotransmitters nicely, one needs to balance t and e, i.e. run correct trt protocol.

Is this correct in the nutshell?

[100%]

Might want to look into these studies The (TAAAA)n polymorphism of th... [Exp Clin Endocrinol Diabetes. 2011] - PubMed - NCBI
http://pmr.cuni.cz/Data/files/Prague...06_Duskova.pdf

[Kwn]

I know that low SHBG may be an indication of metabolic syndrome. I also did some research on SHBG factors. It looks like SHBG goes UP when people:
1) lose weight
2) drink alcohol (which worsens liver condition)
3) eat less protein (become vegeterian)
4) age
5) have more estrogen
6) lower insulin

I believe I do have a metaboilc syndrome:

GLUCOSE 91 65-99 mg/dL Fasting reference interval
HEMOGLOBIN A1c 5.8 H <5.7 % of total Hgb.

I am on low-carb diet, trying to get rid of it. In the mean time I am trying to find another reason why I have no response from TRT.

[100%]

I know that low SHBG may be an indication of metabolic syndrome. I also did some research on SHBG factors. It looks like SHBG goes UP when people:
1) lose weight
2) drink alcohol (which worsens liver condition)
3) eat less protein (become vegeterian)
4) age
5) have more estrogen
6) lower insulin

I believe I do have a metaboilc syndrome:

GLUCOSE 91 65-99 mg/dL Fasting reference interval
HEMOGLOBIN A1c 5.8 H <5.7 % of total Hgb.

I am on low-carb diet, trying to get rid of it. In the mean time I am trying to find another reason why I have no response from TRT.

Might give this a try. Drop the hcg for now this will do two things. One let you know if your high estrogen levels are being caused by hcg or possibly intratesticular E2. Two give you more control in adjusting your total testosterone . Now take your weekly dose of test C divide it by 7 and inject daily sub Q. I don't believe that test prop is what is given some more benefit as much as it is the frequency of injections.

[Vettester]

Vette, thank you for reply. I was thinking along similar lines. I seem to over-respond to Arimidex . If I do not take it my E2 goes up to 40. If I start 0.25 mg E3D, it drops into 10. I get off Arimidex - and a week later it is 40 again.

On Prolactin - since I am in range I seriously doubt doctor will be willing to prescribe it. Also, deca is not even an "official medication", is it? Does it exist in doctor's world? I am sorry for being so naive, I just never dealt with it before.

Also, are cabergoline or deca permanent medications to maintain prolactin low? Or can you lower prolactin and get off them, and prolactin stays in check? I have no idea why prolactin is high, I had putuitary MRI, came back normal.

Good to hear on the MRI. I presumed you would probably checkout fine, as your prolactin isn't off the charts or anything, but it's always better to be safe than sorry. No no on the deca being a treatment for prolactin. The nature of Nor19 compounds like Deca will actually promote hyperprolactinemia, which as you might describe as a "man hating bitch" lol. Yes, it does selectively get prescribed by various physicians. I have always got it from mine. I'd refrain any consideration of it until you really get a complete handle on your situation.

plus, also, the way I understand it, dopamine is great neurotransmitter, it creates good mood, energy, libido, arousal, and orgasms. Prolactin is man-hating bitch, it pretty much negates all dopamin's good things. Testosterone and estrogen determine balance of neurotransmitters in brain, with dopamine being increased by testosterone, and prolacting defined by estrogen. So if your estrogen is high - prolactin dominance, no libido. Therefore, to balance neurotransmitters nicely, one needs to balance t and e, i.e. run correct trt protocol.

Is this correct in the nutshell?

Looks like you've been doing some reading ... When I first had some issues with Deca, I was prescribed some caber, I believe it was 0.5mg per week (0.25mg x2/wk). Anyways, a few weeks later all was good. The next time that deca came into play, I just ran the same amount of caber with it right out of the gate, never had one problem.

[Kwn]

Looks like you've been doing some reading ... When I first had some issues with Deca, I was prescribed some caber, I believe it was 0.5mg per week (0.25mg x2/wk). Anyways, a few weeks later all was good. The next time that deca came into play, I just ran the same amount of caber with it right out of the gate, never had one problem.

Vette, definitely, I first intend to get to the bottom of what is going on. I will not jump on deca /caber right up.

Question: do you have to stay on caber to suppress prolactin? What happens if you stop? Does prolactin creep back up? I know there were published studies that caber promotes libido etc, but they were limited in time. Medical jerkoffs ran it for a few months published the paper and said "it is not cleat if the effects persist long term upon discontinuation of caber".

[Kwn]

I have a question to a respected community. I am in really bad shit right now, and need help desperately.

My last post was almost a year ago. Since June 2013 I tried different protocols of cypionate /propionate /HCG , in different doses:
- cypionate 8 mg/day
- cypionate 16 mg/2 days
- cypionate 30 mg/3 days
- propionate 2 mg/day
- propionate 5 mg/day
- propionate 8 mg/day
- HCG mono 100-150 IU/day

and many others.

on the labs my results were all over the place, TT from 110 to 1200, for the most part stayed around 500-600. E2 was consistently low, even in the single digits, when I was using Adex. So in August 2013 I stopped adex and never used it after that. My E2 was in 15-20 range, occasionally coming into 20-25 range.

Symptom-wise I am in complete shit. Shortly after starting cypionate in July 2013 I saw mild ED. I lost morning wood, and developed insomnia. Libido is zero. Over the course of one month ED got progressively worse. But here is the horrifying part: I started to see penile atrophy in August 2013. The penis shaft got thinner, with loose skin, and veins very pronounced on the top of it. It never happened before. No matter what my levels were, testosterone , or estrogen, symptoms did not change. Finally in March 2014 I decided to go back on Testopel. Last time in 2013 I was on it, my boners were good, I had morning wood. My only problems were no libido and weak orgasms.

So 3/17/2014 I got Testopel (12 pellets). Nine days after implant, I got strong woody, and dick went back to its good old full shape (overnight). I measured TT=850, E2=39 (sensitive). It lasted 4 days, and disappeared again. No wood, thin shaft. I measured again, and it came back as TT=680, E2=24. So I attributed loss of wood to significant drop in E2. Later measurements revealed TT=450-470, E2=18-19.

So it appears that my body cannot hold onto E2. Magical wood coming back and disappearing again puzzles me immensely.

If you guys have any comments/suggestions, the are highly appreciated. I am at the world end, as you can imagine. The wood is gone close to 1 year and I cannot bring it back. The idea to go back on Testopel was to bring back my dick, because previous time on Testopel I had no dick problems. But for no apparent reason it is not working this time, even though the dose is almost identical.

My sleep is still messed up (insomnia).

Please, guys, help me out, I am at the end of the line.

[Kwn]

Please, guys, any advise! I am in living hell right now.

[Times Roman]

you should start your own thread instead of digging this one up from the boneyard............

[Beethoven]

you should start your own thread instead of digging this one up from the boneyard............

And post complete BW. Also are you self medicating or under a Drs care?

[APIs]

BTW, what the hell happened to Vettester? His title says "Banned"? What happened?

[J DIESEL3]

^^^^^^ I was thinking this myself a couple days ago...