Climbing out of the abyss

[Todayistomorrow]

Hi all, I’m down in a hole, losing my soul every day. Not sure if I can be saved but I’m not going down without a fight. My life changed when a suv ran a red light pedal to the medal, clipped the rear end of my Honda Pilot sending it airborne, did a 180 in the air while traveling 10-20 yards and landed on its side. I escaped from the driver side window that shattered open and collapsed on the side of road, seeing two totaled cars as bystanders surrounded me, sirens flashed, helicopters hovering up above. I started hyperventilating, went into state of shock where I just stared down at the road, and felt extreme burning sensation through my extremities.

34 yr old male, 200lb 16% BF

MRI is clean but I have post concussion symptoms being brain fog, chronic tension headache, head pressure, post convergence insufficient(hard to track objects, draw eyes inward), sensitive to light and sound, low energy, inability to handle stressors, disturbed sleep.

I’ve been researching for the past 6 months the hormone connection with TBI. At times, my T levels were 204,340,and 540 over span of 4 months.

There is a book out by Dr Larry Komer, who I believe trained under Dr Mark Gordon, that T levels should be above 600 for TBI patients to optimally heal.

I also have chronic tense neck muscles with trigger points that refer pain to my head and mimics the tension headaches I experience. I’ve done physical therapy, lidocaine injections, facet injections, dry needling/trigger point massage 1xweek for over a year. Cervical mri was clean.

I’ve done ketogenic diet past 6 weeks but it made pain much worse, and I was taking 4 Lortab pills to function. I am now weening off them and down to 1day. I also take ambien to sleep as pain prevents me from getting to bed but still often wake up at 3am. My circadian ryythm got completely messed up after my 2nd child.

My primary dr is willing to do TRT. He’s open minded and has said he’s seen the research showing TRT can help with tbi.

I’m a bit lost when it times to GH. I know Dr Mark Gordon proton has to do with some type of hormone...progesterone possibly in conjunction with TRT. Problem is doing initial analysis with him cost $2500.

It seems most anti-aging Clinic are extremely expensive and I’ve already spent 5 figures on therapies that haven’t worked.

My plan was after I’ve been off pain pills for 2-3 months, to start TRT. And then if that doesn’t help with my neck muscles, I’d do BPC-157 and/or TB500.

All I do is research everyday; but this is not my area of experitse so seeking guidance on if my plan makes sense. I’ve seen the top neuro’s at Mayo Clinic, they are pretty much useless and dismissive saying I should be fine since MRI doesn’t show damage. Thank you for any input.

[kelkel]

One hell of a story and I'm very sorry to hear of your problems. It is great to see the amount of work that you've done to solve the issue. Putting a band aid on it is not a means to an end. Trauma, either head or testicular can impact hormone production. I'm surprised the doc's at the Mayo Clinic feel the need to actually see something on an MRI (pituitary or otherwise) to actually concur.

I've read studies on progesterone combined with Vit D as a possible remedy but can't remember the outcome of the research at the moment. Also, as you are no doubt aware pain meds in higher doses can also impact T levels. So your hormone levels are getting hit from two sides.

Easy to say "If it were me" but, I'd more than likely opt to start with a solid HRT protocol and give that some time on it's own and see how you do. Know that it can take months for the beneficial effects of testosterone replacement to help. It's also important that you have a doctor that understands hormone replacement as some are in the stone ages unfortunately.

This particular forum is really just for introductions but I wanted to respond to you. I will see about getting this moved to the HRT Forum for more responses.

Welcome!

[brazey]

Welcome....

[Youthful55guy]

I know little about TBI/hormones (it's not my issue), but I can personally vouch for Dr. Gordon. Yes, he's a bit pricy, but NO ONE knows TBI better than him. He literally wrote the book on interventional endocrinology on the subject.

Have you read this book? Tales From the Blast Factory: A Brain Injured Special Forces Green Beret's Journey Back From the Brink
:https://www.amazon.com/Tales-Blast-F...don+book+brain

I believe that the guy who wrote it was treated by Dr. Gordon. I know Dr. Gordon wrote the forward to the book. The Table of Contents looks like it has some information on the biology and treatment of TBI.

Best wishes!

[RoxRunner]

Good luck man. My wife suffered a TBI 8 years ago in a bike race. Definitely a life changer. I hope it all works out.

[Todayistomorrow]

I have not read that, will see if he gives any protocol dosing away in the book.

here’s is my blood work from a few months ago
muscles.

Dihydrotestosterone 179 pg/mL 112 - 955 pg/mL

Testosterone ,Free 6.42 ng/dL 4.85 - 19.0 ng/dL

Testosterone, Bioavailable 79 ng/dL 72 - 235 ng/dL

TESTOSTERONE,TOTAL 207 ng/dL 240 - 950 ng/dL

T3, Free 2.9 pg/mL 1.7 - 3.7 pg/mL

Free T4 1.16 ng/dL 0.70 - 1.48 ng/dL

TSH 1.36 mcIU/mL 0.35 - 4.94 mcIU/mL
Cortisol 10.2 mcg/dL See Below mcg/dL

Prolactin 12.7 ng/mL 3.5 - 19.4 ng/mL

FSH 2.0 mIU/mL See Below mIU/mL
LH 1.9 mIU/mL See Below mIU/mL
Estradiol, Sensitive 23 pg/mL 10 - 40 pg/mL
Vitamin D, 25-OH, Total 103 ng/mL See Below ng/mL

SEX HORMONE-BINDING GLOBULIN,S 18 nmol/L 10 - 57 nmol/L

Thanks everyone for your input. I appreciate it.

[Youthful55guy]

My gut reaction is that since you have a good idea of the source of your problem (TBI), and your labs show an obvious deficiency in testosterone , that starting with TRT (at a minimum) is a good idea. With regard to other hormones (e.g. progesterone), you can layer them in later. In fact, I usually suggest that guys starting out with TRT take it slow and layer in one new treatment or dose change at a time followed by appropriate labs to evaluate the effectiveness of the change. I know you want to feel better quickly, but with hormones, slow and steady wins the race.

I also HIGHLY recommend at least twice weekly dosing of T-cyp. Better yet, I prefer Dr. Gordon's approach of every 3 day (E3D) dosing. That way the time interval is the same between doses, which will give you a smoother ride with the added benefit of being able to draw labs on any dosing day rather than a spefic day of the week as with twice weekly dosing.

Dr. Gordon likes to prescribe a compounded blended T product consisting of 180 mg T-cyp and 20 mg T-prop. I'm not totally convinced the T-prop is necessary. It's also very hard to find this blended T via prescription. The one source I did find no longer makes it. Rather than changing my protocol to a straight T-cyp, I have chosen to blend up my of T with prescribed 100% T-cyp some t-prop I obtain from alternative channels. Again, I don't think this is necessary, I just don't like changing a protocol that has worked for me for 6+ years.

Regarding dose, I HIGHLY recommend that you also follow Dr. Gordon's protocol of starting out with 40 mg (0.2 mL of a 200 mg/mL solution) E3D. This amounts to just under 100 mg/wk (93.3 mg to be specific). One of the most important things to remember with TRT is that the more frequent the dosing, the lower you can go on the overall weekly dose and feel the same (that it, feel "normal"). You should follow up with new labs in about 6 weeks and evaluate whether you need to increase your T dose. More than likely you will not need to decrease it, but the possibility is there. Let the labs dictate what you do next.

I also recommend that at the same time you start TRT, that you also start taking 50 mg Pregnenolone and 25 mg DHEA daily. This is again part of Dr. Gordon's standard starting protocol. These are important upstream steroid hormone precursors that are probably lacking in your system because you are producing an inadequate amount of LH. This also may be where the progesterone (p4) you mentioned comes into play. P4 is made directly from Pregnenolone in the steroid synthesis pathway. That is, it's just one conversion away. You may indeed be low on P4, but supplementing guys with P4 at the start of TRT may not be a good idea. When you start TRT, your Estradiol (E2) will also increase, since E2 is just one step away from T. In many cases, this is good because Low E2 can cause many of the same symptoms as Low T (particularly ED). However, when both P4 and E2 get too high, the combination of the two can set you up for a bad case of gynecomastia . Therefore, by supplementing with the upstream precursor to (pregnenolone) P4, it allows your body to control the rate of conversion so P4 levels do not get out of control.

Regarding HCG , I do recommend it, but I also recommend you wait until you have your T dose optimized and then layer it in. Dr. Gordon is not hugely keen of HCG, but he will prescribe it. He likes relatively low doses (180 IU 3X weekly). I like to go higher than this. There is a good study that shows that approximately 1000 IU per week (divided into at least 3 doses) will help to normalize testicular function in guys receiving TRT. This will be important to you at your age, particularly if you ever plan on having children.

[Couchlockd]

try to get off the opiates and any other narcotics as soon as you can. (if your not still,in,bad pain)

those will just add to the low T situation. as well as the depression, I hope for the best.

titrate down gradually over a period of a few weeks

[Todayistomorrow]

Thank you for the detailed response. It was very helpful in further understanding how to proceed. I will bring up the protocol Id like to start with my primary Dr. and see if he’s onboard or what I’m able to get through a prescription. The T-cyp and T-prop is foreign to me, so will need to look into that further.

Main concern I have with starting TRT is testicle shrinkage and testicle pain. HCG is suppose to prevent this correct? I’m not sure if it’s similar to pain I get after doing NOFAP for 10 days, and only way to relieve it is to have an orgasm. I don’t want to add 24 hour ball pain to the list of pain symptoms.

I have 2 kids with no plan of any more. If I was pain/symptom free it would be different story. Priority is to get better so I can be best father possible and get back to work.

As far as opioids, I took last pill yesterday. OTC stuff doesn’t touch my pain. I was going to wait a couple months of being off pain pills and retest my T levels, but regardless of where they are, I want to be at the higher range plus pregnenolone and DHEA sound like they could help brain function. (Are they only used in conjunction with TRT?)

I’m reading all the FAQ and trying to absorb as much as possible so I can do this properly, safely, and optimally for best chance of success....and not spending 10k on a specialist, as if this doesn’t work I’m going to have to look into HBOT(one thing at a time...I’m cautiously optimistic about HRT).

I may need to result to going back to medical marijuana to control the pain...is that a problem if I’m doing TRT? Literally 1-3 puffs usually is enough to decrease my headaches. i take CBD oil now and Lion’s mane mushroom which have some effect on T levels.

[Todayistomorrow]

try to get off the opiates and any other narcotics as soon as you can. (if your not still,in,bad pain)

those will just add to the low T situation. as well as the depression, I hope for the best.

titrate down gradually over a period of a few weeks

yes it’s an awful slope. I was able to manage the first 4 years with drugs like amitryptaline that are known to help post concussion migraines. after 3 years, I got off all meds and while my Brian fog never went away, my headaches were manageable.

Once I had kid, everything spiraled out of control. My second son was born premature, and had frequent awakenings for a year. when I tried to get back on amitryptaline, it made me even more depressed, suicidal, and unbearable fog. Tried a host of antidepressants and other meds but nothing worked besidess Lortab for the pain and ambien to help me sleep.

But then you need more and more to control the pain, it causes rebound headaches, and more brain fog. having a break from the 24/7 pain sometimes is just necessary for ones sanity.

If TRT can help with sleep, handle stress better, more energy, help neck muscles heal, it may lead to better cognition. It may just be a piece of the puzzle but I know using opioids as a bandaid won’t get me anywhere.

[Todayistomorrow]

One hell of a story and I'm very sorry to hear of your problems. It is great to see the amount of work that you've done to solve the issue. Putting a band aid on it is not a means to an end. Trauma, either head or testicular can impact hormone production. I'm surprised the doc's at the Mayo Clinic feel the need to actually see something on an MRI (pituitary or otherwise) to actually concur.


Welcome!

Thank you and I appreciate you moving my thread to gain more insights into HRT!

In regard to Mayo, basically Post concussion symptoms and mTBI fall outside the standard protocol of care. There are no massive research trials that show any one of therapy of having success. Each injury is unique and complex that their answer is either to blame depression, or that some people just don’t get better.

Now that could be a possibility that it doesn’t matter what I do and my symptoms will stay with me forever. The overwhelming amount of evidence from my life experience and in general from people who don’t recover after 1 year, this shit never ends. Every day is Groundhog Day, no escape from the fog and pain. I like to say pain is my best friend, he never leaves my side.

Certainly after suffering for so long, depression/suicidal thoughts is going to come into play. SSRI’s did not work for me, and actually made me much worse. But I’d say it’s not really depression, it’s frustration going from doctor to doctor, going down countless rabbit holes, having your family and friends accuse you of being an addict because they read an article on CNN about the opioid crisis.

[Todayistomorrow]

Quick update, found an endocrinologist to do STIM test on my pituitary. My primary Dr. wants me to start Clomid, but I wanted to wait until I hear back from Dr. Gordon if I'm able to get into his protocol.

This Dr. I'm seeing next week is suppose to be one of the best if you need GH. There's some debate whether or not GH or GH secretagogue are better. Gordon seems to prefer the latter so I'll have a decision to make if results show deficiency. Given he's had the biggest sample size of treating traumatic brain injuries, I'm leaning doing whatever he suggest if I can get into him.

I'm not sure how much of a factor cost come into play for his decision since most people can't afford 15k+ year if insurance won't cover it. I listened to his lecture stating other pros/cons so I'll just dive in more once I get more info. Thanks again for all your input.

[Todayistomorrow]

Did the STIM test today where they drew my blood every 30 minutes. The insulin they gave to induce hypoglycemia was rough but doing that with the glucacon test make it so its 98% accurate to test for GH deficiency. They gave me a sample 10mg norditropin pen to do 0.2mg every day. If my test results show a deficiency, I'll start 0.6mg a day plus clomid. If I can get GH improved by insurance, then it's not even a question which route I should go right? That being do the GH protocol or pay out of pocket to see Gordon and do clomit with GH secretetogues?

[Jedi1337]

My advice would be to try TRT for short period and see how it works for you. Treat it like a cycle - i.e. 3 months - but TRT dose, to see the effects whilst preserving the long term functionality of your hormonal system.

My situation is very different however brain fog and headaches are no longer an issue for me since starting AAS.

I wish you all the best.

[Mr.BB]

Sorry to hear about your problems, sounds like post traumatic shock to me.

Would advice not to try keto diets while accessing testosterone values, as it may lower values intermittently.

Also patching your problem with testosterone may cause bigger problems than solutions as you get shutdown.

[ScotchGuard02]

In my past life, I had an opportunity to work with a neuro-surgeon specializing in Brain Injury. Autism, depression, TBI, mild BI, etc were all considered some form of brain injury. A radioactive carrier was injected which went directly to the brain and the brain was scanned with a special, VERY high resolution, MRI scanner. Most MRI scanner for the body doesn't have to resolution to detect small blood vessels in the brain. There were an assortment of treatments depending on the exact area of the brain that was affected. I'm not a doctor so I can't tell you exactly what's up with your brain. I do know that for every single patient he prescribed hyberbaric chamber treatment. The patient was place in a pressurized chamber with 2 ATM of oxygen rich environment. It was found that pressurized oxygen will get into the brain through pathways and actually "heal" the brain rather than taking brain numbing medication which just covers up the symptoms. Again, I'm no doctor. Based on my experience working with the neurosurgeon I would say that TRT and bi-weekly hyperbaric chamber treatment would do you a world of good. Good luck bro

[Todayistomorrow]

In my past life, I had an opportunity to work with a neuro-surgeon specializing in Brain Injury. Autism, depression, TBI, mild BI, etc were all considered some form of brain injury. A radioactive carrier was injected which went directly to the brain and the brain was scanned with a special, VERY high resolution, MRI scanner. Most MRI scanner for the body doesn't have to resolution to detect small blood vessels in the brain. There were an assortment of treatments depending on the exact area of the brain that was affected. I'm not a doctor so I can't tell you exactly what's up with your brain. I do know that for every single patient he prescribed hyberbaric chamber treatment. The patient was place in a pressurized chamber with 2 ATM of oxygen rich environment. It was found that pressurized oxygen will get into the brain through pathways and actually "heal" the brain rather than taking brain numbing medication which just covers up the symptoms. Again, I'm no doctor. Based on my experience working with the neurosurgeon I would say that TRT and bi-weekly hyperbaric chamber treatment would do you a world of good. Good luck bro

I feel like there has to be imaging to show why my brain is messed up. My vision is 20/20 but I went to neuro ophthalmologist recently who noted my convergence is really bad and am getting new prism lenses to bend the light outward. It sounds like vodoo but the glasses make a huge difference, even though my current ones are not optimal.

It just can’t be normal to have headaches and fog everyday, something is majorly F up. Of course it’s complicated by the fact my sleep is destroyed and a polypharmacy that has made matters worse, but the horrendous fog has been there since I came out of shock of the trauma.

HBOT is my next plan after I start HRT. Good to know that Dr. was a proponent of doing it. I almost got into a HBOT study behind done for the military but Medical Marijuana disqualified me.

[Todayistomorrow]

Sorry to hear about your problems, sounds like post traumatic shock to me.

Would advice not to try keto diets while accessing testosterone values, as it may lower values intermittently.

Also patching your problem with testosterone may cause bigger problems than solutions as you get shutdown.

I thought Keto would raise T levels. I’m hoping a lot of my problems are due to low T and/or GH deficiency, and fixing those levels will help my brain repair itself. Better sleep lead to better cognition, less headaches. Chronic pain is a horrible cycle to try to dig yourself out of and certainly has worn me down. That to me is much more traumatizing than the actual accident which I didn’t feel a thing from. I have PTSD symptoms if I go through interesection of accident or if I see another car accident.

[Todayistomorrow]

Got lab results which look normal but haven't discussed with Dr. yet. Looks like I'm not GH deficient as you need <5 for the value and I'm at 6. Total T is 581 ng/dl. Free T is 11 ng/dl.

FSH 2.8 range 1.5-12.4
LH 3.6 range 1.7-8.6
DHEA-Sulfate 185
T4 free 1.11 range 0.82-1.77
T3 total 126 range 71-180
TSH 1.19 range 0.45-4.5

[macmathews]

Got lab results which look normal but haven't discussed with Dr. yet. Looks like I'm not GH deficient as you need <5 for the value and I'm at 6. Total T is 581 ng/dl. Free T is 11 ng/dl.

FSH 2.8 range 1.5-12.4
LH 3.6 range 1.7-8.6
DHEA-Sulfate 185
T4 free 1.11 range 0.82-1.77
T3 total 126 range 71-180
TSH 1.19 range 0.45-4.5

Free T was on what range ?

[Todayistomorrow]

Free T was on what range ?

None listed but the ones I’ve seen in past with that measurement are 6-30. Dr Mark Gordon said he likes to shoot for 15 for the free T.

Will be interesting to see if this Dr recommends anything or if he thinks I could benefit from GH secretegogues.

[Todayistomorrow]

Turns out I was reading labs wrong. I was suppose to average my results instead of adding them so I do have hypopituitarism. The plan will be to start at 0.6 mg of GH. I'm going to look into doing a cycle of either BPC-157 or TB500 and then after 3-6 months, do HBOT if I don't achieve desired results. I am not sure if I need to use caution with using those peptides while also doing HBOT. I doubt there are many people who have done both therapies and I'm not sure if there could be increased cancer risk stacking them.

Should I notice increase in muscle gain if I'm working out consistently from the GH? I still am waiting to see if Dr. wants to do clomid or TRT.