Advice on what I should do??? On shots currently

Low testosterone issues, impacts on health & marriage, treatments, etc.
Runningwithdog
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Advice on what I should do??? On shots currently

Postby Runningwithdog » Thu Jul 28, 2016 7:32 am

Been reading threads and I will admit I'm not the sharpest dog in the pack when it comes to medical things. Been trying to piece together a course of action based on what I've read but I'm not confident I'm understanding correctly. So forgive me if this seems like an obvious, easy thread to answer, but for me it's not.

I've been taking T therapy for about 5 years. Started with the underarm stuff, but after my 1 year of cost assistance, I had to change because my insurance did not cover it. Then I lost my job and went to shots because they were cheapest. I was feeling better than before therapy began on a purely subjective scale. More motivated in general and sex drive was adequate.

My original doctor had me injecting once per month (do not remember the dosage). He insisted on having it done in his office so paying for more than once a month was hard. I felt a cycle really badly. Would feel good for a couple of weeks and by the 4th week I could not wait to get back for another shot. Just felt cruddy.

Got a new job and changed doctors. Now see a PA for this issue. She seems very supportive and easy to talk to but I do not know how knowledgeable she really is. She allowed me to do shots myself. I asked her if I could do half dose twice a month and she was good with trying that. I was injecting 1ml of 100mg/ml medicine every 2 weeks.

The last time I was tested (Feb 2016) she said my free T was still low. Total Testosterone 371 ng/dL Free testosterone 7.3 pg/mL. This was taken right before I was due for a shot. I had a physical right about the same time so lots of other blood work but I do not see anything that looks like estrogen type testing. She said my free T was still low and increased my dose to 1.5ml of 100mg/ml twice a month.

In April the 100mg bottles I had been buying were not available. She changed my prescription to 200mg/ml bottles which effectively upped my dose again a bit Now 1m of 200mg/ml twice a month. On this dosage I feel the biggest difference in desire. Before I wanted to make love in a good general sense - physical touch has always been a love language of mine so it was largely about feeling loved and showing love. Now, I catch myself looking at my wife, feeling the heart palpitating and just thinking "man, I want her". More lusty as it were. There is a little bit of a cycle but not bad at all.

Reading a bit here, I am concerned about not seeing any estrogen testing. My weight is at its highest point ever (190 pounds at 6 feet). 54 years old. Slightly overweight but I used to be around 170 4 years ago. I've attributed that largely to not running nearly as much but I've also been trying to lose some weight and run more and the weight isn't coming off as easily as in the past. Also started lifting again but just feel soft overall if you understand. Could that contribute?

So what should my plan of action be? Cost is an issue - while I'm working money is tight. I think I need to:

- Ask my PA to test for estrogen (?) when I have my next labs in August. If so what should I ask for?
- What is she doesn't understand or support estrogen testing?
- Take zinc just because? How much?

What else?

Hoosier52
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Re: Advice on what I should do??? On shots currently

Postby Hoosier52 » Thu Jul 28, 2016 8:05 am

Sadly, most doctors/PA's are NOT knowledgeable on TRT. My story is similar to yours - trans-dermal cremes for a couple years, then 1 shot a month and feeling no change. In March I found a local TRT doc who did mostly pellets. I asked to do injections and he ok'd it. I was doing 100mg/week divided into 2 SubQ injections. I felt better, but began to have other issues like HBP, high estradiol and raised PSA. He said TRT didn't effect BP which is not true. He did the wrong estradiol test and when I asked about the correct SENSITIVE estradiol test he said he'd never heard of it although the lab report recommended it on the lab sheet! He never checked my PSA or prostate. He refused to check my T levels after I started injections saying you couldn't accurately check them if you were injecting (not true)

That's when I decided to go with Defy Medical. They are licensed to practice in all 50 states. I had to get a physical and extensive blood work. Found out my Total was 1500! Too high and my free T was low (indicating high SHBG). Also found that my sensitive estradiol was low as was my DHEA. Also found a raised PSA (4.1) which is probably due to inflammation. I'm going next week to get a DRE to be safe. The lab report was 9 pages long!!!

I had a 50 minute phone consult with Dr. Saya of Defy Medical in Tampa. He was very thorough. Asked lots of questions and answered many questions. I lowered my TRT to 36 mg/week divided into 2 doses, added HCG injections twice weekly to counter testicular atrophy and to increases natural T production and libido, and added daily DHEA/Pregnenolone capsules to lower SHBG (which binds with Free T), aids sleep and also raises libido. The Pregnenolone is a precursor to all of the other hormones in your body.

I HIGHLY recommend Defy. There is no medical group more qualified in HRT. Dr. Saya is amazing. You get discounted blood work through them and they also prescribe and send meds to you from one of several compounding pharmacies (mine is coming from APS Pharmacy in FL). The phone consult is $250. You have to be retested every 3 months, have an annual physical with your local doc and a phone consult with Dr. Saya or one of his nurses twice a year. They don't take insurance but your insurance MIGHT pay for it anyway - especially the blood work. MY extensive blood work was $169.00. My initial 3 month of supplies, including needles, syringes and 2 day shipping, was about $250.

After I hung up with Dr. Saya I breathed a sigh of relief - FINALLY, someone who knew what they were doing! MY BP actually went down to almost normal after talking with him. Look them up and at least talk to them. There's no cost for the first consult.

Also, I have had more contact from Defy than I've ever had from the previous Doc. Very involved and professional.

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Re: Advice on what I should do??? On shots currently

Postby Runningwithdog » Thu Jul 28, 2016 8:45 am

Thanks for the info. I'll admit to swallowing a bit hard at the prices. My current injection costs me $10/month and my doctors visits are also $10. Of course, what is the saying, you get what you pay for?

I think I'd like to know what test I should ask for next month as a start to see where I may be lining up right now.

Hoosier52
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Re: Advice on what I should do??? On shots currently

Postby Hoosier52 » Thu Jul 28, 2016 9:33 am

Call Defy and ask. Great people. You won't be disappointed. One thing I've learned is that TRT can be dangerous to your health. The same doc I was seeing has also been treating my wife. He has never done any blood work on her. She's switching to Defy today. Maintaining health is cheaper than trying to recover it. I may be able to trim my costs, but had them send me everything just to get it all at once and to be sure I get top quality meds. I may be able to save money on the syringes and the DHEA/Pregnenolen capsules. Their cost on T and HCG is very competitive.

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Re: Advice on what I should do??? On shots currently

Postby txtwindad » Thu Jul 28, 2016 12:28 pm

Getting shots once a month is so far out of practice it is laughable. Your doctor is definitely way, way out of the loop on T treatment. IMO, this kind of stupid is not fixable. Get a new doctor.
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Re: Advice on what I should do??? On shots currently

Postby Runningwithdog » Thu Jul 28, 2016 12:35 pm

txtwindad - somewhere in that long thread I think that point got lost. I did get a new doctor - went from the 1 per month doctor to a PA who changed it to 2 times per month. And if I still need to get a new doctor, I'm still seeking for enough information to know how to find a knowledgeable one.

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Re: Advice on what I should do??? On shots currently

Postby SquarePants » Thu Jul 28, 2016 1:05 pm

Monthly injections are a terrible idea, and any doctor knowledgeable in testosterone therapy would know that. Every 2 weeks is still not enough. Injections should be performed no less frequent than once a week, or else you’ll crash before your next injection. I do mine twice a week.

Runningwithdog wrote:Now 1m of 200mg/ml twice a month.

You’ll get a huge spike in testosterone from that dosing schedule, which will cause your estrogen levels to climb. High estrogen levels will block many of the positive effects of testosterone, and can also have negative effects on your prostate and can cause breast enlargement. I loose muscle tone when my estrogen is high.

If your PA is willing to work with you (and you’d like to continue working with her), then I’d suggest that you read up on testosterone therapy. I HIGHLY recommend reading a book called “Testosterone Replacement Therapy: A Recipe for Success,” by Dr. John Crisler. It’s available on Kindle, and is extremely cheap compared to the other expenses of therapy. He discusses lab work and treatment options.

I recommend that you continue the 200 mg/ml vials rather than the 100 mg/ml vials. This reduces the amount of liquid that needs to be injected.

Many of us are doing subcutaneous injections, which require a smaller needed which is used to inject into the fat. I’m squeamish about large needles, though, other people don’t seem to mind the larger needles used for intramuscular injections. Subcutaneous injection of testosterone is somewhat new, and some doctors aren’t familiar with it, though there have been multiple studies which report its effectiveness.

Ask for the “ultra-sensitive” estradiol lab. The standard estradiol lab is for women which have much higher levels of estrogen. Men need the ultra-sensitive lab. Not everyone has the same chemistry, so optimum estradiol levels can vary from person to person. However, a target range of 20-30 pg/ml for men is a good starting point.

Your PA may simply not know to monitor estradiol levels. This wouldn’t be surprising.

Injecting smaller doses of testosterone (rather than large infrequent injections) will reduce the wide swings of testosterone, and will also reduce the conversion to estrogen that takes places when testosterone is high. A small dose of Arimidex is often used to reduce estrogen levels. Zinc is supposed to be able to keep estrogen levels lower, but I've heard that this only works if your zinc levels are low. I understand that doses of 50 mg/day or less are safe.

Make sure that your are also checking your red-blood cell counts and hematocrit. The high testosterone spikes from large infrequent doses of testosterone can cause these levels to rise. High levels can increase the chance of stroke.

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Re: Advice on what I should do??? On shots currently

Postby Hoosier52 » Thu Jul 28, 2016 2:20 pm

The half-life of T is short. That's why you need to inject at least twice a week. As stated above, it also reduces the rise of estrogen and hematocrit. You'll avoid the feel good/feel terrible troughs.

Check our the Peak Testosterone and ExcelMale websites. Lots of great info for free.

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Re: Advice on what I should do??? On shots currently

Postby Runningwithdog » Thu Jul 28, 2016 3:22 pm

squarepants - thanks. Type of info I need. I'll check Nook for that book as well - I can afford the cost of a book!

Again this may be an obvious question. Since I do my own injections, and needles are very cheap, I could just inject .5ml of my 1ml bottle every week instead of the whole ml twice a month, right?

I will be sure to ask for all those test when I have my work done next month. We'll see if my PA understands what I learn from the book and here.

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Re: Advice on what I should do??? On shots currently

Postby SquarePants » Thu Jul 28, 2016 3:47 pm

Runningwithdog wrote:I could just inject .5ml of my 1ml bottle every week instead of the whole ml twice a month, right?

Right. That would be MUCH better.

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be64
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Re: Advice on what I should do??? On shots currently

Postby be64 » Tue Aug 02, 2016 2:25 pm

I have been doing daily subcutaneous testosterone and hCG injections for several years now and sex has been absolutely fantastic, the best ever. About three weeks ago my libido dropped and my sexual performance dropped and erections became more difficult. I asked my doctor to check my testosterone and estradiol. My total testosterone came back high at 1250 and my free testosterone was high as well. My estradiol was 33 which is high for me considering it's usually around 17 to 20. I took an extra amount of Arimidex for a few days and within a couple days my libido and performance were back to usual. My point here is that even with high testosterone libido can be low if estradiol is also high.

I lowered my testosterone dose from .08ml/16 mg per day to .06 ML/12 mg per day. I also inject 70IU HCG daily.

All of my blood work is done at the doctors office in-house lab. The reference range for estradiol a 0 to 56 which I believe means it's a relatively sensitive test since the insensitive tests do not detect low numbers such as below 20.

While daily injection is not necessary, frequent injection has the benefit of a much more level testosterone level. However something to remember is that at the same dose more frequent injections will give you a higher level at testing time so if your doctor doesn't know what you're doing he may think you're testosterone is too high.

I would recommend having your estradiol tested and also doing more frequent injections at least once a week if not more.
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Re: Advice on what I should do??? On shots currently

Postby Runningwithdog » Thu Aug 04, 2016 5:00 am

be64 - thank you for the info. I'm really noting from everyone's input here that a big void in my treatment so far has been the testing for estradiol. I'll see what my PA says about that when I call to set up my blood work in a few weeks. I'm interested to see how that estradiol reading comes back though we'll have to see what it means personally. My libido (other than right before the next injection) has overall been fine and I have had no erection issues during lovemaking regardless of where I was in the cycle. However, I have been retaining more body fat which I am having trouble losing. I do run regularly and lift heavy weights a couple of times a week so I shouldn't be feeling this soft overall, which is somewhat the fat but not totally if that makes sense.

I am now doing injections essentially once per week - obviously I just started doing that last week. Also started making sure I'm getting Zinc.

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Re: Advice on what I should do??? On shots currently

Postby ledgemoor » Sat Aug 06, 2016 7:24 am

You're on a low dose of testosterone -- my guess is that estrogen won't be a problem. You can order most any test online nowdays, so if you are on a budget....

Has your body fat increased since you've been taking testosterone? Now that you are shooting weekly, has it increased? For me it took years for the fat to come off. I was 20 years getting that way, so it isn't going to go away overnight.

Be sure to take 2 mg copper with that Zinc. Zinc slows absorption of copper, so you need extra, assuming you are getting enough to begin with. Also, DIM is good for estrogen control.

Also, most people are deficient in Vitamin D. It' isn't as toxic as they thought. I take 4000IU/day, and my brown wife takes 8000. She can feel it when she takes less.
Everything you ever wanted in life is just outside your comfort zone (Jamie Lee Curtis)

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Re: Advice on what I should do??? On shots currently

Postby Runningwithdog » Fri Aug 12, 2016 9:34 am

ledgemoor - yes, it has, but there have been too many other variables for me to find any causal relationship between the testosterone and the body fat level. Up until about 2 years ago I was running races competitively, so training at a good solid miles per week level and intensity. We had a tragic situation at our church while I was elder chairman that basically took a year to handle and took me out of running. Add that to the reality that I eat when I'm stressed, and I think the fat (roughly 20-25 pounds) is more related to a surplus of calories. HOWEVER...I am not trying to lose the weight, running more and paying attention to food, and it is not coming off the way it used to. But I am also 54 now.

I'll check the copper in my daily vitamin. Thanks for that.

Also on the test - no idea you could order those on-line! I'll look into it.


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