Kanecore said:
Hi everyone! I've been taking 60 mg of T cyp every three days along with 100 iu of HCG a day. My estradiol is normal but my total Es are high. I am supposed to take Arimidex at .25 mg every other day to drop m total Es but this makes me feel horrible. So I've been taking it as needed or when I feel anxiety and/or prostate pain. This isn't working either. My sex drive sucks! When I do have sex, I don't even need to take Arimidex for the next few days because it seems to lower my hormone levels significantly and I experience no estrogen related side effects. After sex, I have no recovery and can't get another errection for hours. Also, if I stop taking the HCG for a few days, I feel like crap. And if I stop the HCG and take Arimidex on those days, I feel like death. I also get bad prostate pain, but I don't have an elevated PSA. I've already had two biopsies for red spots, but they turned out to be non cancerous. My thyroid and adrenals (24 hour urine) was optimal. My TT and FT are in the upper normal range and my DHEA, LH, prolactin and SHBG are in optimal range. I'm so frustrated because I've been going through this for over ten years! The labs say I should be like a bull but I always feel like crap! Can anyone offer some advice?
1. Prostate pain - is it truly prostate pain or is it rectal pain?
2. Estradiol level is a better measure of estrogen activity than total estrogen level. This is because each estrogen has a different potency. Estradiol level is a sum of the estrogen activities of the estrogens skewed toward estradiol, the most potent estrogen.
3. The other estrogens are fairly weak - so weak that they may even reduce estrogen activity by blocking estradiol from estrogen receptors. Estriol does this, for example. This is why Estriol can be viewed as an anti-estrogen, protecting a woman from breast cancer, when in the presence of estradiol.
4. When estradiol level, then, is normal. There is no reason to use Arimidex. Using Arimidex may lower estradiol level excessively, causing symptoms including loss of sex drive, depression, anxiety, etc.
5. Estradiol is necessary for sex drive. Estradiol provides sexual aggression and thus drive. Estradiol also determines the number of testosterone receptors made, making testosterone more potent.
6. Excess estradiol can reduce sex drive. Estradiol, for example, acts as a monoamine oxidase inhibitor, which can primarily drive sertonin levels up. HIgh serotonin levels can inhibit sex drive directly or by reducing dopamine production - where dopamine is the most direct determinant of libido, sexual desire/drive.
7. The sympathetic nervous system triggers orgasm. This may occur via an increase in norepinephrine - the sympathetic nervous systems main chemical messenger - made primarily in the group of neurons called the locus ceruleus in the brain stem.
8. Dopamine production is reduced during and after an orgasm. This results in the Refractory Period - during which achieving another erection and sex drive are inhibited. The dopamine reduction causes an increase in Prolactin. Lower dopamine and higher prolactin can reduce testosterone production - reducing sex drive further.
9. If the refractory period is long - such as when men age - this means dopamine levels do not return to their basal levels quickly because production is slow. This may also mean there were low dopamine levels to begin with, and orgasm lowered the levels even more.
10. As humans age, dopamine neurons die off. There are only about 50,000 of them in the brain. They control huge chunks of function and behavior.
11. Other neurotransmitter/hormone/and immune-system cytokine problems can cause a lowering of dopamine production, makes the refractory period longer.
12. Note that dopamine levels need to vary with time so that the brain can sense dopamine.
13.. Increasing dopamine to high levels artificially may result in insensitivity to dopamine. This may occur when testosterone levels are too high - since testosterone increases dopamine production. Low dopamine levels, such as from prolonged testosterone deficiency, may result in suprasensitivity to dopamine. This may cause the initial and transient euphoric effects of testosterone when TRT is started.
14. Thyroid and adrenal testing via 24-hour urine testing may not be sensitive enough to find problems. For thyroid tests, it is far better to obtain blood TSH, Free T3, and Free T4. For adrenal testing, obtaining a blood Cortisol - AM, DHEA-s, Progesterone, Albumin, fasting glucose as well as obtaining multiple Saliva Cortisol and DHEA levels would give a better idea as to the presence of adrenal fatigue as a factor in sexual function.
15. Neurotransmitters, hormones, and immune-system cytokines are highly linked in function.
16. When total testosterone is in the upper normal range, other neurotransmitter, hormone, or cytokine problmes are present to cause the problem.
17. High normal free Testosterone may actually be a clue that there are other hormone problems occurring.
18. Even with normal thyroid hormone levels, some people are still hypothyroid. They have thyroid hormone resistance caused by mitochondrial problems. There is not test for this mitochondrial problem. Thus it is highly important to look at the history of a person and perform a physical exam to determine if hypothyroidism is present, even with normal thyroid tests. For such a person, treatment with thyroid hormone replacement is necessary. The goal of treatment is to reduce the signs and symptoms of hypothyroidism, not to treat the lab test since it would look like the person is becoming hyperthyroid on the lab test, but they are still hypothyroid clinically - based on the exam and history. With many hormone problems it is not simply enough to look at the lab test.
19. For 24-hour urine tests, it is highly important to evaluate the hormone metabolites to determine what is actually occurring. Even with a normal urine cortisol, if the metabolites are deficient, then the person may actually be deficient in cortisol since the cortisol in the urine represents cortisol which has not been used or has been active.
20. It is also important to look at the person to determine if there is a particular hormonal problem. For example, a person who appears obese may appear to have a high growth hormone level (via high IGF-1 of 300). However, such a person may actually be deficient when obesity is taken into consideration. Similarly with hypothyroidism as discussed above.
21. Neurotransmitter levels can be obtained using a urine test. It can be ordered by a health care provider from NeuroScience, Inc. or Sanesco, Inc. The neurotransmitter levels then can be correlated with the signs and symptoms and other hormone and cytokine levels to determine what is happening. There is a good correlation between urine neurotransmitter levels and brain neurotransmitter levels. But this is not always so. For example, 90 percent of serotonin is produced by the gut's nervous system. It is up to the skill of the physician to determine what a particular neurotransmitter level means both alone and in concert with other chemical messengers.
22. "Optimal range" depends on the person evaluating the lab test. It would be nice if you would provide us with the actual levels from your lab tests so we can see for ourselves whether they are optimal or not. As Cuban Gooding said, "Show me the money!"