I would really like everyone's input on my dilemma. Dr. John, I especially want to know what you think. I have been trying to do TRT for six months, and the results have been disappointing, to say the least.
I am 52 yo. Other health problems: allergies; asthma; 2 episodes of lower extremity DVT. Meds: inhaled steroid, bronchodilator and warfarin.
Here are my inital labs:
WBC 3.30 4.0- 10.5
RBC 4.17 4.1- 5.6
Hgb 13.8 12.5- 17.0
Hct 39.6 36.0- 50.0
A1c 5.5 4.5 - 5.7
E2 27.5 <54
Total T 282 241- 827
Free T 9.4 7.2- 24
DHT 27 30- 85
IGF1 140 87- 238
Cortisol 14.0 4.3- 22.4
Prolactin 5.3 2.1 17.7
SHBG 21.1 13- 71
LH 3.0 1.5- 9.3
FSH 4.3 1.4- 18.1
TSH 2.415 .35- 5.5
FreeT4 1.1 .61 1.76
Free T3 3.1 2.3- 4.2
Based on my Total and free T values, I talked to an age management doc about TRT. I was also sleeping alot, but never feeling rested, had difficulties with focus, mood, mental clarity, losing muscle mass and strength, controlling body fat, flagging libido, erectile difficulties, night sweats. Based on the lab values and what I told him I was experiencing, he agreed that I was a candidate for TRT.
We first tried a compounded T cream, 10% - 1gm. of cream qd. At first I loved the stuff. Started feeling better within 2 or 3 days. I noticed it did turn the skin of my torso red, but I felt so good that I figured it was worth putting up with. After awhile, I began to notice that it made me feel pretty agitated in the morning, and then after a couple of hours I would get so sleepy that I would need to take a nap, so I tried splitting the dose in two, which worked a little better. Then, it started aggravting my respiratory symptoms - my chest would get tight and I would start wheezing. The flushing became a lot worse - I was red all over, and I felt hot, like I had a fever. I suppose that might have been a hot flash, but I felt that way most of the time - even though my tempature was normal. Then it started causing elevations in my BP and heart rate. So, after all of this, we decide to dc the cream. I now suspect that the problem was simply that the T dose was too high, and/or that the unpleasant symptoms might have been from too much DHT or E2.
My doc was leary of having me do IM cyp only because I take warfarin and he was concerned about the possibilty of big hematomas. So we decide to try HCG SQ. He started me on a dose of 5000 IU of HCG qw (I know, I know - 5000 is an elephant dose - but I was ignorant at the time). After the first dose, I felt terrific. After the second dose, not so terrific. I began having the same kind of symptoms as I had with the cream, only worse. I then took a third dose of 2500 IU and the symptoms were even worse. I was bright red from head to toe, and the respiratory symptoms were bad enough so that I was afraid I would have to go to the ER. On SWALE's strong recommendation, I dc'd the HCG (although it definitely didn't take much prompting).
We next decide to go to cyp injections. Because of my previous problems, the doc wants me to try the cyp SQ first, at a 10 mg. dose, and then we work up gradually and then switch to IM at 50mg. and continue to work up to a dose of 100mg. qw. The SQ injections went OK, although they gave me a runny nose and I did get minor wheezing. They also elevated my HR and BP slightly. I did the first IM injection of 50 mg. last week. The day after the injection, I again felt terrific, although later in the day started to feel agitated. The next day, I felt ROTTEN. Jittery, agitated, heart racing, BP elevated. But, at the same time, also felt completely wiped out - I felt like I might fall asleep right on my keyboard at any second. Felt this way for three days, and began to feel better. Today, I feel nearly normal.
We have never repeated any of the blood tests because my doc though it wouldn't be worthwhile, since I wasn't on any one regimen for more than a short time.
Now, I have decided to completely stop with the TRT for the time being. I'm preparing for a professional certification exam at the end of July and I don't need the distraction of careening hormone levels.
I am afraid that I might simply not be a candidate for TRT. But, I also suspect that I could tolerate it if it were managed by somebody more skilled than my current doc. I like him, and he is really knowledgeable, but I think he lacks clinical experience. I think it is possible that I could tolerate it at lower doses, with lots of testing to fine tune, and appropriate anti-E and/or anti-DHT agents. I don't want to give up on the TRT unless I really have to, because the short windows of feeling good have been terrific.
I don't have any theory at all why the 50 mg. IM injection made me feel so lousy. But I think the experiences with the transdermal cream and the HCG could have been caused by too high a dose of hormone.
I know this has been a long post, but I am really searching here. I appreciate all feedback and advice.
Chris
I am 52 yo. Other health problems: allergies; asthma; 2 episodes of lower extremity DVT. Meds: inhaled steroid, bronchodilator and warfarin.
Here are my inital labs:
WBC 3.30 4.0- 10.5
RBC 4.17 4.1- 5.6
Hgb 13.8 12.5- 17.0
Hct 39.6 36.0- 50.0
A1c 5.5 4.5 - 5.7
E2 27.5 <54
Total T 282 241- 827
Free T 9.4 7.2- 24
DHT 27 30- 85
IGF1 140 87- 238
Cortisol 14.0 4.3- 22.4
Prolactin 5.3 2.1 17.7
SHBG 21.1 13- 71
LH 3.0 1.5- 9.3
FSH 4.3 1.4- 18.1
TSH 2.415 .35- 5.5
FreeT4 1.1 .61 1.76
Free T3 3.1 2.3- 4.2
Based on my Total and free T values, I talked to an age management doc about TRT. I was also sleeping alot, but never feeling rested, had difficulties with focus, mood, mental clarity, losing muscle mass and strength, controlling body fat, flagging libido, erectile difficulties, night sweats. Based on the lab values and what I told him I was experiencing, he agreed that I was a candidate for TRT.
We first tried a compounded T cream, 10% - 1gm. of cream qd. At first I loved the stuff. Started feeling better within 2 or 3 days. I noticed it did turn the skin of my torso red, but I felt so good that I figured it was worth putting up with. After awhile, I began to notice that it made me feel pretty agitated in the morning, and then after a couple of hours I would get so sleepy that I would need to take a nap, so I tried splitting the dose in two, which worked a little better. Then, it started aggravting my respiratory symptoms - my chest would get tight and I would start wheezing. The flushing became a lot worse - I was red all over, and I felt hot, like I had a fever. I suppose that might have been a hot flash, but I felt that way most of the time - even though my tempature was normal. Then it started causing elevations in my BP and heart rate. So, after all of this, we decide to dc the cream. I now suspect that the problem was simply that the T dose was too high, and/or that the unpleasant symptoms might have been from too much DHT or E2.
My doc was leary of having me do IM cyp only because I take warfarin and he was concerned about the possibilty of big hematomas. So we decide to try HCG SQ. He started me on a dose of 5000 IU of HCG qw (I know, I know - 5000 is an elephant dose - but I was ignorant at the time). After the first dose, I felt terrific. After the second dose, not so terrific. I began having the same kind of symptoms as I had with the cream, only worse. I then took a third dose of 2500 IU and the symptoms were even worse. I was bright red from head to toe, and the respiratory symptoms were bad enough so that I was afraid I would have to go to the ER. On SWALE's strong recommendation, I dc'd the HCG (although it definitely didn't take much prompting).
We next decide to go to cyp injections. Because of my previous problems, the doc wants me to try the cyp SQ first, at a 10 mg. dose, and then we work up gradually and then switch to IM at 50mg. and continue to work up to a dose of 100mg. qw. The SQ injections went OK, although they gave me a runny nose and I did get minor wheezing. They also elevated my HR and BP slightly. I did the first IM injection of 50 mg. last week. The day after the injection, I again felt terrific, although later in the day started to feel agitated. The next day, I felt ROTTEN. Jittery, agitated, heart racing, BP elevated. But, at the same time, also felt completely wiped out - I felt like I might fall asleep right on my keyboard at any second. Felt this way for three days, and began to feel better. Today, I feel nearly normal.
We have never repeated any of the blood tests because my doc though it wouldn't be worthwhile, since I wasn't on any one regimen for more than a short time.
Now, I have decided to completely stop with the TRT for the time being. I'm preparing for a professional certification exam at the end of July and I don't need the distraction of careening hormone levels.
I am afraid that I might simply not be a candidate for TRT. But, I also suspect that I could tolerate it if it were managed by somebody more skilled than my current doc. I like him, and he is really knowledgeable, but I think he lacks clinical experience. I think it is possible that I could tolerate it at lower doses, with lots of testing to fine tune, and appropriate anti-E and/or anti-DHT agents. I don't want to give up on the TRT unless I really have to, because the short windows of feeling good have been terrific.
I don't have any theory at all why the 50 mg. IM injection made me feel so lousy. But I think the experiences with the transdermal cream and the HCG could have been caused by too high a dose of hormone.
I know this has been a long post, but I am really searching here. I appreciate all feedback and advice.
Chris
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