Hypothalamic Hypogonadism

[Karen8]

I'm a 40 year old female competitive bodybuilder. The years of my glory are long gone but in 2016 January - June, I ran a cycle of test propionate starting at 20 mg/week never more then 80 mg. For about 6 weeks during that time period I added Primobolan injections 40 md twice a week and that worked wonders to lean me out. Yes...yes...I know...it was too long...but I've never felt so good when I was on the test. I suspect my levels of test and estrogen were low even before I started but today, a year later my total test is 5, estradiol <6, FSH and LH undetectable.

In addition to that my hematocrit is 48 and I can't donate blood because I lived in England for 10 years during the 1980s. My PCP won't write an order for phlebotomy so do I just do it myself? I've got the supplies...and medical background...

There's so much written about PCT for men but nothing about women! Long time ago, I only used Anavar + Winstrol 20 mg/day for 8 weeks and never had any problems except elevated liver enzymes while on.

I'm totally exhausted, lost all the muscle I've built, and don't know what to do. My PCP of course thinks I'm in menopause but this is not the case.

Any good suggestions are welcomed. Thanks guys & gals

 

[master.on]

I'm a 40 year old female competitive bodybuilder. The years of my glory are long gone but in 2016 January - June, I ran a cycle of test propionate starting at 20 mg/week never more then 80 mg. For about 6 weeks during that time period I added Primobolan injections 40 md twice a week and that worked wonders to lean me out. Yes...yes...I know...it was too long...but I've never felt so good when I was on the test. I suspect my levels of test and estrogen were low even before I started but today, a year later my total test is 5, estradiol <6, FSH and LH undetectable.

In addition to that my hematocrit is 48 and I can't donate blood because I lived in England for 10 years during the 1980s. My PCP won't write an order for phlebotomy so do I just do it myself? I've got the supplies...and medical background...

There's so much written about PCT for men but nothing about women! Long time ago, I only used Anavar + Winstrol 20 mg/day for 8 weeks and never had any problems except elevated liver enzymes while on.

I'm totally exhausted, lost all the muscle I've built, and don't know what to do. My PCP of course thinks I'm in menopause but this is not the case.

Any good suggestions are welcomed. Thanks guys & gals

1 Can you please post reference ranges?

2 Low dose HCG works nice for women too

3 Exhaustion often comes from reduced T4 to T3 conversion inside cells, as androgens increase said conversion and your body got used to it. IMO a little T3 (less than 25 mcg/day assuming properly dosed) does wonders for pct fatigue.
Be aware that blood tests may not help spot low T3 INSIDE CELLS.

4 I'd tip an off-duty nurse to help with blood draw.

Hope this helps

 

[Karen8]

@master.on yes, thank you. Please see attached. Maybe it'll help someone with a similar problem although most women don't have the experience or adventurous desire to go this way. Testosterone total is 6 reference range 8-48 ng/dl

I have an appointment with my gynecologist tomorrow to discuss so we'll see...

 

[Snapcracklesquat]

Karen, I'd also start looking at your endocrines, when's the last time you had a thyroid panel done? 40 and up seems to be when they tend to go tits up, mine did, so I feel you. If you get it make sure to include not just T4 but TSH and free T3 too to get the whole picture.

 

[Dr JIM]

I'm a 40 year old female competitive bodybuilder. The years of my glory are long gone but in 2016 January - June, I ran a cycle of test propionate starting at 20 mg/week never more then 80 mg. For about 6 weeks during that time period I added Primobolan injections 40 md twice a week and that worked wonders to lean me out. Yes...yes...I know...it was too long...but I've never felt so good when I was on the test. I suspect my levels of test and estrogen were low even before I started but today, a year later my total test is 5, estradiol <6, FSH and LH undetectable.

In addition to that my hematocrit is 48 and I can't donate blood because I lived in England for 10 years during the 1980s. My PCP won't write an order for phlebotomy so do I just do it myself? I've got the supplies...and medical background...

There's so much written about PCT for men but nothing about women! Long time ago, I only used Anavar + Winstrol 20 mg/day for 8 weeks and never had any problems except elevated liver enzymes while on.

I'm totally exhausted, lost all the muscle I've built, and don't know what to do. My PCP of course thinks I'm in menopause but this is not the case.

Any good suggestions are welcomed. Thanks guys & gals

If your weak and tired directed blood donation with a crit of 48%
is unlikely to be of much help, in fact I suspect, such a course would be more likely to worsen your symptoms

If I'm reading your post correctly
the last time you ran any AAS was roughly ONE YEAR ago and you have yet to recover your menstrual cycles???

If that is the case, it would behoove you to follow up with an OB/GYN and tell him/her the truth about your use of AAS, since chronically suppressed E-2 levels at your age is anything but healthy.

 

[master.on]

@master.on yes, thank you. Please see attached. Maybe it'll help someone with a similar problem although most women don't have the experience or adventurous desire to go this way. Testosterone total is 6 reference range 8-48 ng/dl

I have an appointment with my gynecologist tomorrow to discuss so we'll see...

Some key points

1 in women, like in men, Estrogen is the main thing to suppress LH/FSH, yours is low

2 women don't usually get as/permanently suppressed like men do.
Loot at contraceptives: many women use it for years, even decades nonstop, are quite suppressive, yet most recover from them.

3 Blocking Estrogen with Clomid/Nolva can help, your Estro is already low. Serms will block the little Estro you have left, making you feel horrible.
I'd ask doctor to start low dose HCG instead (beware doctors who put you on fertility treatment like, 5000 IU+ week schedules

4 Did you get tested for Progesterone too?


best of luck

 

[Karen8]

OK Guys - I visited my Gynecologist and he put me on bio-identical estrogen creme, estrogen vaginal tablets (to reduce dryness etc) and testosterone creme. I'm supposed to do this for 4 weeks and then see him for an exam. Hope my large clit won't shock him

@Dr JIM Yes - I haven't had a period in years...and I told my Ob/Gyn about the testosterone...he was more concerned about my stress in everyday life...and my test levels were low even before I ran the cycle.

My GP ordered extensive lab work, on my demand, but I think I'll wait till I get the hypothalamic disorder under control. Thanks everyone!

 

[Dr JIM]

OK Guys - I visited my Gynecologist and he put me on bio-identical estrogen creme, estrogen vaginal tablets (to reduce dryness etc) and testosterone creme. I'm supposed to do this for 4 weeks and then see him for an exam. Hope my large clit won't shock him

@Dr JIM Yes - I haven't had a period in years...and I told my Ob/Gyn about the testosterone...he was more concerned about my stress in everyday life...and my test levels were low even before I ran the cycle.

My GP ordered extensive lab work, on my demand, but I think I'll wait till I get the hypothalamic disorder under control. Thanks everyone!

"Psychosocial stressors" ah and that's why seeing a doc in real time can make all the difference, bc forum members
are only rarely provided with such important details.


If your GP ordered additional labs I'd follow thru ASAP, as the results are more likely than not to compliment what your GYN has requested.

Heck at the very least, the testing may establish your current hepatic, renal, hematologic etc baseline.

While you may already be aware of this, but it's worth mentioning nonetheless, hypogonadal amenorrhea is a very common problem in female athletes once TBF approximates 5%.

Jim

 

[Karen8]

@Dr JIM I'm supposed to be taking 8 mg Estradiol for 3 days, then 4 mg every day. 5 mg testosterone daily and 50 mcg Estradiol vaginal capsule twice a week for 4 weeks.

I know you're not a gynecologist and I respect your time that you devote to this forum but the Vagifem FDA approved is only 10 mcg! I don't have any recurrent UTIs or hot flashes. Really don't feel comfortable loading 50 mcg twice a week! I don't want to become fertile or get pregnant ffs! Just need enough to restore my balance...

I took all this, except the vaginal thing, today and feel loopy. Very sleepy and sedated. Certainly wouldn't take this in the morning....

I'm honestly totally confused now to even think about going to the lab....it'll have to wait. The Gyno didn't order any lab work anyway.

 

[master.on]

OK Guys - I visited my Gynecologist and he put me on bio-identical estrogen creme, estrogen vaginal tablets (to reduce dryness etc) and testosterone creme. I'm supposed to do this for 4 weeks and then see him for an exam. Hope my large clit won't shock him

@Dr JIM Yes - I haven't had a period in years...and I told my Ob/Gyn about the testosterone...he was more concerned about my stress in everyday life...and my test levels were low even before I ran the cycle.

My GP ordered extensive lab work, on my demand, but I think I'll wait till I get the hypothalamic disorder under control. Thanks everyone!

@Dr JIM I'm supposed to be taking 8 mg Estradiol for 3 days, then 4 mg every day. 5 mg testosterone daily and 50 mcg Estradiol vaginal capsule twice a week for 4 weeks.

I know you're not a gynecologist and I respect your time that you devote to this forum but the Vagifem FDA approved is only 10 mcg! I don't have any recurrent UTIs or hot flashes. Really don't feel comfortable loading 50 mcg twice a week! I don't want to become fertile or get pregnant ffs! Just need enough to restore my balance...

I took all this, except the vaginal thing, today and feel loopy. Very sleepy and sedated. Certainly wouldn't take this in the morning....

I'm honestly totally confused now to even think about going to the lab....it'll have to wait. The Gyno didn't order any lab work anyway.

you need another doctor ASAP
you're dealing with a pharma yes-man, a prescription-filling robot

1 He ignored your low LH/FSH, likely the main cause your Estradiol is so low

2 He put you on Estrogen without checking Progesterone too?
Unopposed Estrogen can sharply lower metabolism = fatigue. Not for nothing T3 package inserts warn about Estro preventing proper T3 function

3 He didn't mention any GnRH test where GnRH (or at least a -relin analogue) is injected to see if your pituitary can still make enough LH*FSH

4 He didn't mention any test where HCG, LH and/or FSH is injected to see if your ovaries can still make enough Estrogen, Progesterone (and some) Testosterone.

Again, time for a new doctor
IMO fertility doctors/clinics are a better choice since they know how to make use of HCG/LH/FSH.
Just tell them that you don't want to conceive, just recover your natural hormone levels, so they take it easy and don't flood you with massive HCG dosages.
Or you can start your domestic, big-pharma, hcg-only source from all the unused prescriptions lol JK

Get well and keep us posted

 

[Dr JIM]

It's best to discuss your concerns
signs and symptoms with your GYN directly and if that's not possible for whatever reason with this particular gynecologist
locate another.

That being said, in light of how you arrived in your current "hypogonadal" hormonal predicament, modifying or adjusting your physicians therapy after only ONE visit, is just not a good idea IME.

So talk with your Doc and try to work thing out rather than retraveling a road of "self therapy". and try not to overlook the fact hormonal therapy will have little impact on those signs and symptoms related to psychosocial stressors.

In short you didn't develop HGH overnight and it won't be reminded
overnight either, so give it some time Gal.
Jim

 

[Docd187123]

Please ignore our resident idiot masterbot

 

[Dr JIM]

Having completed a history and physical exam your DOC exceeded the "FDA approved dose" of a poorly absorbed vaginal cream.

I know higher doses are used in some parts of Europe and he apparently believed a higher dose is warranted in YOUR situation.

And kudos for him/her bc that's why the PRACTICE of medicine is soooo important, individualized patient care based on existing evidence, FDA guidelines and the experience of a competent physician.

My suggestion as long as you can TALK OPENLY with your Doc, sit back and enjoy being the patient for a while.

Good Luck

 

[Dr JIM]

@Dr JIM

I know you're not a gynecologist

.

Correct, but I still see my fair share of gals with a variety of
complaints.

And although only a few are the result of androgen supplementation, a considerable portion are the result of hormonal irregularities almost all females experience at some point in their life.

All that being said I now refer the most fascinating of ALL "hormonal irregularities" - pregnant gals beyond the age of viability. (The latter being a gestation 16-18 weeks)

Nonetheless the latter simplifies things somewhat bc I now only have to field questions from MALES with "prolactin" related issues.

 

[Karen8]

@Dr JIM The Gyno Doc didn't do an exam. He took my history, and I mentioned symptoms I had in 2016 (shortly after I stopped AAS) but which I don't have anymore! I don't have hot flashes, frequent UTIs, and what not. 8 mg estradiol is a very high dose and I feel like shi* I'm going to stay on it but lower the dose to 2-4 mg.

I will try the vaginal capsule but if I get a Yeast infection or it makes me feel worse then I'm getting off. The Doc came highly recommended but I don't understand how he can treat me without even examining me! That'd be like you treating someone's symptoms over the Internet. And I'm not talking about treating a common cold. Over & Out

 

[Dr JIM]

@Dr JIM


1) Doc didn't examine me ....


2) The Doc came highly recommended

3) I don't understand how he can treat me without even examining me!

4) That'd be like you treating someone's symptoms over the Internet.

1) Many folk underestimate the amount of information that can by a HISTORY alone, in fact in most cases a reasonable DX can be made by a history alone ---- BUT!

2) Consider the source FIRST and foremost

3) And your concern is LEGITIMATE yet since we both know the MOST LIKELY cause of your hormonal imbalance, is AIH, empiric therapy based on that history alone is sufficient IMO.

(IYou told your Doc the truth about the use of PEDS right? )

- many GYNs defer the initial exam knowing the cause of menstrual irregularities are the result of hormonal rather than structural (such as cystic ovarian disease, endometriosis, infections etc) abnormalities.

- the deferred exam is even more common in those who have had a baseline exam from a prior visit

- oh and some defer the exam to our friendly neighborhood radiologist ordering an Ultrasound, Labs etc on any NEW patient.

4) surely you jest bc that's what
many are doing on Meso, after
some noob posts a one liner on a single thread ----- but you're absolutely correct, much of the info isn't worth the page it's printed on.

So hopefully new members understand the limitations of the "advice" being rendered on any PED forum.

5) To that end, although I consider a baseline pelvic exam MY standard of practice for almost all NEW patients with an OB/GYN complaint, whether it's the standard of care depends upon the Who, What, Where and When of a patients visit.


Ultimately IMO the most important factor is having a DOC that is not only competent (and one who is highly recommended is usually competent) but who WILLINGLY SITS IN A CHAIR and talks to you!

So again be patient AND talk to your Doc like you those whom are your confidants with respect to MEDICAL issues.

Jim

 

[Karen8]

Update after a month of HRT my results are attached. The total Test is somewhat low but my free test is 2.0 which is right in the middle. My estradiol is finally somewhat normal! I'm going to stop the testosterone HRT it's a cream 2.5 mg/day because my HCT, RBC, hemoglobin, iron and ferritin are high. I feel much better overall but have less ambition and desire to lift weights. Still don't feel like wearing dresses though...just sort of a happy blah feeling. I'm guessing it's the serotonin effect.

I take 2 mg of estradiol creme now, was on 6 then 4 mg.

Anyway...hope everyone is doing well.

 

[Dr JIM]

Ya know it's difficult to quantify or qualify an individual baseline when PEDs are cycled for a long time.

In part bc "hormonal recovery" is often a tedious, prolonged and in some ways fleeting process esp for those in their prime of life gal

 

[Dr JIM]

Still don't feel like wearing dresses though...just sort of a happy blah feeling.



Anyway...hope everyone is doing well.

Oh and at this point it seems unlikely your "la belle indifference" about life in general is hormonally mediated.

But what does that have to do with "wearing a dress", seriously?

 

[Karen8]

I've been feeling weak and I mean my legs are barely holding me, no strength at all! And today I noticed all my thigh muscle mass is gone! I've also lost all of my upper body, doesn't bother me that much, but my biceps is gone! I wish the doctor mentioned that taking such high dose of estrogen would cause muscle atrophy! I mentioned several times that I'm very athletic and active, even when not hitting weights, but this is really unexpected.