Please help critique these protocols - very confusing

[tomguy]

Need help with protocols (confused)- choosing new M.D.

I've been trying my very best to locate a hrt physician in the D.C. area that I can trust to help me (my former physician left the business). I'm 59. I've found 2 M.D's (Dr's Fishman and Brodsky) and 1 DO (Dr. Rothstien). I met with both M.D's but not with the DO yet. To address my hormone imbalance (high Test, estrogen, dht - low libido,ED problem -never experienced this before) Latest bloodwork: Estradiol free .62pg/ml (range .30-.90), Est % free 2.06% (range 1.66 - 2.11); Estradiol 30pg/ml (range 10-50); Total Test 1408 ng/dl (age range 119-1104);Free Test % 2.71% - Free Test % range .60 - 2.60); Free Test 381.pg/ml.- can this be correct? (Free test for age group 11.0 - 141.00; SHBG 25nmol/L, prolactin 5.1ng/ml. MY DHT results will be in this Friday. Last Test shot was 3/18 - 100mg cypionate. Since then feeling tired, low energy. I guess my estradiol is ok if I'm with the ranges - unless I'm reading this incorrectly. It's my Test that's high and free test seems unusually out of wack. Can this and not the E levels cause my problem?

Dr. Fishman wants me on 3000 I.U's of hcg a week for 2 weeks before I resume test (cypionate) injections of 100mg week. Also I'm taking .5mg week of arimidex. From what I've read about hcg on this site - isn't this way too much? This also seems to be a cycle apporach but he said my Test was too high and needs to come down and wouldn't prescribe any more test right now. Dr. Fishman also believes in the mind body connection and wants me to meet with his meditation therapist to explore healing your body naturally.

Dr. Brodsky seemed interested in correcting my problem ASAP and does not want me to discontinue testosterone but instead wants me to use androgel vs the IM injection. He said the androgel would provide me with a more consistent application of testosterone throughout the week so my T levels and other hormones won't spike and get out of balance. He wants more frequent monitoring of my hormone levels under this approach. He does not prescribe hcg to his patients and he didn't think my test levels, although high, were much of a problem if everything else was in sync. He noted from my prior blood work and records that I've had high test levels, dht, E2 etc in the past and had no problems with libido, etc. and didn't quite understand why I was having a problem now. He wants me to start right now on the androgel (daily) and then wants to check my levels after two weeks. He said I should continue with taking the .5mg weekly of arimidex but prescribed Wellbutrin to help with my moods. He said that Wellbutrin would also eventually help to increase my libido. So as you can see, this is very confusing to me and I'm really struggeling with a direction to take. My last resort is to interview the DO to find out his method. I gave both MD's Swale's post on a recipe for success.

My primary physician (and others on this site) just think I should continue taking my weekly testosterone shot but at a dose lower dose of 100mg along with the .5mg per week of arimidex and then just take it from there.

I'm trying to understand why the divergence of treatment methods, which just complicates things and now I'm hesitant in selecting a physician. Both M.D's thought the rebalancing of hormones would be the key to getting me to feeling my old self again. However, the more consistent application of testosterone through application of androgel makes some sense but introducing Wellburtrin into my system is scary. Also, taking large quantities of hcg seem scary as well.

I look to this board for support and would appreciate any thoughts or help.

P.S. I've experienced the death of my partner of 23 years about 5 months ago so I think most physicians hone in on this aspect of my life to explore its affect on my libido vs whether or not it's purely hormone imbalance.

 

[Ender]

Sorry about the loss of your partner, I hate even thinking about that sort of pain.

FWIW: my perspective is as an ex-steroid user. Although, not a terribly experienced one. I had run a few cycles in the past with pretty consistent monitoring of my hormone levels both on and off cycle. I am also a patient of Swales and have that perspective as well.

Here are some random things Ive noticed:

Libido and mood:

--When my T levels got high I experience sexual dysfunction. Libido isnt really the right word now that I think about it, then again maybe it is. If I was only on too much Test (say T levels were 1200-1300 on a normal scale that tops out in the 800s) I would notice that I had normal, and frequent, erections but had difficulty to extreme difficulty ejaculating. Psychologically I could best describe the situation as, Id be horny but the feeling would just go away sometimes literally while having sex. Sometimes I would be VERY interested, aka horny as hell, but still couldnt ejaculate for what seemed a lifetime. If I took anabolic drugs (Anavar, EQ, etc) I would have difficulty even getting or maintaining an erection THAT was horrible as sometimes I would actually be in the mood. Trying to correlate all this to E and DHT levels makes things difficult. I have all the data as Ive and have been in just about every high T scenario (ie: along with High/low E and high/low DHT) and the results were always the same, sexual dysfunction with high T levels.

--Normal/high E along with low/no DHT along with low/normal T: decent libido not great overall outlook on life and terrible trouble maintaining good body composition. This was on Proscar and no other drugs.
--Normal/high E along with normal DHT along with low/normal T: decent libido, not the best but not the worst overall outlook on life. Not the best body composition, difficulty making any improvements in said.
--Normal/low-normal E, normal to elevated DHT, normal T: great libido, good outlook, body composition changes seem to almost take care of themselves.
--Normal/high E, normal DHT, high T all from Clomid therapy: SERMs just arent a great way to go, Ill leave it at that. Yes, they elevate T but theres nothing good about the resulting feeling. Libido sucked, mood was horrible, the list goes on.


The various Ts:

Ive used Test Cyp and Androgel at therapeutic levels. Heres what I think

Androgel delivers much more Bang for the buck than does Cyp. Actually, taken quite literally, thats not true as Andro is ridiculously expensive but you get my real meaning. The best I ever felt on Cyp was just decent not great. Libido, on Cyp, was really only good when I added in HCG and even then it was more like a libido rush a couple times a week. Androgel delivers a much more pleasing sense of wellbeing, a more consistent libido and better body composition. Honestly, Andorgel makes me feel more consistently better (wow, there goes the grammar) than I remember feeling in many years. More consistent as in fewer mood swings and better libido. My DHT levels are always somewhat elevated on Androgel, this has to be a big part of the picture.

Due to its slow action Cyp was more difficult to gauge from a improving/declining point of view. I have gone too high on Androgel before and the results were felt in days with sexual dysfunction problems. Those problems were correctible inside of a few days while on Andro. Similar problems on Cyp would seem to creep up on me and then only slowly taper-off once corrections were made. It was insidious in that Id constantly be asking myself Is this different than how I felt a few days ago? Is this significant? Correct dosing on Cyp was not necessarily difficult but was time consuming further confounding matters was the fact that I never really ended up feeling like I thought I should so I was always prodding my doc to mess with the dosage. On Androgel I never really have that urge.

Sorry, now that I read this it all looks like a random jumble of thoughts. Hope Ive provided some perspective, though.

 

[Redi Kilowatt]

Great Info

tomguy-

Thanks! Getting "field experience" like yours is really valuable. Appreciate it allot.

RK

 

[tomguy]

I especially appreciated ender's comparison of his hormone levels under different scenario's with his libido and moods. This really helped me to understand the importance of monitoring more frequently my hormone levels and the importance of consistently applying TRT. Also, I hadn't realized that androgel and Cypionate could yield different results and that cypionate takes longer to adjust the dosage vs androgel, etc,. I can do the same comparison with my levels since the lab I went to (Kronos Science) provides you with a 5 year history of your results. This information was more valuable to me than any information that any medical doctor has ever given to me on the affects that hormone levels have on sexual performance and the importantce of being in balance. Usually they say my levels are too high abut they don't explain the affect that has on my system. I think it also helps me to understand that even increasing your test shot marginally can put you over the range and can shut you down. I hadn't realized that. I thought that bodybuilders taking very large amounts of Test and other drugs would fall victim to problems with performance, et.

 

[SWALE]

I would always recommend a DO over an MD--but I am unashamedly biased.

You would not be living at that Total T in my practice. I do believe it is an important point.

I think we know here that 3000IU per week HCG is way too much, but Dr. Fishman's exploration into the mind/body connection is wonderful.

Dr. Brodsky will not be able to draw valid labs after only 2 weeks post switch to Androgel. In fact, he will need to give osme thought to a protocol to step up the Androgel from a very low dose to maintain more stable serum T levels.

I lost the woman I had planned to spend the rest of my life with in 1992--it still seems like yesterday.

 

[tomguy]

Thanks Swale for the feedback. I'm very aware now about what high Test levels can do to your system and my my goal is to get my T levels to within normal ranges under the supervision of an M.D. (or DO). Currently, I'm following the protocol that Dr. Brodsky established for me. I will definitely inquire about the validity of testing after only 2 weeks from switching to androgel, etc. We did talk about adjusting the dosage so that I eventually receive the optimum results possible and maintain it there. So, I guess only time will tell. Meanwhile, I will also speak with Dr. Rothsein (DO) about his methods and get his opinion on things. At least I feel good that I will have sought the opinion of at least 3 professionals. The hard part is the selection process. I am, however, feeling a much better than I did last month. My libido has returned somewhat, although it's not where it use to be. The only thing diffent that I've done was to reduce the dosage (significantly) of my weekly Terst shot. Also, I really appreicated all the responses I recieved from everyone on this message board, it helped me put things in perspective and gave me peace of mind that my condition can be corrected.
Sorry to hear about your loss. I know the feeling very well.
Tom