TRT Jungle - What to do now?????

My BP averages 124/75 on the ACE. My doctor likes to use it because of the small number of side effects, especially the sexual ones for men. My wife is also on an ACE - lisinopril. I used to use it, but got the dry cough side effect. I get no noticeable side effects on fosinopril. My total cholesterol is pretty good - 195, but my HDL is low at about 45-50 and my LDL is normally about 125. I tried a statin about 8 years ago, but after 3 months, I could hardly walk from joint and muscle pain. I got off it and it took 3 weeks to walk without pain and about 2 months to feel normal again. I now have started to use 1000 mg of instant release niacin just before bed. That is supposed to increase HDL and lower LDL. I was splitting it between breakfast and dinner for the past year and my 195 was with that regime. I was about 210 to 225 before the niacin. I'm hoping that taking it all before bed will work better.

Yes, having the wife do the DRE is definitely more fun, but she doesn't know what to look for. Perhaps a good looking female doctor is in order. :D Oh well, I guess I can let her practice anyway.

I have an appointment with my doctor this afternoon on my hormones. I'll have to read about alpha blockers before I go there. However, I thought it was one of the ones that had unfavorable sexual side effects. I get mixed up which is which though, so I'll have to look.

By the way, thanks for the discussion and advice.
 
OK, I just did some research on alpha blockers. I will ask him about doxazosin. My wife remembers that she was taking it before going on an ACE. She doesn't remember why he switched her. It did say to avoid alcohol and that any of the ED meds can increase the effects of the drug, so it might not be a good choice for me. I don't drink much, just a small amount of wine with dinner most days, but I do take 25 mg of Viagra about twice a week.

USRF - Alpha-blocker precaution added to Viagra

Here is also some interesting info on how doxazosin might help men with ED and return them to normal function with ED drugs.

Data Suggest Cardura (Doxazosin) Can Improve Sexual Function in Men

"One hundred percent of men (8 of 8) with pre-existing erection problems regained their potency with doxazosin (Cardura(R)), compared to 43 percent of those on placebo and 31-to-50 percent of those taking other medications."
 

zkt

Member
It`s been my pleasure.
Statins can do that in some- most unfortunate since they do the job on the lipids very well. Possibly a small dose of Crestor would be better tolerated. The lower your LDL the better. Mine is ~80, but I have a family and personal history of arterial plaque.
HDL can be raised to the maximum by use of a statin in combination with SLOW release naicin, and gemfiprozil. Niacin alone does some good, naicin and gem is substantially better. All three- well my HDL is almost equal to my LDL. Gem also lowers triglycerides. Naicin 1000mg/2xd, gem 300/2xd, Crestor 20mg/d works for me and is about at the max dose for me. Monitor trigglycerides if using gem.
The AB`s seldom have sexual side effects, you might be thinking of Beta blockers. But then neither do the ACE`s. If the night time urination or slow stream is a problem then an AB might be better than SP and ACE. Limiting hydration in the evening will help too. But part of the hypertension thing is fluid retention during the day and release by urination at night. To really address this issue we are into diuretics and thats another level of complication.
Good Luck at the appointment.

My BP averages 124/75 on the ACE. My doctor likes to use it because of the small number of side effects, especially the sexual ones for men. My wife is also on an ACE - lisinopril. I used to use it, but got the dry cough side effect. I get no noticeable side effects on fosinopril. My total cholesterol is pretty good - 195, but my HDL is low at about 45-50 and my LDL is normally about 125. I tried a statin about 8 years ago, but after 3 months, I could hardly walk from joint and muscle pain. I got off it and it took 3 weeks to walk without pain and about 2 months to feel normal again. I now have started to use 1000 mg of instant release niacin just before bed. That is supposed to increase HDL and lower LDL. I was splitting it between breakfast and dinner for the past year and my 195 was with that regime. I was about 210 to 225 before the niacin. I'm hoping that taking it all before bed will work better.

Yes, having the wife do the DRE is definitely more fun, but she doesn't know what to look for. Perhaps a good looking female doctor is in order. :D Oh well, I guess I can let her practice anyway.

I have an appointment with my doctor this afternoon on my hormones. I'll have to read about alpha blockers before I go there. However, I thought it was one of the ones that had unfavorable sexual side effects. I get mixed up which is which though, so I'll have to look.

By the way, thanks for the discussion and advice.
 

zkt

Member
There are half a dozen A1 blockers. They vary in half lives and time to peak serum concentration and theraputic dose. Both Ter and Dox last for 24 hrs but Dox peaks in 6 hrs and Ter in 1-2. Imagine the time-comcentration curve and shifting the peak while keeping the endpoint(~24hrs) the same. The point being that if you take either at bedtime, and you should to avoid hypotension as it peaks, Ter effect will last longer than Dox. But its not all that significant and you might not notice the difference unless you monitor your BP several times during the day.
If you use dox or Ter start small, and slowly work up else you will be watching TV for a day or two.
There is definitely a synergistic effect with V, etc. Dont take one within 4 hrs of the other. But taking the AB at bedtime eliminates the interaction problem. Taking V sublingual causes a much faster serum peak btw.
1-2 drinks/d is not a problem with much of anything unless you wash down a handful of Xanax with it.[:eek:)]
Lemme know how it goes.

OK, I just did some research on alpha blockers. I will ask him about doxazosin. My wife remembers that she was taking it before going on an ACE. She doesn't remember why he switched her. It did say to avoid alcohol and that any of the ED meds can increase the effects of the drug, so it might not be a good choice for me. I don't drink much, just a small amount of wine with dinner most days, but I do take 25 mg of Viagra about twice a week.

USRF - Alpha-blocker precaution added to Viagra

Here is also some interesting info on how doxazosin might help men with ED and return them to normal function with ED drugs.

Data Suggest Cardura (Doxazosin) Can Improve Sexual Function in Men

"One hundred percent of men (8 of 8) with pre-existing erection problems regained their potency with doxazosin (Cardura(R)), compared to 43 percent of those on placebo and 31-to-50 percent of those taking other medications."
 
I just also checked terazosin. Caps are covered by my insurance as generic, but the tabs are non-formulary. I see that drugstore.com only has the caps and they cost less than dox and a lot less than fos. Of course, they are all the same copay for me, so what ever works is fine. I had also tried taking my fos at night, but it worked better taking when I wake up. I really are interested in the alpha blockers. I don't want to take up too much time discussing that though, as my main concern is the hormones. It would be great if I could solve HBP, BPH and ED with one pill though. And a generic one at that. Not having to buy Viagra, or even the Indian stuff would be a plus. Besides, I will be on Medicare in a few months, so there goes my Viagra for $25 for 4 100 mg pills.
 
On the BP side, he said that I can't take enough dox alone to control my BP. He wrote a script for dox 4 mg and told me to cut my fos in half and start with 2 mg of dox. then monitor my BP for a couple of weeks and go up to 4 mg of dox if necessary. So I will take my fos in the morning and the dox just before bed and see how it goes. I will keep taking the SP too in case the dox is not enough to help the BPH.

He was also puzzled by the big drop in T and E2. It does not seem like lowering Testim by 25% should have such an effect. He agrees with what I want to do, as he doesn't have a better suggestion. He also agreed that seeing a endo isn't worth it, as they just send back a report that the patient is within lab limits. So I am going to stay at Testim 10 mg, stop the soy isoflavones, take the 1/2 DIM and continue with no DHEA and then test again in 6 to 8 weeks. He wrote a lab request for total and free T and E2. He also hasn't gotten back the DHEA-S lab report form Quest, so he is going to have somebody check on it and add it to my lab request if it is not found. I also showed him this post from Dr Mariano's forum:

Subcutaneous Testosterone Injections - The Definitive Mind - Forums

Check out post #7 from JanSz. He reduced his Tcyp from 50 mg EOD to 40 mg EOD (20%), but kept his hcg the same. His TT dropped by 32%, BAT and free T by 45% and E2 by 49%. Since he kept his hcg the same, it would seem that the 20% drop in Tcyp would only have the effect of like dropping Tcyp by something like 10% let's say. Look at the big drops in the hormones. What I'm thinking is that perhaps my drop in hormones from a 25% drop in Testim is not so confusing. I guess I'll just have to wait until I get retested or if I start to feel better again. Actually, I don't feel bad. It's just that the ED is back and fantasies and dreams are no more. Libido is not real bad though.

A parting thought. I did 2 hours of work yesterday where I was stooping and going up and down the entire time, without a rest. I am stiff today. That's the problem with getting old. The wrong joints get stiff. :D
 

zkt

Member
Acxcording to Kaplan (Kaplan`s Hypertension) the max dose of dox is 16mg/d. But I would assume he is right. If NE isnt the problem then blocking the A1 receptor on the smooth vascular muscle wont fix it. There are many causes of HBP and apparently NE isnt yours. But it should help the BPH. For me I replaced 50mg metroprolol/2xd with 4 mg Ter/d. Have you had creatinine and BUN checked? The kidneys are one of the main controllers of BP thru the RAS, which the ACEs effect.
The damn thing cut off the rest of my post. FUCK

On the BP side, he said that I can't take enough dox alone to control my BP. He wrote a script for dox 4 mg and told me to cut my fos in half and start with 2 mg of dox. then monitor my BP for a couple of weeks and go up to 4 mg of dox if necessary. So I will take my fos in the morning and the dox just before bed and see how it goes. I will keep taking the SP too in case the dox is not enough to help the BPH.
The link didnt work, please fix it as I am eager to read anything Dr.M has to say.
I`m not quite what your point is re Jan`s post. Everyone is the same but different. You have the same feedback mechanisms and hormones as Jan but not neccesarily the same amounts, setpoints and receptor activity. Jan cutting his T by 20% and FT dropping X% doesnt relate to you except generally.
Sex is a lot in the head, but T has a hell of a lot to do with it too, for whats thats worth. HT is also a factor in ED. Frankly I dont see a problem with a 50 cent pill under the tongue befor I do the wife.
The one good part of injections is that its easy to titrate your individual doseage.


He was also puzzled by the big drop in T and E2. It does not seem like lowering Testim by 25% should have such an effect. He agrees with what I want to do, as he doesn't have a better suggestion. He also agreed that seeing a endo isn't worth it, as they just send back a report that the patient is within lab limits. So I am going to stay at Testim 10 mg, stop the soy isoflavones, take the 1/2 DIM and continue with no DHEA and then test again in 6 to 8 weeks. He wrote a lab request for total and free T and E2. He also hasn't gotten back the DHEA-S lab report form Quest, so he is going to have somebody check on it and add it to my lab request if it is not found. I also showed him this post from Dr Mariano's forum:

Subcutaneous Testosterone Injections - The Definitive Mind - Forums

Check out post #7 from JanSz. He reduced his Tcyp from 50 mg EOD to 40 mg EOD (20%), but kept his hcg the same. His TT dropped by 32%, BAT and free T by 45% and E2 by 49%. Since he kept his hcg the same, it would seem that the 20% drop in Tcyp would only have the effect of like dropping Tcyp by something like 10% let's say. Look at the big drops in the hormones. What I'm thinking is that perhaps my drop in hormones from a 25% drop in Testim is not so confusing. I guess I'll just have to wait until I get retested or if I start to feel better again. Actually, I don't feel bad. It's just that the ED is back and fantasies and dreams are no more. Libido is not real bad though.

A parting thought. I did 2 hours of work yesterday where I was stooping and going up and down the entire time, without a rest. I am stiff today. That's the problem with getting old. The wrong joints get stiff. :D
 
Acxcording to Kaplan (Kaplan`s Hypertension) the max dose of dox is 16mg/d. But I would assume he is right. If NE isnt the problem then blocking the A1 receptor on the smooth vascular muscle wont fix it. There are many causes of HBP and apparently NE isnt yours. But it should help the BPH. For me I replaced 50mg metroprolol/2xd with 4 mg Ter/d. Have you had creatinine and BUN checked? The kidneys are one of the main controllers of BP thru the RAS, which the ACEs effect.
The damn thing cut off the rest of my post. FUCK

Yes, they were checked at my annual physical in May. BUN was 14 (7-23) and creatinine was slightly low at 0.6 (0.7-1.5). It is checked every year, but this is the first time that I have gotten all of my blood test results mailed to me.
 

zkt

Member
I dont think you can compare Jan results to yours except in the most general way. Who said the body`s response to exog T was linear ? We differ from computers in that we are dynamic and constantly changing. There are so many factors involved. Maybe you ate more eggs and increased your serum albumin and the free T was more bound.
Its like BP readings- you have to look at the trends and the big picture- a single reading doesnt mean much.
Your parting remark makes me wonder if you might have misidentified the side effects of the statin. Joint pain is not a common effect- muscle pain and degeneration is. Degererative AO is common at our age. The immune response is also more easily set off with increasing age and is at the root of AO. Just a thought.
 
I missed this reply imbeded in my quoted post:

"The link didnt work, please fix it as I am eager to read anything Dr.M has to say.
I`m not quite what your point is re Jan`s post. Everyone is the same but different. You have the same feedback mechanisms and hormones as Jan but not neccesarily the same amounts, setpoints and receptor activity. Jan cutting his T by 20% and FT dropping X% doesnt relate to you except generally.
Sex is a lot in the head, but T has a hell of a lot to do with it too, for whats thats worth. HT is also a factor in ED. Frankly I dont see a problem with a 50 cent pill under the tongue befor I do the wife.
The one good part of injections is that its easy to titrate your individual doseage. "

I just clicked on my link and it worked fine. What I meant about JanSz's post is that he lowered his Tcyp by 20% and kept his hcg the same. Because of this, I would have expected his T and E2 to drop by less than 20%. However, they dropped by 32% to 49%. I lowered my Testim dose by 25% and my TT dropped by nearly 70%. This is the same trend as his results, where a small drop in testosterone resulted in a much bigger drop in blood levels. That is confusing to me and my doctor. If anything, we would expect a small drop in exogenous T to result in a same or even smaller drop in blood levels. It is like most medications. A doubling does not result in a doubling of effect on the body. Why does a small adjustment to applied T result in a much bigger change in the results?

Let's try this for the link. Go here:

The Definitive Mind - Forums - Powered by vBulletin

Click on Men's Health at the bottom of the health forums.
Then click on Subcutaneous Testosterone Injections. It is currently the 3rd one down.
The post I referenced is #7.
 

zkt

Member
Thats good to know. The other big health problems are diabetes, obesity and family history of health problems. Rule those out?

Yes, they were checked at my annual physical in May. BUN was 14 (7-23) and creatinine was slightly low at 0.6 (0.7-1.5). It is checked every year, but this is the first time that I have gotten all of my blood test results mailed to me.
 
I dont think you can compare Jan results to yours except in the most general way. Who said the body`s response to exog T was linear ? We differ from computers in that we are dynamic and constantly changing. There are so many factors involved. Maybe you ate more eggs and increased your serum albumin and the free T was more bound.
Its like BP readings- you have to look at the trends and the big picture- a single reading doesnt mean much.
Your parting remark makes me wonder if you might have misidentified the side effects of the statin. Joint pain is not a common effect- muscle pain and degeneration is. Degererative AO is common at our age. The immune response is also more easily set off with increasing age and is at the root of AO. Just a thought.

It was more than just pain. I had severe pain in my right hip and knee and muscle pain in my thigh. My right leg was also very weak. I would lie down in bed and I couldn't lift my right leg into bed. My wife had to lift it up for me for a few days. I stopped the pravachol as soon as the pains started. I don't have a very strong upper body, but my leg strength is great. I used to leg press 660 pounds for like 2 or 3 reps. That was the most weight my buddy and I had combined. I don't do leg exercises any more, but I tried a weight machine at an exercise equipment store about 8 years ago and I set the machine at the highest 500 pounds and did 10 reps. Leg weakness is something that I am not used to. Upper body presses, now that's another story. I had X-rays and a body scan and no reason was found. I forget what type of scan it was. I also think that I lost some thigh muscle mass during this, but I didn't measure to know. I have gained all my strength back as far as I know, but I only do upper body weight exercises. I walk a lot, hike and mountain bike.
 
Thats good to know. The other big health problems are diabetes, obesity and family history of health problems. Rule those out?

My glucose consistently runs 96 to 99, which is below the pre-diabetes range. My BMI is 25.8. That is a little high and I could lose a bit of fat around the waist. However, I can't float in a swimming pool. My legs sink and then the rest follows until I am on the bottom. Father died of heart disease, but he had a terrible diet. Loved beef brains and scrambled eggs just before bed. :eek: Mother died of cancer. Both over 30 years ago.
 

zkt

Member
I`m convinced. Its easy is mistake cause and effect but you are clear.

It was more than just pain. I had severe pain in my right hip and knee and muscle pain in my thigh. My right leg was also very weak. I would lie down in bed and I couldn't lift my right leg into bed. My wife had to lift it up for me for a few days. I stopped the pravachol as soon as the pains started. I don't have a very strong upper body, but my leg strength is great. I used to leg press 660 pounds for like 2 or 3 reps. That was the most weight my buddy and I had combined. I don't do leg exercises any more, but I tried a weight machine at an exercise equipment store about 8 years ago and I set the machine at the highest 500 pounds and did 10 reps. Leg weakness is something that I am not used to. Upper body presses, now that's another story. I had X-rays and a body scan and no reason was found. I forget what type of scan it was. I also think that I lost some thigh muscle mass during this, but I didn't measure to know. I have gained all my strength back as far as I know, but I only do upper body weight exercises. I walk a lot, hike and mountain bike.
 

zkt

Member
Both parents dies at age ~35 from different causes?


My glucose consistently runs 96 to 99, which is below the pre-diabetes range. My BMI is 25.8. That is a little high and I could lose a bit of fat around the waist. However, I can't float in a swimming pool. My legs sink and then the rest follows until I am on the bottom. Father died of heart disease, but he had a terrible diet. Loved beef brains and scrambled eggs just before bed. :eek: Mother died of cancer. Both over 30 years ago.
 

zkt

Member
Appears to me that you are well informed and doing all the best things. There doesnt seem to be much that can be done to circumvent a genetic predeliction for cancer except for what I am sure you are doing. And you may not have one anyway.
The HT and athersclerosis is another matter and they are under control with diet, exercise and drugs. I`ve run out of things to say except to reiterate.
If you are interested in understanding all this in detail check out Alibris books- good, cheap, used medical texts. I`m sure you are up to the task.
:)
 
Yeah, I don't know what to try next, except for what I am doing now. I really don't want to start using Tcyp shots, hcg, Arimidex and other things all together. I know a lot of guys do this, but they still don't seem to be able to get everything balanced or keep it balanced. i don't know what going on Medicare next year will mean. At the cost of Testim, the doughnut hole will be costly. However, I have not seen my company retiree medicare supplemental or Advantage plan yet. I am retired now and have no issue with the current insurance company with Testim for my company supplied insurance, except for the high premium cost. I may have to switch to Tcyp or compounded gel next year depending on the cost of Testim. My doctor has not used either. He asked me if there was one of the docs who specialize in this close, as he didn't know any in our area. I told him that Dr Shippen was not too far away, but that he is close to retirement. He seemed to note the books by Shippen and Morgantaler and mentioned them during our discussion.

Thanks for all the suggestions and information. Hopefully switching to a combined fos and dox will help BPH and perhaps ED.

I will just stay on 10 gm of Testim, try the dox and fos, stay on the SP and adjust the Indoilplex DIM to try to get the E2 right. If I find something that makes me feel great then I will just ignore the labs unless they are really out of range a lot. I felt pretty good before I tried to get my free T, DHT and E2 down. Perhaps just stopping the DHEA would have done it.
 

lovevixen

Junior Member
DO not waste time or money on Saw Palameto instead sepnd it on DIM and Beta_Sisterol my spelling sucks and spell check does nto have these words so just sue google and let it fix the spelling! DIM is so much better and keeping test/estrogen in check and preventing it's conversion to estridol. Beta-sisterol is the active ingredient in Saw Palametow and by buying it instead of raw Saw Palameto ground up and stuffed in a cap you have a concrete way to dose yourself as it is reported basedon it's strength not just the weight of raw ground up plant pieces. It would be like trying to treat a headache with willow bark versus useing refined Asprin! WItht he Asprin you know exactly what dosage youa re getting but with the ground up willow bark it would be hit and miss as to wheater you where getting enough of the active chemical as it would vary with each batch from eaach diffeent tree in each region etc......Also beta-sisterol is cheap and works much better!
 

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