TRT seems great, need guidance

[fireshot]

First of all I would like to thank everyone for the quality of this forum. It's great to read how so many of you are willing to spend time helping complete strangers and in most instances improving lives.

I have lurked for a few weeks now (here and TNation) reading everything i could to try and understand the links between the HPTA and how it all fits together. So I figured it would be good to present my case and hope that you guys would guide my trx and dissect my mistakes.

Some of my stats:
30 Y/O
5'9"
32" waist
180 lbs
Hx- was on zoloft for a few years (2003-2006) Libido was great while on it but climax became a problem.
I take daily: fish oil and multi vitamin. Just started taking D3 and B12
Diet is good. No fast food. Most clean meats and veg and potatoes.
Training was better up until a year ago. Weights and boxing. Have started more on the cardio only side the past couple of months. I don't have the will for the gym or much boxing anymore.
Never did AAS

I have unknowingly had Low T symptoms for around 2 years now although I feel like I have had the brain fog for longer. I thought this was the way life was until i started researching and read the success stories and symptoms of others on TRT. It sarted with fatigue, lack of ambition, no joy for the things I used to love doing, headaches, couldn't get out of bed, moody, weakness in the gym, aches, etc. 12 months ago is when the ED and ZERO libido started. Nuts were pulled closer to my body and my joint felt like it had no blood flow. This is when i started to visit my doc and trying to fix this. We just wrote it off as stress and I dealt with it.

In Feb of this year my doc mentioned low T. He ran some labs (not all the tests needed but he tries) My levels came back low (see below). While we waited for the results he offered Prozac, zoloft seemed to help years ago). So I started on that. When my labs came back he offered TRT. I was put on Testim 5mg. i did this for 2 weeks and felt nothing. In this time I began reading this forum realizing i jumped the gun. i went back to my doc with print outs for protocols and info on HCG. I asked to be placed on Test Cyp 50mg E3D. He agreed and gave me a rx for anestrozole also, as needed, I have not takin yet. He was going to make some calls and read up on HCG. BTW, I only stayed on Prozac for 3 weeks.

I have been on the inj for 2 weeks now. The first week was pretty good. More energy a little clearer head but no help with ED or libido. Then a few days of lethargy and real fogginess. Guessing that my own supply shut down. And now I feel pretty good. Morning wood is sporadic though not as raging as i would like. No wood in any other parts of the day and no urge to do anything with it anyway.

My pcp is very accomodating when it comes to me knowing my symptoms and making my own health decicions. He's not as up to date as i would like on TRT but if I put the time in I can guide my own treatment.

I have an apt next week where I will have a list of needed blood tests. I was reading how HAN handles his pts and it seemed to make sense. I was thinking of waiting for the results then adding anestrozole to level things out then adding HCG....... ? Any thoughts on why libido hasn't picked up yet? e2? Others had mentioned thyroid?

Thank you for taking the time to read this and any comments would be appreciated.

Labs done at Quest.

Testosterone, total, lc, ms, ms ; 295 -- (250-1100 ng/dl)
Free Test ; 53.4 -- (35-155 pg/ml)
FSH ; 1.9 -- (1.6-8.0 mIU/ml)
Estradiol ; 22 -- (13-54 pg/ml)
PSA, total ; 0.5 --( <=4 ng/ml)
TSH 3rd generation ; 1.4 -- (0.4-4.5 mIU/L)
T4 Thyroxine, Total ; 9.5 -- (4.5-12.0 mcg/dl )
T4 free ; 1.2 -- (0.8-1.8 ng/dl)
T3 total ; 97 -- (76-181 ng/dl)

Glucose ; 90 -- (65-99 mg/dl )
Urea Nitrogen ; 21 --( 7-25 mg/dl)
creatinine ; 1.00 -- (.79-1.33 mg/dl)
egfr ; >60 -- (>60)
sodium ; 139 -- (135-146 mmol/l)
potassium ; 4.3 -- (3.5-5.3 mmol/l )
chloride ; 102 -- (98-110 mmol/l)
co2 ; 25 -- (21-33 mmol/l )
calcium ; 9.8 -- (8.6-10.2 mg/dl )
protein, total ; 7.7 -- (6.2-8.3 g/dl )
albumin ; 4.7 -- (3.6-5.1 g/dl )
globulin ; 3.0 -- (2.1-3.7 g/dl calc)
albumin globulin ratio ; 1.6 -- (1.0-2.1 calc)
bilirubin total ; .6 --( .2-1.2 mg/dl )
alkaline phosphate ; 71 -- (40-115 u/l)
ast ; 20 -- (10-40 u/l )
alt ; 23 -- (9-60 u/l)
creatine kinase, total ; 157 --( 44-196 u/l)
myoglobin, serum ; 18 -- (<=50 mcg/ )
prothrobin time inr ; 1.0 -- (.9-1.1 )
pt ; 10.6 -- (9-11.5 sec )

CBC (incl diff/plt)
white ct ; 8.6 -- (3.8-10.8 thou/ul)
red ct ; 5.03 -- (4.2-5.8 mil/ul )
hemoglobin ; (15.8 -- 13.2-17.1 g/dl)
hematocrit ; 45 --( 38.5-50 % )
mcv ; 89.6 -- (80-100 fl )
mch ; 31.4 -- (27-33 pg )
mchc ; 35.1 --( 32-36 g/dl)
rdw ; 13.2 -- (11-15 % )
platelet ct ; 242 -- (140-400 thous/ul)
abso neutrophils ; 5848 -- (1500-7800 thous/ul)
lymphocytes ; 1944 -- (850-3900 cells/ul )
monocytes ; 619 -- (200-950 cells/ul )
eosinophils ; 129 -- (15-500 cells/ul )
basophils ; 60 -- (0-200 cells/ul )
neutrophils ; 68 --
lymphocytes ; 22.6
monocytes ; 7.2
eosiniphyls ; 1.5
basophils ; .7

vit B 12 ; 893 -- (200-1100 pg/ml)

ana ifa screen w refl to
titer and pattern
ana screen, ifa positive -- negative

antinulear antibodies
titer and pattern
ana pattern nucleolar

 

[CubbieBlue]

What does the following mean below:

ana ifa screen w refl to
titer and pattern
ana screen, ifa positive -- negative

antinulear antibodies
titer and pattern
ana pattern nucleolar

Do you have an autoimmune issue?

Your testosterone is indeed low. It is really impossible to tell if boosting it will solve your problems. It may. It may not. I think most new guys should start with 7.5-10 mg of Androgel/Testim first. If that works and you like it, great. Stop there.

Injections work well too but many people get tired of them.

 

[fireshot]

Yeah I don't know what those tests are. I will ask on Tuesday, my next apt.

My doc did say he ruled out autoimmune issues.

I wasn't a big fan of having to rub on the gels everyday. I know that they may help with libido better than shots (raises fst or was it shbg) but I was not able to apply at the same time every morning and I live in FL and sweat alot. I feel the inj are just more convenient for me and the needles don't bother me...... yet.

 

[fireshot]

CubbieBlue
The test that you asked about was continued on another page of the test and I didn't know they were connected. My ANA titer was in the low antibody level. 1:80 with range 1:40-1:80 low antibody level. My doc said it was just something to keep an eye on in the future but no worries as of now. I'm thinking it's like an exposure maybe. Good catch, thank you.

In regards to my apt yesterday: after research done on this site I got some #25 5/8" needles as opposed to the #21 1" my doc was pushing. I haven't used them yet but am looking forward to not sticking a #21 in my quad anymore. My doc also prescribed HCG 250iu E3D. I asked for Ovidryl and he said they come in prefilled syringes. As much as read about HCG I don't hear too much on how the script is written for or how it is sold. I've only read about the powder that has to be mixed and refrigerated so if it really is in prefilled form thats pretty great, although probably more expensive. So, I was thinking of starting:
Day 1 HCG 250iu
Day 2 Test Cyp 50mg
Day 3 .25 anestrozole (if needed)

I got my TT, FT, and sensitive estradiol done this morning. Just wanted to have some numbers while only on the test prior to starting the HCG and anestrozole. I will have much more in depth labs done in about 5 or 6 weeks.

I feel like I am slowly getting better. Fog seems to be lifting, I have more energy and coordination. However my libido and ED is still consistently dead and my mood is inconsistant.. I keep telling myself its only been a month but it's hard to not want immediate results.

Questions;
Should I wait for this mornings test results to come back before starting HCG and anestrazole?
I'm adding Iodine in my diet, would it be necessary to look into supplementing with Iodoral or is that overkill?

Any comments or guidance anyone might have on my treatment are greatly appeciated. Thank you.

 

[Structure]

CubbieBlue
The test that you asked about was continued on another page of the test and I didn't know they were connected. My ANA titer was in the low antibody level. 1:80 with range 1:40-1:80 low antibody level. My doc said it was just something to keep an eye on in the future but no worries as of now. I'm thinking it's like an exposure maybe. Good catch, thank you.

In regards to my apt yesterday: after research done on this site I got some #25 5/8" needles as opposed to the #21 1" my doc was pushing. I haven't used them yet but am looking forward to not sticking a #21 in my quad anymore. My doc also prescribed HCG 250iu E3D. I asked for Ovidryl and he said they come in prefilled syringes. As much as read about HCG I don't hear too much on how the script is written for or how it is sold. I've only read about the powder that has to be mixed and refrigerated so if it really is in prefilled form thats pretty great, although probably more expensive. So, I was thinking of starting:
Day 1 HCG 250iu
Day 2 Test Cyp 50mg
Day 3 .25 anestrozole (if needed)

I got my TT, FT, and sensitive estradiol done this morning. Just wanted to have some numbers while only on the test prior to starting the HCG and anestrozole. I will have much more in depth labs done in about 5 or 6 weeks.

I feel like I am slowly getting better. Fog seems to be lifting, I have more energy and coordination. However my libido and ED is still consistently dead and my mood is inconsistant.. I keep telling myself its only been a month but it's hard to not want immediate results.

Questions;
Should I wait for this mornings test results to come back before starting HCG and anestrazole?
I'm adding Iodine in my diet, would it be necessary to look into supplementing with Iodoral or is that overkill?

Any comments or guidance anyone might have on my treatment are greatly appeciated. Thank you.

Have you ever checked your LH? The assumption is that you have secondary hypogonadism, but your LH really should be checked to confirm this diagnosis. If you have primary hypogonadism, the HCG won't do a thing for you; you'll be wasting your time, effort, and money.

Also, you really shouldn't start anastrozole until you verify that your E2 is too high while on TRT. If you take it and your E2 isn't very high, you are just going to make libido issues worse, and possibly create some pain in your joints.

In general, the advice I'm giving you here is: don't treat a problem with medication until you have confirmation that it exists (through blood tests). Not only do you run the risk of unwanted side effects, you will make it more difficult to correctly identify and treat what is going wrong.

As far as blood tests go, here is what I usually check when I go in: LH, FSH, T (total and free), DHT, E2, prolactin, SHBG, 17-OHP. Most people don't need to check DHT, so you can lose that one. The 17-OHP gives a good measure of how much endogenous T you are creating; most people don't need to know this either, so you can probably lose that too. The rest are good for giving you a nice picture of what is currently happening in your HPT axis. You're probably already doing this, but for those that don't know: be sure to get your blood drawn first thing in the morning while fasting.

 

[fireshot]

Yeah LH would make sense...... Would getting that tested after starting TRT give an accurate result though? I was going soley on the fact that my FSH was low. Is it wrong to think that low FSH patients should respond to HCG or is it just that it is only half the picture?
My test in 5 weeks is going to include:
TT
FT
E2-sensitive
DHEA-s
Progesterone
DHT
Prolactin
SHBG
8am cortisol (I know, not too useful)
Ferretin
Lipid Panel
CBC

Anything missing? Should I add LH and FSH?

As far as the Anestrozole, I was planning on waiting for the results from todays test to come back before popping those. I am however impatient on starting the HCG........

Thank you for reading.

 

[Structure]

Yeah LH would make sense...... Would getting that tested after starting TRT give an accurate result though? I was going soley on the fact that my FSH was low. Is it wrong to think that low FSH patients should respond to HCG or is it just that it is only half the picture?
My test in 5 weeks is going to include:
TT
FT
E2-sensitive
DHEA-s
Progesterone
DHT
Prolactin
SHBG
8am cortisol (I know, not too useful)
Ferretin
Lipid Panel
CBC

Anything missing? Should I add LH and FSH?

As far as the Anestrozole, I was planning on waiting for the results from todays test to come back before popping those. I am however impatient on starting the HCG........

Thank you for reading.

Yes, testing LH and FSH at this point is pretty useless for you. I forgot to mention that the reason why I check LH and FSH regularly is specific to my physiology (as long as I don't use too much T, I can keep my LH and FSH in the normal range --- this is due to a mutation); most people don't need to check these values while on TRT.

It would have been nice to know what your LH was before you started TRT... At this point, we'll just have to infer: If HCG doesn't bring your T levels up, then we'll know that you are primary. However, it is possible that it will be difficult to tell since you are already on T.

If I were you, I'd try to figure out how to correct my symptoms using as few medications as possible. For instance, some people with secondary hypogonadism will try to use small, daily HCG injections alone to fix their issues. Others will use gels alone. If you find that you have high E2, you might be better off changing your dosing / injection schedule instead of just adding anastrozole into the mix. Likewise, if you find that you feel better after starting HCG, you might want to try using HCG by itself.

Out of curiosity: did you have any labs done at the end of your two weeks on Testim? If your T levels were normal, I would be suspicious that perhaps some of your symptoms at that point were due to the Prozac.

The way it looks right now, you run the risk of not knowing what medication is helping, and what medication is hurting. For example, you can't really say for certain if the Testim wasn't working; its benefits may have been countered by the side effects of Prozac. That's why I would advise modifying one variable at a time (and hence, I think it is a bad idea to concurrently start T, anastrozole, and HCG all at the same time).

If you are curious exactly what I would do if I was you, let me know and I'll go into more detail. Just keep in mind that what I would do reflects my bias; there's more than one way to approach this problem, and my way isn't necessarily more correct that someone else's. For example: I tend to think that the gels are better at recreating what it feels like to be "normal", whereas the gels have T peaks and troughs that make you feel (respectively) better for a while, then worse.

 

[fireshot]

Out of curiosity: did you have any labs done at the end of your two weeks on Testim? If your T levels were normal, I would be suspicious that perhaps some of your symptoms at that point were due to the Prozac.

No, nothing done after Testim.

If you are curious exactly what I would do if I was you, let me know and I'll go into more detail. Just keep in mind that what I would do reflects my bias; there's more than one way to approach this problem, and my way isn't necessarily more correct that someone else's. For example: I tend to think that the gels are better at recreating what it feels like to be "normal", whereas the gels have T peaks and troughs that make you feel (respectively) better for a while, then worse.

I am interested as to what you would do. I know I should suck it up and do what is going to help me the most but the gels were just a hassle for me plus I would be reminded of it all day with a sticky shirt. I am liking the inj so far (for now) and do realize that I get impatient when it comes to feeling better so I get impulsive with wanting to jump into HCG. Thanks Structure.

 

[fireshot]

I haven't started HCG yet but i have a couple questions regarding how its packaged and written for.

I asked my doc for Ovidrel and he complied. I don't think he has written for this before but he is very open to learning and doesn't mind me making suggestions from my own research and symptoms. He lets me be my own advocate. Does anyone have any experience whith Ovidrel in particular? I have read plenty on HCG but can't find anything too specific on packaging, potency, etc. I know it comes in prefilled syringes but I'm sure its more than my 250ius. How much in each prefill? how do I multi dose from a prefill? I read that the cash price should be around $75 but the pharmacy said my rx was $975!!!!! How are the scripts written? I'm thinking my doc wrote it wrong. Any ideas why it would come up as $975? Sorry if this is basic HCG knowledge but I would like to know what I'm talking about when I talk to the ins co. or pharmacy.

As always THANK YOU in advance.

 

[fireshot]

Sorry couldn't edit the above please disregard...... Heres my knewest post, thanks

I haven't started HCG yet but i have a couple questions regarding how to multi dose and how long each syr lasts.

I asked my doc for Ovidrel (I read it was the most resiliant) and he complied. I don't think he has written for this before but he is very open to learning and doesn't mind me making suggestions from my own research and symptoms. He lets me be my own advocate. Does anyone have any experience whith Ovidrel in particular? I spoke to the pharmacist and Ovidrel comes in a 250 mcg per 0.5 ml prefilled syr. How long is that supposed to last at 250 iu's E3D? How do I multi dose a prefill? I read that the cash price should be around $75 but the pharmacy said my rx was $975!!!!! How are the scripts written? It looks like my rx is for (10) 250 mcg per 0.5 ml prefilled syr. Any ideas why it would come up as $975? Sorry if this is basic HCG knowledge but I would like to know what I'm talking about when I talk to the ins co. or pharmacy.

As always THANK YOU in advance.

 

[Structure]

No, nothing done after Testim.

I am interested as to what you would do. I know I should suck it up and do what is going to help me the most but the gels were just a hassle for me plus I would be reminded of it all day with a sticky shirt. I am liking the inj so far (for now) and do realize that I get impatient when it comes to feeling better so I get impulsive with wanting to jump into HCG. Thanks Structure.

If I was you, the first thing I would do is resume the Testim; I'd start on one 5g tube per day. After two weeks, I'd have my blood drawn to check T (free and total), SHBG, DHT, and E2.

Next, I would deliberate on the HCG issue: do you want to retain your fertility? Do you mind if your testes atrophy? If your answer is yes to either of these questions, then I'd start on a low dose of daily HCG. I would start the HCG on the second week, after the blood test (but before the results are back). Your doc wants you to use 250 IUs every 3 days; I'd suggest using a daily dose (this corresponds to about 85 IUs every day). I'd recheck my blood after two weeks, and this time I'd add androstenedione to the tests (TT / FT, SHBG, DHT, E2, and androstenedione).

This way, you'll have blood tests from before and after the HCG to help you figure out which drug is responsible for which effect. The goal is to get your T in the high-normal range without significantly elevating E2. Your doctor can use your SHBG value to help determine how much E2 is too much. I'd try reducing one (or even both) medications to reduce E2 before trying an aromatase inhibitor; the whole reason that you would want to inject HCG daily is to avoid the E2 spike.

The androstenedione test can be used to figure out how much of the T is coming from your testes, and how much is coming from the testim --- androstenedione is a precursor to T; think of it as the step in the hormone assembly line that occurs right before testosterone. If it is too low, then your body isn't making much of its own T, and you'll need more HCG. If it is too high, then you'll need less HCG. You can also use this blood test to figure out if your testes are responding to the HCG --- if you have primary testicular failure, you won't respond to the HCG, and thus have no reason to use it. Keep in mind that since you are planning on using Testim and HCG together, you don't need your androstenedione to be very high --- since the T level you want is in the normal range, but only some of that T is coming from your body, you'd expect that your androstenedione would be a bit on the low side.

If you find out that you are primary (or if you aren't concerned about your fertility), then just adjust your dosage of testim to get your T / E2 where you want it to be.

If you find that your DHT is going too high, then you can compensate by applying the gel to a smaller surface area of skin; 5-a reductase (the enzyme responsible for converting T into DHT) is expressed in skin, so the more skin you cover, the more 5-a reductase is involved, and the more DHT you will create. Also, different parts of the body have more or less 5-a reductase; in general, hairy parts of the body have more 5-a reductase.

In my opinion, this would be the best way to approximate what feels "normal". Hope that helps. Others will disagree. In any case, you'll have plenty of information to help you make informed decisions. There's a lot of info here, so if you need me to clarify on something, just ask.

 

[fireshot]

Ok, in regards to the Ovidrel I found this thread from farmerjohn "one day on ovidrel"

The procedure is to empty a vial of bac. water, then fill it with 4.5 ml of bacteriostatic water, then add the 0.5 ml of Ovidrel from the syringe it comes in. It is supposed to be the equivalent of a 10,000 unit vial of HCG. At that point each 0.1 ml is the equivalent of 200 units of HCG (5 ml contains the whole 10,000 units).

So, 0.15 ml = 250iu's. Is this correct?

Also from cpeil2;

I just got a script filled for Ovidrel at Walgreen's about three weeks ago. One 250 mcg pre-filled syringe cost me $67.00. I can't imagine how it ended up costing you that much.
Ovidrel is different from Pregnyl or Novarel. It is recombinant hCG rather than human-derived and it is dosed in mcg., not in IU. 250 mcg of Ovidrel is the equivalent of 10000 IU of human-derived hCG. 2.5 mcg of the Ovidrel is the equivalnt of 100 IU of human-derived hCG.
When you get a 10000iu vial of Novarel of Pregnyl it is usually supplied with a 10ml vial of sterile water, which you use to reconsitute it. You can do the same thing with the Ovidrel. The volume of the Ovidrel in the pre-filled syringe is .5ml. All you have to do is remove .5 ml from a 10 ml vial of sterile water, inject the Ovidrel from the pre-filled syringe into the vial of sterile water and you are good to go.
If you had reconstituted 10000IU of hCG in 10 mls of water, in order to draw up 100IU, you would draw up .1 ml of the reconstituted hCG. If you dilute the Ovidrel as I just described and draw up .1 ml, you will have 2.5 mcg of Ovidrel, the equivalent of 100IU of human-derived hCG.
The math is initially a little confusing, and you would have had to know that 250 mcg of Ovidrel is the equivalent of 10000IU of hCG. After that, it is no more complicated than reconstituting a vial of human-derived hCG.

Can anyone confirm that 0.1ml of 10ml reconstituted = 100iu's?


Thank you Structure. I really appreciate your advice. i don't think I am ready to switch back to testim but I will definitely look into daily HCG. Also, thanks for the info on androstenedione. I wasn't aware of the significance of that.

 

[Structure]

Ok, in regards to the Ovidrel I found this thread from farmerjohn "one day on ovidrel"

So, 0.15 ml = 250iu's. Is this correct?

If it is true that one prefilled syringe of 0.5 mL of Ovidrel is equivalent to 10,000 IUs of HCG, then it would follow that, when mixed with another 4.5 mL of BSH2O, 0.1 mL of the solution would contain 200 IUs, and 0.15 would contain 300 IUs, not 250.

Also from cpeil2;

Can anyone confirm that 0.1ml of 10ml reconstituted = 100iu's?

Again assuming that one prefilled syringe of 0.5 mL of Ovidrel is equivalent to 10,000 IUs of HCG, it would follow that, when mixed with another 9.5 mL of BSH2O, 0.1 mL of the solution would contain 100 IUs.

Thank you Structure. I really appreciate your advice. i don't think I am ready to switch back to testim but I will definitely look into daily HCG. Also, thanks for the info on androstenedione. I wasn't aware of the significance of that.

Anytime. Keep us updated on your progress...

 

[fireshot]

Or if anyone can explain this posted by JansZ

Mixing instructions.

250 ?g rhCG =(6500iu)rHCG=(5000iu)HCG=0.515 mL=51.5units(on insuline syringe)

Lets make solution having total volume=2.5 mL=250units
Lets use units of "regular/natural" HCG

That solution will have density of

(5000iu)/(2.5mL)=2000iu/mL=(2000iu)/(100units)=20iu/unit

To empty sterile vial add

content of Ovidrel syringe=0.515mL
and
2.5mL - 0.515mL=~2mL bacteriostatic water

250iu =250/20=12.5units
300iu =300/20=15units
400iu =400/20=20units
500iu =500/20=25units
600iu =600/20=30units

all above can be handled the smallest syringe:

BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16inch Short Needle--1/2 Unit Markings


Man, I feel like a window licker!
Thank you everyone for putting up with me.

 

[fireshot]

Hi everyone, thanks for sticking with me so far. I received some new lab results after being on 50mg T cyp E3D for 3 weeks. No other treatments started.

TT 759 (250-1100 ng/dl)
FT 138.9 (35-155 ng/dl)
E2 Sensitive 29 (13-54 pg/ml)

These were just to get a quick look at how I am responding before starting HCG and possibly anestrozole. I will be getting a more extensive work up in 5 wks.

I started 200iu's of Ovidrel (assuming the 250mcg = 10000 iu of Uhcg) 3 days ago. Was thinking of inj hcg on the days in between my T.
Day 1 200iu hcg
Day 2 200iu hcg
Day 3 50mg Tcyp
Does this sound good?

I dont think I have noticed anything from the hcg yet. I did get a nice rush of libido the afternoon after my first dose but it would be hard to attribute that to the hcg right? I was also unable to finish while having sex that afternoon however thats not a new symptom. I have had that problem for years.

I am happy with where my T levels are going but was wondering if anyone had thoughts on whether or not to start anestrozole to get that E2 of 29 down to what I have read is optimal, 22? I don't have the sore or puffy nips but the libido, ed, and moodiness are still there.

Thanks for your comments.

 

[vantage108]

I was also unable to finish while having sex that afternoon however thats not a new symptom. I have had that problem for years.

Question for the experts: Generally speaking, when that starts happening to someone on TRT (where there isn't necessarily a history of SSRI use or whatever), what's the likely culprit? High prolactin?

 

[zkt]

PRL varies inversely with T, and increased levels tend to cause reduced libido and not ejaculation issues. 5-HT definitely inhibits ejaculation. Citalopram is often prescribed for PE. Too much activation at the 5-HT receptor can disable ejac. response.The opiate receptors are also involved and opiates are used for PE treatment. The DA levels/receptors are very important: too much activity and PE, too little, no climax.

 

[fireshot]

I need to add to my medical history. I don't know if this can be related to reasons of getting on TRT, but I would appeciate any insight. I have searched the net and found plenty of people with the following symptoms and none of them have found a treatment or at least none have posted.

I have had the following happen 3-4 times a year for the past 4+ years. As well as this past weekend.

It starts with what feels like a tennis ball size lump (inflamation?) in the right upper quadrant of my abdomen. Mid clavicular below the ribs. This swelling is slightly tender, not really painful, but very uncomfortable. Immediately following the swelling is EXTREME (an 8) pain radiating to my back. The pain is under the right shoulder blade and squeezing my spine between the shoulder blades. This typically lasts 24-48 hrs. The swelling usually lasts another 24-48 hrs but is not as pronounced or uncomfortable.

From everything I have read this seems to point to the gall bladder. I have had an ultrasound and a biliary (hida) scan both of which came back negative. They said there looked to be some thickening of the gall bladder wall but nothing that would explain my symptoms. I can not find any common demonators that are causing this. The attacks seem random. Diet does not initiate it (fatty foods) nor does exercise or lack there of. I have tried many options. Acid reducers, aleve, tylenol, muscle relaxers, vicodin, even massage therapy. The only thing I can think of is hitting the ER while I'm having an attack.

I have read stories of people getting there GB removed because of these symptoms and not only did the pain not stop but now they have chronic diahrea from not having a GB.

Please, if anyone has any insight please share.

 

[fireshot]

Can anyone explain why I feel so bad after a work out? I can handle cardio without a problem but lifting makes me feel sick afterwards. This was part of my symptoms prior to TRT but back then I didn't feel like hitting the gym anyway. I would have a good week at the gym and then I would feel like I got run over. But now I'm feeling the urge to go again. The above post came on the day after I went back to the gym and had a great workout. Last night I lifted and an hour later I felt like I was having anxiety, sob, aches, and queezy. Now tonight my muscles feel cramped after the short work out I just did. Could it be my E2 creeping up. I started HCG on April 12th and just started adding adex .25 eod on April 17th.

 

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I have read that Anestrazole half life is 2, 3, 5 days. Can anyone clarify? I am also wondering if I am feeling the effects of high E2 or low. I have not been too consistent with my anestrozole dosage. I started with .5 mg on April 17 (i noticed some nipple swelling/sensitivity and some emotional symptoms) I then continued for 8 days on .25 EOD. At this time body composition, morning wood, and energy seemed good but I felt I was getting a little testy too quickly. I stopped AI for 5 or 6 days and felt great. I don't know if this was the right move but on day 6 I took .25 before bed. When waking and for the next 3 days (the present) i felt pretty foggy and irratable. I think I'm still getting some wood while i sleep but I don't have any urges during the day.
So, if half life is 4 days, would I be feeling the full effects now and maybe over-responding? Or would it make more sense that E2 is up and causing the emotional problems? Its sounds pretty crazy that I have only taken a small amount of AI for a short period of time and it bottomed me out right?
I have labs scheduled on Monday (in 4 days). I'm tempted to take another .25 or less to see what happens. Should I wait and take nothing till after my BW?
I am also going to have my doc prescribe arimidex to be compounded. Should he write it for 0.1 mg daily?

Thanks for all your help everyone!