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  #101  
Old 12 November 2017, 18:09
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I know of someone who goes to a doctor in Greenville SC..who is a part of this company and gives good reviews.

https://www.bodylogicmd.com/bioidentical-hormone-doctors
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  #102  
Old 20 November 2017, 10:24
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Well, got the lab results back Friday, and had a magic number of 135. I will get a full copy of the report later today for more details. Waiting for my own prescription to arrive (TestC, HCG, DIM), and received an initial starter shot at the office IM into the right glute on Friday.

No major changes yet (of course), except I'm able to get more than 2-3 hrs sleep these last few days.

Will advise of progress and more details.

My gut is telling me already I need to change doctors, as this office seems like herding cattle, and with what seems like a large markup. But, at least the ball is rolling, and I have lab results. So, now, I can optimize and fine tune.

Last edited by Tycon; 20 November 2017 at 10:32.
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  #103  
Old 21 November 2017, 20:47
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Lab Numbers, 56yrs old, very active, BP/BG numbers good.

Albumin 4.9g/dl
Estradiol (E2) <5pg/mL
PSA total 2.860ng/ml
Testosterone total 170 ng/dl (not 135 as I remembered)
SHBO 22nmol/L
Testosterone free 3.69ng/dl
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  #104  
Old 22 November 2017, 08:21
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Originally Posted by Tycon View Post
Lab Numbers, 56yrs old, very active, BP/BG numbers good.

Albumin 4.9g/dl
Estradiol (E2) <5pg/mL
PSA total 2.860ng/ml
Testosterone total 170 ng/dl (not 135 as I remembered)
SHBO 22nmol/L
Testosterone free 3.69ng/dl
Oh boy - you'll be glad you checked! 170ng/dl is LOOOOOOOW

1. That Estradiol reading looks like it was done using the Immunoassay, and not Liquid Chromatography/Mass Spectrometry (LC/MS) - you may want to verify and retest that if true. Males should *always* use LC/MS for E2.

2. How many milligrams was the shot? How often did they say you will get/take one?

3. You need to keep a feel on your nipples. DIM is most likely not going to cut it as an Aromatase Inhibitor (which is also why you need that LC/MS E2 reading). I would contact them back and see if they can at least write you a 1 time fill of 1mg Anastrozole *in case of emergency*, ie. it's Friday night and your nipples light up like a Christmas Tree. For ref, I take 500mcg (micrograms - half a tab using pill cutter) for 70mg Test Cyp twice a week (for a total of 140mg Test, 1mg Anastrozole per week).

4. Sleep will improve quickly. But it'll take about 4-6 weeks for levels to stabilize, and when any Estrogen problems may start without an Rx AI.
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  #105  
Old 22 November 2017, 09:59
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Polypro, I sure appreciate your guidance. I wasn't smart enough to ask the size of the "booster" they gave me (last Friday) while my own prescription is being made, but I did ask if I should have another yesterday after 4 days when I went to pickup my lab copy. They said the doctor likes to wait 7 days between shots (IM). So, knowing the halflife it looks like this doc is not up to speed on smoothing out the sawtooth.

I'm going to immediately transfer to the doc that Xenon mentioned after starting this first batch. Hell, he's only 4 miles away, so still convenient. I also watched a couple good vids on your doc too, with good information.

Also kinda pissed me off when I went in yesterday to get a copy of the lab, they still hadn't ordered the Rx so now I'm looking at 10+ days minimum because of them closing for the 4day weekend. I'm not sure I like this dependency on what appears to be a group of "cattle herding" assholes that can't keep up. Got to fix that ASAP.

I'm losing trust (fast) and I may just call today and cancel this order and start over with Xenon's doctor. I should be able to use my copy of these lab results anyway, I hope. Money's just a little tight now, here at the end of the year juggling a bit.

And hell, I'm a cocky arrogant-enough bastard now, at 175...imagine when I "feel good" again at 800-1000~!

Last edited by Tycon; 22 November 2017 at 10:29.
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  #106  
Old 22 November 2017, 10:38
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With getting older, my hormone levels have completely tanked...man it is no joke...hormones rule the body and mind...it's been a horrible past 2 years for me..seriously. I've been trying everything, researching everything under the sun, and finally decided to do HRT...started last week. Nothing earth shattering yet...but just going to keep on keeping on. I'm on an Estrogen/Progestin patch at the lowest dose...and will consider a T shot in the future if my mojo doesn't return...
Not a girl, but raised three and am married to one.....

Make sure you are religious with the big three periodic tests. My wife who is probably a decade older than you followed a similar course of treatment and is convinced that this lead to her breast cancer (Estrogen and Progesten). No free lunches in getting old.

Guys, if you take a test supplement, keep a watch on your PSA for similar reasons.
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Last edited by The Fat Guy; 22 November 2017 at 10:44.
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  #107  
Old 22 November 2017, 12:39
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For women, brand spanking out of the gate:

https://jamanetwork.com/journals/jam...stract/2653735

For guys: Yea, PSA is always good to get, but the latest is that Estrogen is the culprit - which old guys make more of, and the fatter you are, the more you make (fat is where most of the Aromatase enzyme hangs out). If high Test caused Prostate Cancer, we'd have a bunch of sad 20 year olds. DHT is actually used in other countries to treat Prostate problems. But, it's controversial, so do your homework.
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  #108  
Old 11 December 2017, 13:19
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Put everything on hold until I can get started with different doctor. At least I have some idea of the numbers now.

Just didn't have a good "gut feeling" about the "herding cattle" method of that office. To many opportunities for FU, and price much higher than polypro's advice. Will try again after the holidays at the new doc Xenon had good experience with.
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  #109  
Old 16 December 2017, 14:14
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Originally Posted by Polypro View Post
For women, brand spanking out of the gate:

https://jamanetwork.com/journals/jam...stract/2653735

For guys: Yea, PSA is always good to get, but the latest is that Estrogen is the culprit - which old guys make more of, and the fatter you are, the more you make (fat is where most of the Aromatase enzyme hangs out). If high Test caused Prostate Cancer, we'd have a bunch of sad 20 year olds. DHT is actually used in other countries to treat Prostate problems. But, it's controversial, so do your homework.
Soy supposedly increases estrogen, too.
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  #110  
Old 18 March 2018, 08:07
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For 256 et, al.

Good on that tech to run your hormones after TBI. There's a condition called a benign pituitary adenoma that causes low T in young males (which is a simple surgery to reverse), so it doesn't surprise me that you had a problem after a head injury. What are your Total and Free Test numbers, as well as your SHBG (Sex Hormone Binding Globulin) and Estrodiol (E2)? Individual responses vary, but 100mg is low for me. I'm at 180mg/week, and you want your trough (the lowest point before your next injection) to be as high as possible in the therapeutic range. My first Doc was a 'regular Joe' who wouldn't budge off of 100mg because I was 500ng/dl - which sucks for TRT because if you're going through the trouble to get Rx'd TRT, why not optimize it? It's like telling a Thyroid patient to only take a smidge of Synthroid - NO, you take enough to be perfect.

If you were told to give blood - you may be genetically pre-disposed to high Hematocrit and RBC from it - that's not a given, my numbers are in range at 180mg. But if you have to, you have to - you help someone else out and feel great at the same time.

If you are not on HCG, DHEA, and Pregnenelone, ask your Doc. HCG is a Leutinizing Hormone (LH) mimetic, and in addition to having receptors all over the body for it (meaning it is needed), it will reverse the testicular atrophy resulting from the exogenous Testosterone (there are two cells in there - Leydig and Sertoli - one makes sperm, the other makes Testosterone - those shrink when you are on TRT). 10 units a day is all you need. But if your Doc doesn't deal with a compounding pharmacy, the name brand stuff is EXPENSIVE! I get mine from Empower Pharmacy out of TX and it's affordable. If you are using insurance though, then I guess it doesn't matter. DHEA and Pregnenlone are OTC supplements - I get mine at Life Extension Foundation. 100mg Preg 2x/day and 25mg DHEA sublingual 2x/day. But check your DHEA with blood work to verify you need it - most after age 40, do.

Last edited by Polypro; 18 March 2018 at 08:31.
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  #111  
Old 18 March 2018, 08:13
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What is hard , is I am in my early 50s. Yet we want to still eat, havevsame appetite as when we were in the Army in our early 20s.

Learning have to , and force myself to, eat smaller portions - use smaller plate. And certain foods have to severely restrict like pizza, cheeseburgers, fries, ice cream, cake etc.

And have to keep active move more. I find out that 3 - 5 shorter 15-20 minute workouts spread throughout the day, is much better than one long gym session or one long cardio session.

Lifted weights 15 minutes earlier this morning. Then did 20 minute martial arts just a bit ago. Later this morning do 22 minutes on eliptical trainer. This afternoon take dog on about a 40 minute walk. Then in evening do 15 minutes on water rower.
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  #112  
Old 18 March 2018, 22:06
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For 256 et, al.

Good on that tech to run your hormones after TBI. There's a condition called a benign pituitary adenoma that causes low T in young males (which is a simple surgery to reverse), so it doesn't surprise me that you had a problem after a head injury. What are your Total and Free Test numbers, as well as your SHBG (Sex Hormone Binding Globulin) and Estrodiol (E2)?
This was the very first results I got from the VA lab tests. I appreciate you taking the time to type this out. It's slightly embarrassing but I also want it to get out to others because it took my doc a LONG time to make the connection. I was only 32 at the time of these results (33 now).


From what I remember the results listed below are the first test.

Albumin 4.4 g/dL 3.9 - 4.9 g/dL
Sex Hormone Bind GLB 20 nmol/L 14 - 82 nmol/L
Testosterone 206 ng/dL 193 - 824 ng/dL
A testosterone level in the 193-320 ng/dL range with associated clinical symptoms is considered low and may indicate hypogonadism (from NEJM 2010 363:123-135). Results >320 ng/dL are considered normal.
Testosterone, Free Calculation 46.0 pg/mL 38 - 120pg/mL
Testosterone, Percent Free 2.2 % 1.1 - 2.6 %
Testosterone, Bioavailable 126.8 ng/dL 105 - 324 ng/dL


These are the results after a week, before another injection.

Albumin 4.7 g/dL 3.9 - 4.9 g/dL
Sex Hormone Bind GLB 19 nmol/L 14 - 82 nmol/L
Testosterone 203 ng/dL 193 - 824 ng/dL
A testosterone level in the 193-320 ng/dL range with associated clinical symptoms is considered low and may indicate hypogonadism (from NEJM 2010 363:123-135). Results >320 ng/dL are considered normal.
Testosterone, Free Calculation 44.3 pg/mL 38 - 120 pg/mL
Testosterone, Percent Free 2.2 % 1.1 - 2.6 %
Testosterone, Bioavailable 130.2 ng/dL 105 - 324 ng/dL

I would give you my more recent results but I can't seem to find them. This was the test when they started me on Test. It's very frustrating because it seems there's more bro-science out there about TRT. The "bros" seem to know more about this than anyone else. My Doc always seems confused about what he wants to do. Now he's concerned my pituitary gland is ok and wants to take me off Test completely so he "figure out" what's going on. SO now that I finally feel normal again he wants me to stop completely. I read a lot about TRT and thought about mentioning HCG but I get worried about him thinking I'm drug seeking. My testes are SUPER small. He said they look normal from a guy on 100mg of Test a week.

At first, he had me on 50mg every other week. I felt worst then than not being on anything at all. Again, it seems most Doctors are very confused about how to treat this. Everyone I talk to about it says 100mg a week is too low, but my Doc tells me it's too high. The VA Endo seems ultra confused and I thought about taking it to the TRT Clinic in Cleveland and just paying them to get it done correctly.
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  #113  
Old 18 March 2018, 22:13
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What is hard , is I am in my early 50s. Yet we want to still eat, havevsame appetite as when we were in the Army in our early 20s.
I always HATED cardio, running, biking it's all so boring to me. What I don't mind doing is throwing my Alicepack (40 pounds) on grabbing up the pooch and walk a few miles. It's low impact and it gets the heart rate up. It's no EIB standard (I blame the dog, she's old lol) but I can clear my mind and get a good cardio session in.
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  #114  
Old 19 March 2018, 06:56
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At first, he had me on 50mg every other week. I felt worst then than not being on anything at all. Again, it seems most Doctors are very confused about how to treat this. Everyone I talk to about it says 100mg a week is too low, but my Doc tells me it's too high. The VA Endo seems ultra confused and I thought about taking it to the TRT Clinic in Cleveland and just paying them to get it done correctly.
You need a new doc IMO. This is typical of non-specialists (and I don't mean even regular Endo's either) - they went through one 2hr block in medical school and haven't kept up with the latest research/real world results.

50mg EOW is f'n INSANE! Just enough to suppress what little production you had, but not enough to do anything therapeutic - no doubt you felt worse.

He should have started you on 100mg/wk and waited at least a month to do another blood draw - your natural production doesn't immediately stop - it trickles down - so in the first week or two, your numbers are a combination of natural and exogenous - it's a false read. After a month you will get a true read on what the levels are.

My idiot (original clueless D.O.) did the same thing even though I protested - had me draw blood after a week: I was 850'ish and he claimed success. I said "watch what happens in a month" and emailed him the results of bloodwork I had done myself: I was back down to 550. He fired me after that, LOL! <--- Yeah dude, I know more than you. Best thing that ever happened because It forced me to quit being a cheap ass and go to one of the the best TRT guys in the country.

I also see your guy never pulled Estradiol? (and didn't Rx an Aromatase Inhibitor) I'd love to know what your Estrogen is at right now? You have any nipple sensitivity? For men, it has to be the LC/MS Sensitive Estradiol test, don't let them run the normal one - it's inaccurate for males. But maybe your not a high aromatizer and don't need an AI at your current dose? You probably will if you go higher though.

Your situation is why trying to do TRT through insurance is just a crap shoot PITA, unfortunately. You either have to spend weeks/months conducting interviews with prospective doctors on your plan to find one that knows the deal, or you get the type of treatment you (and I) got. And now he wants to pull you off!? What did he do to fix your Pituitary? Shake-My-Head.

Luckily, paying out of pocket for TRT isn't that expensive (but I guess that's an individual call). That's what I'm doing.
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  #115  
Old 20 March 2018, 08:57
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You need a new doc IMO. This is typical of non-specialists (and I don't mean even regular Endo's either) - they went through one 2hr block in medical school and haven't kept up with the latest research/real world results.
Seems a quick look at Testosterone.com would provide them better information.

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50mg EOW is f'n INSANE! Just enough to suppress what little production you had, but not enough to do anything therapeutic - no doubt you felt worse.
Yeah, I had zero motivation, and I was tired all the time regardless of the amount of sleep I got.

Quote:
Originally Posted by Polypro View Post
He should have started you on 100mg/wk and waited at least a month to do another blood draw - your natural production doesn't immediately stop - it trickles down - so in the first week or two, your numbers are a combination of natural and exogenous - it's a false read. After a month you will get a true read on what the levels are.
Can you just write me a prescription, 180 a week sounds good? I just need to be more assertive when it comes to speaking with my doctor.

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My idiot (original clueless D.O.) did the same thing even though I protested - had me draw blood after a week: I was 850'ish and he claimed success. I said "watch what happens in a month" and emailed him the results of bloodwork I had done myself: I was back down to 550. He fired me after that, LOL! <--- Yeah dude, I know more than you. Best thing that ever happened because It forced me to quit being a cheap ass and go to one of the the best TRT guys in the country.
I didn't know your doctor could fire you as a patient. I wouldn't mind paying to go to the TRT clinic in Cleveland, but the price seemed outrageous to me ($1,800 for six months). If that's the going rate for people that know what they are doing, I assume it's a small price to pay. When I spoke to them about my labs, the doc at the TRT clinic told me my doc was treating it incorrectly.

Quote:
Originally Posted by Polypro View Post
I also see your guy never pulled Estradiol? (and didn't Rx an Aromatase Inhibitor) I'd love to know what your Estrogen is at right now? You have any nipple sensitivity? For men, it has to be the LC/MS Sensitive Estradiol test, don't let them run the normal one - it's inaccurate for males. But maybe your not a high aromatizer and don't need an AI at your current dose? You probably will if you go higher though.
I don't have any sensitivity issues, but I am going to request that the next time I am in to see him. Maybe I should make that call now for him to add it to the requested labs.

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Your situation is why trying to do TRT through insurance is just a crap shoot PITA, unfortunately. You either have to spend weeks/months conducting interviews with prospective doctors on your plan to find one that knows the deal, or you get the type of treatment you (and I) got. And now he wants to pull you off!? What did he do to fix your Pituitary? Shake-My-Head.
My TRT started with primary care Cleveland Clinic Doc, but he didn't find the cause (pituitary gland, initially). That's when he did the 50mg every other week. Then my primary care VA doc said she wanted to find out why I had low Test in the first place and sent me to the VA Endo, he did the Cat-scan, found the pituitary issue (he related it to the TBI issue) and increased it to 100mg because of the fed back I gave him. My Primary care VA doc was satisfied with that. Just a couple weeks ago a new Endo took over at the Cleveland VA and called me in for an appointment. He thought my pituitary gland looked fine and wanted me to start to gradually decrease my injection amount every week until I wasn't on it at all. He explained that my dose was too high and he wants to find the cause.

This is where I start to get frustrated because I know what looms with being back to low levels of Test; back to feeling like shit. Every Doc has their opinion of what should be and what shouldn't. Maybe I need to call around and send my lab results to other TRT clinics or even take a day trip to a better Clinic and see what the prices are because $300 a month seems expensive. That's probably because I know if my Doc knew what the hell he was doing the medication would be really cheap with my insurance.

Seems I would have to get off of Test completely for a while for the TRT clinic to reevaluate my labs, maybe that's off.

Quote:
Originally Posted by Polypro View Post
Luckily, paying out of pocket for TRT isn't that expensive (but I guess that's an individual call). That's what I'm doing.
Not to mention they actually specialize in the treatment. As you originally said, I need to find a new doc. If you didn't mind, could you PM me what you pay for your treatment from the TRT clinic?
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  #116  
Old 20 March 2018, 10:32
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I don't go to a "TRT Clinic", I go to one guy in private practice - he's considered one of the best guys in the country - Dr John Crisler.

http://www.allthingsmale.com/newpt.html

You can drive or fly in for the initial consult, or he can work with your physician (which I suspect may be like pulling teeth with a VA doc ((or any))).

The initial "Set Up" is a little pricey because you need multiple adjustments to get optimized - so it's $595 initial consult + meds (~$75) + blood work (~$250 at DiscountedLabs) after ~2 weeks (if you are already on therapy/suppressed. Probably 4-6 weeks if just starting). Depending on how you respond, there may be another increase, so it's $75 follow up, and bloods again. I think I had 4 sets of bloods done between Aug 1 and Dec 1 when I was "tuned up".

But after that, it's pretty cheap - he only needs to see you (or do a phone consult) twice a year to be an active patient, so that's $150 - and 2 sets of bloods is ~$500.

The medications will depend on what you want - you can get 10ml vials (3-4months depending on your final dosage amount) of Watson Testosterone Cypionate at CVS, using the free too use GoodRx(.com) program for $45. Generic Anastrozole is $6 at Kroger (3 months at 1mg/week) GoodRx again. Pregnenolone and DHEA are OTC supplements (Life Extension Foundation).

I just get everything through Dr. Crisler and the Compounding Pharmacy he uses - it's just easier (online ordering) and only a tad more expensive. I'd say a year of Test, AI, and HCG is ...$800?

That $3600 you got quoted seems really high to me - but that's how those places can be - you pay but don't get jerked around. If you can drive to Cleveland, you can drive to Lansing me thinks

Last edited by Polypro; 21 March 2018 at 07:39.
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  #117  
Old 20 March 2018, 11:18
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If you can drive to Cleveland, you can drive to Lansing me thinks
Driving to Lansing means I have to drive through Ann Arbor, gross.

Thank you for all the information.
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  #118  
Old 21 March 2018, 07:08
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Driving to Lansing means I have to drive through Ann Arbor, gross.

Thank you for all the information.
No prob. I wish more 'oldsters' would get sex hormone levels checked and hop on if qualified - I don't care if you *think* you feel fine now - I thought I did too... and I was 300. Just wait until you're in the 900s - new life.
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