First I must divorce any misconception this is the first flirtation with TRT. About 8 years ago, after taking the blood pressure medication Prinzide – a combination Thiazide diuretic/ACE inhibitor – I had a collapse after four days. Profound in nature, this event changed my life. From a strapping young man capable of 100 push-ups, I could not longer manage even 10. A visit to a local endocrinologist indicated all of my endocrine systems were compromised. Suddenly I was diabetic, I became seriously depressed, and all of my muscles experienced a weakness that was frightening. This included my diaphragm and I required a velcro weight belt to provide support and assist in relieving any weight on the diaphragm just so I could breathe.
I immediately began to treat the depression, and began an exercise program that consisted of 100 deep-knee bends, as many push-ups as I could handle, and walking for short distances. After the depression resolved itself, additional tests which indicated high cortisol and I barely passed a dexamethasone supression test. Failure of this test is indicative of adrenal issues. Measured testosterone was very low at 185 ng/dL. I decided to treat the testosterone only and attempted both Androgel and Testim, finally deciding on the Testim. I saw many specialists including a neurologist, a lung specialist, a neurosurgeon, and a cardiologist. After over fifty thousand dollars worth of tests they found….nothing wrong. MRIs, stress tests, multiple visits to my general practitioner and nothing, nada, zilch. I first suspected rhabdomyolysis, which testing quickly ruled out. MRIs of the pituitary, hypothalamus, and adrenals were negative. The only conclusion offered by one doctor – I suffered from a variant of Guillain-Barre syndrome, an ascending paralysis that in the worse cases becomes complete, with the patient on a ventilator. The disease usually resolves itself after a period of months, weeks, and sometimes years.
Six months later, with no improvements at all, I awoke one day to find all the symptoms gone. It was like a light suddenly switched on. To this date the only consensus is that I should stay away from ACE inhibitors – a type of blood pressure medication that blocks Angiotensin II, a very potent chemical that causes the muscles surrounding blood vessels to contract increasing the pressure within the vessels thereby causing high blood pressure. With the recovery complete, I decided to stay on TRT. It would be many years before I attempted my first restart protocol. After the protocol failed, I found myself back on TRT and looking for an answer. With the recovery of my the rest of my endocrine system – including the complete reversal of diabetes – it makes sense that my Hypothalamus-Pituitary-Testicular Axis (HPTA), involved in testosterone regulation and production, would recover as well. As long as I had left it alone. With years of HPTA suppression the chance of a spontaneous recovery was slim to none. Hence the attempt to restart. When this failed, I visited my general practitioner whose heart was in the right place but whose knowledge of TRT left much to be desired. With a simple total testosterone test, the conclusion to start me on Testosterone Cypionate at 100mg/week began. This is where my recent experience and education start. As the details below note, this latest adventure lead me to Dr. Daniel Freeland and Shawn Bean. This is my story to date. Future posts will begin to detail labs related to the information below, which is merely a synopsis of my experience with the various methods of TRT for the past 8 months and is not exhaustive of my personal experience during this time.
Test Cypionate. Wow. What a month I had. Libido – through the roof. Erections? Top notch. Muscle gains – out of this world. Weight loss, lean body mass, mood improvement – fantastic. Six weeks in – everything remained the same except for two items – libido and erection quality. Both dropped off not just a little but completely. The reason is related to the bodies response to initial TRT. There is a strong dopergenic affect that lead to the brain desensitizing to the effects of dopamine over a short period of time. While sensitivity is regained, the proper balance of dopamine is directly related to many other systems propranolol sans ordonnance. Something else was also going on in my body. Only two weeks away from an anniversary cruise I panicked. The GP, flummoxed, called an endocrinologist who recommended an increase in my dose. As my hemaocrit levels were already high I refused. I was just beginning to push myself into polycythaemia, a condition no heart patient wants to find themselves in – especially one with 25 stents. Also, there was very little liklihood the increase would have worked. Why? Even though I had never had SHBG, E2, or DHT measured I already guessed the answer. My bet was my E2 was screaming high and DHT was low. Gels increase DHT far more than shots through the 5-AR enzyme, present in the body, but also found on the skin . The more surface area covered by a gel, the higher the DHT. E2 can also increase, but I needed something and I needed it fast. I decided to test out my theory by visiting Dr. Freeland.
I switched to Testim immediately with 250IU HCG every three days. By the time my cruise date arrived, I was able to once again perform and my mood was markedly improved. As Androgel’s efficacy left much to be desired for me in the past, I decided on the Testim. One problem. My insurance does not cover Testim. Even with Auxilium’s coupon of $75 and Costo’s lower cost of $300 compared to most pharmacies charging over $375, I was looking at paying $225/month. It would get worse. Soon I would find that I required more than just the 5 gram tube of Testim and that 10 grams, spread across two applications, provided optimum results. The coupon worked for just one box of 5g tubes. Therefore, the total cost to me now was $525/month. Still, I tried it for about three months, loathe to attempt the compounded creams or Androgel. During this time I played around with Arimidex (which I will never do again), and varied my HCG dosing as multiple labs were drawn. It was then I decided, after prodding by Dr. Dan Freeland, to give Androgel another go, this time using more of the gel than my prior attempt all those years ago.
Starting with 6g 2x per day and 250IU of HCG I noted very high levels of testosterone – over 1200 ng/dL. Also, the levels were constant enough dropping to around 900 ng/dL the following morning. Dosing twice per day is important for me. I am insulin resistant, driving my SHBG low. A single application under these conditions drives my Free-T so high my body dumps testosterone into estrogens as fast as possible and excretes the rest. Measurements the following morning would be at hypogonadal levels. Dosing at twice a day mitigates this effect. However, at 1200 and 900ng/dL (two hours after application on day one, and before application on day two) I experienced a breakout of bad back acne. The above protocol with Androgel included times where HCG was used and also not used. The usual protocol recommended by Shawn is to use gel only first, get the levels where you want them, then add in HCG for additional subjective and physiological benefits, retest, and adjust the HCG.
Lowering the dose to 5g 2x/day seemed to help, but for reasons unknown to me at this time, my E2 levels on Androgel, unlike Testim, were low normal and low respectively for the two measurements. I added HCG back in at 100IU every three days and did note a drop in testosterone, high free-T, high DHT, high normal E2, and high E1.
Since this last lab, HCG dosing changed to 50IUs every three days. My next labs due to be drawn in a few weeks will indicate my state under this new protocol with Androgel and HCG. Low ferritin levels were also noted at this time with suspected thyroid issues being the possible culprit. However, so much blood was drawn over a two week period that I suspect one of two things – too many blood draws or gastrointestinal bleeding – a complication of Plavix use for some patients. Being on Plavix for over 5 years now, this later case cannot be ruled out.
It was also during this time that a complete Nutra-Eval from Genova Diagnostics was reviewed by both Dr. Freeland and Shawn Bean (who specializes in interpreting these tests). Multiple supplements were recommended and follow up labs in two weeks will recheck ferritin levels as well as look at the thyroid in detail.
Shawn’s ultimate goal is to get my body the proper building blocks and resolve any outstanding health issues to give the next restart protocol the best chance at success. The adventure continues.
Filed under: Testosterone Replacement
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