Thoughts on my new Doc's advice?

[jaybird151]

Finding a good HRT Doc is beyond frustrating to say the least.

Background:

Came off after extended use and tried to get my levels back up and could not. Felt like absolute shit during the time that i tried to get them back up. Only was able to get total test up to a level of 205.

Went through a few different docs, and during that time i settled in on 100mg per week. The doc that had me on that insisted that i have to come in and get the injections in the office, i tried to plead my case but finally had to leave and find another doc.

All of this was around 4 weeks worth of time from when i took my first shot. After this 4 week mark i started to feel like shit again, and was fairly sure it was estrogen related. I didnt want to mess up my new blood-work with this doc so i waited until i got the BW done ( which was today).

Well i was right and my estrogen was almost dbl normal ( Estrone, Serum).

I will attach the blood-work but here are the main things.

Total test: 766 ng/dl range -- 348-1197
Free Test: (high) 34.85 ng/dl range -- 5-21
Estradiol: 25.6 pg/ml range -- 7.6-42.6
Estrone, Serum (high) 124 pg/ml range -- 12-72

Vitamin B-12 (low) 188 pg/ml range -- 211-946


My thoughts on all this was to keep the test dosage at 100mg per week and add an anti estrogen to pull that back in line. I told him i like where my total test number is and i would like to keep that at or near that 700ish number. He said, " I dont care what the total test numbers are all i care about is the free test and your free test is too high as well as the estrogen. I am advising that we cut the test dosage in half to 50mg per week and aim to get your free test to 15ng/dl and the estrogen will come back in line."

Now all i really want to do is feel good again, been feeling like ass for way too long.

My question is, if you were me would you follow his advice of trying to aim for a free test of 15ng/dl and not worry at all what the total test comes in at? Backing down to 50mg a week will drastically lower my total test as i will be cutting that dosage in half from where i am at now.

Or would you stay at 100mg a week and add in some armidex or whatever to bring that estrogen back in the 20-30ish area?

I felt pretty good the first 4 weeks but after the estrogen started to build up is when i started feeling like shit again, so i am thinking since i felt good on 100mg per week before the estrogen built up then i am wanting to get back to that area of time when i felt good.

If i do what he wants to do it is going to be around 6 weeks of this until i see him again and i am not sure i want to risk feeling like ass for that long.

Also, he started me on B-12 injections once per month to get those levels up, and said that will probably help in making me feel better.

One last thing, he said that i have a Goiter Thyroid. Did an ultrasound and it was enlarged but he didn't see anything that looked to be of a concern as far as growths or anything. ( all my thyroid numbers are in the normal ranges)


I would appreciate anyone's advice on this one.

Thanks

 

[Stewie]

Discuss with your physician to be checked for hypo pituitarism.
Also
You may want to discuss with your physician about checking to see if your elevated E1 (Estrone) levels are Aromatization of Androstenedione generally adrenal related, the testicles and the brain are other areas that produce Androstenedione at a lesser degree, most circulating E1 is derived from the Peripheral tissue.

You may also ask to have your DHEA-S and SHBG levels checked.

Reducing the amount of mg per week doesn't necessarily mean your FT will drop proportionally to your TT, in other words yes your FT should come down as will your TT, but you still may have a higher amount of FT to an unequilibrium balance of TT.


Taking an AI will lower your E1,E2 and E3 levels, but this will also lower your possibly already low SHBG as well as raising your FT.... your situation, maybe not such a good idea

 

[Stewie]

Also as far as your B-12 levels being a little low, that may be from a depletion from something else you may of or maybe something interfering with the absorption of B-12, Have you taken Metformin recently or any other meds?

 

[alpha6164]

I am not sure why your physician is testing estrone. Estrone since it can come from many other sources than just conversion of test to estrogen is not a reliable means of detecting "estrogen" in a male. Estradiol is more accurate and yours seems pretty good.

 

[jaybird151]

Discuss with your physician to be checked for hypo pituitarism.
Also
You may want to discuss with your physician about checking to see if your elevated E1 (Estrone) levels are Aromatization of Androstenedione generally adrenal related, the testicles and the brain are other areas that produce Androstenedione at a lesser degree, most circulating E1 is derived from the Peripheral tissue.

You may also ask to have your DHEA-S and SHBG levels checked.

Reducing the amount of mg per week doesn't necessarily mean your FT will drop proportionally to your TT, in other words yes your FT should come down as will your TT, but you still may have a higher amount of FT to an unequilibrium balance of TT.


Taking an AI will lower your E1,E2 and E3 levels, but this will also lower your possibly already low SHBG as well as raising your FT.... your situation, maybe not such a good idea

I will get that bloodwork done and see where it comes in at. So if my SHBG comes back low and that paired with the FT being so high would that mean I have hypo pituitarism?


I guess i am a little confused on how my FT is so high but my total is in range----- based on 100mg per week.

Also as far as your B-12 levels being a little low, that may be from a depletion from something else you may of or maybe something interfering with the absorption of B-12, Have you taken Metformin recently or any other meds?

no

 

[jaybird151]

I am not sure why your physician is testing estrone. Estrone since it can come from many other sources than just conversion of test to estrogen is not a reliable means of detecting "estrogen" in a male. Estradiol is more accurate and yours seems pretty good.

I have no idea.

What are your thoughts on him not caring about TT and wanting me to cut the 100mg per week dose in half to 50mg. He wants to bring my FT in at 15 and he says FT is all that matters TT doesnt matter at all.

Would you advise someone to do anything about that high Estrone # or not worry about it at all?


Any thoughts about why my TT is in range but FT is so high, and if i were to have a low SHBG how that would relate to all of it?

thanks

 

[Stewie]

I am not sure why your physician is testing estrone. Estrone since it can come from many other sources than just conversion of test to estrogen is not a reliable means of detecting "estrogen" in a male. Estradiol is more accurate and yours seems pretty good.

I agree, why some physicians Pull Total Estrogen baffles me, or in this young mans case Estrone,although it may or may not hold evidence too something more relevant other than Testosterone induced hypogondism.

 

[Stewie]

I will get that bloodwork done and see where it comes in at. So if my SHBG comes back low and that paired with the FT being so high would that mean I have hypo pituitarism?


I guess i am a little confused on how my FT is so high but my total is in range----- based on 100mg per week.



no

Hypopituitarism can be caused by several things, have you been hit in the nose area, fight, bike wreck or any thing of the such?
This will give you a brief overview
Hypopituitarism: Causes - MayoClinic.com
Estrone and Estradiol are subsets of Estrogen, Estradiol is Aromatization from Testosterone, Estrone is Armomatization from DHEA,which Androstenedione is a metabolite of of DHEA, both of these hormones are produced by the Adrenal Glands,they both convert to Estrone.

Why is your FT above range..... ? Hard to say, are you taking any nettle root or any over the counter supplements that act as an AI, 6-Oxo any thing?

 

[jaybird151]

Hypopituitarism can be caused by several things, have you been hit in the nose area, fight, bike wreck or any thing of the such?
This will give you a brief overview
Hypopituitarism: Causes - MayoClinic.com
Estrone and Estradiol are subsets of Estrogen, Estradiol is Aromatization from Testosterone, Estrone is Armomatization from DHEA,which Androstenedione is a metabolite of of DHEA, both of these hormones are produced by the Adrenal Glands,they both convert to Estrone.

Why is your FT above range..... ? Hard to say, are you taking any nettle root or any over the counter supplements that act as an AI, 6-Oxo any thing?

I have not been hit or had a bike wreck or anything.

i will look at that link and read up on it.


No, not taking any nettle root or any supplements that would act as an AI.


So, if i understand what you are saying. A possible reason that my Estrone is so high could possibly tie into my DHEA levels, or no?

i will go and get SHBG and DHEA checked and see what they come in at.



thanks

J

 

[jaybird151]

Does anyone think that a B-12 level of 188 pg/ml from a range of 211-946 can make you feel like total shit?

What is weird is once i started the HRT i felt pretty good and then around 4 weeks later started feeling like ass again. So i thought it was the estrogen but Alpha said that the Estradiol was more important and it is in normal range.

Not sure what the deal is but i do not feel good at all, i know that much.

 

[jaybird151]

Hypopituitarism can be caused by several things, have you been hit in the nose area, fight, bike wreck or any thing of the such?
This will give you a brief overview
Hypopituitarism: Causes - MayoClinic.com
Estrone and Estradiol are subsets of Estrogen, Estradiol is Aromatization from Testosterone, Estrone is Armomatization from DHEA,which Androstenedione is a metabolite of of DHEA, both of these hormones are produced by the Adrenal Glands,they both convert to Estrone.

Why is your FT above range..... ? Hard to say, are you taking any nettle root or any over the counter supplements that act as an AI, 6-Oxo any thing?

Bold above----- So Testosterone cannot convert to Estrone at all?

Why would the DR want me to reduce my test dose in half in order to lower that ? Or he may have just said that bec he wants my FT to be lower, and tried to use that as a supporting reason to convince me.

I may need to YET AGAIN try and find a new DR.

 

[alpha6164]

Does anyone think that a B-12 level of 188 pg/ml from a range of 211-946 can make you feel like total shit?

What is weird is once i started the HRT i felt pretty good and then around 4 weeks later started feeling like ass again. So i thought it was the estrogen but Alpha said that the Estradiol was more important and it is in normal range.

Not sure what the deal is but i do not feel good at all, i know that much.

Yes your B12 is low. We never go by that range. No matter what 200-400 is not even normal. Do this find a clinic, urgent care center that administers B12 shots. They are usually $15-20. Go get one daily for five days straight, then one injection weekly for four weeks, then once injection monthly. I promise you by end of 2nd week you will feel 100 times better. Also we dont adjust TRT based on free test levels. Reducing your testosterone dosage to half does not necessarily cut your free test by half they are different ratios. Also since a healthy male produces 12-17mg of test daily it takes more than 50mg weekly to replace what a healthy male will produce in one week. I suggest find another doc.

 

[Stewie]

Yes, your DHEA S levels may be high and or your Androstenedione may be high causing a high conversion too Estrone.

Or

Elevated Estrone can be also caused by a pituitary tumor possibly causing hypo pituitarism ...An MRI would be best suited.

Or may be just a one time high lab value?
I would discuss these things with your physician.

 

[jaybird151]

Yes your B12 is low. We never go by that range. No matter what 200-400 is not even normal. Do this find a clinic, urgent care center that administers B12 shots. They are usually $15-20. Go get one daily for five days straight, then one injection weekly for four weeks, then once injection monthly. I promise you by end of 2nd week you will feel 100 times better. Also we dont adjust TRT based on free test levels. Reducing your testosterone dosage to half does not necessarily cut your free test by half they are different ratios. Also since a healthy male produces 12-17mg of test daily it takes more than 50mg weekly to replace what a healthy male will produce in one week. I suggest find another doc.

Thanks i will try that and see if that helps the way i am feeling.

Would you be concerned at all about that Estrone level or not worry about it?

Thanks

J

 

[jaybird151]

Yes, your DHEA S levels may be high and or your Androstenedione may be high causing a high conversion too Estrone.

Or

Elevated Estrone can be also caused by a pituitary tumor possibly causing hypo pituitarism ...An MRI would be best suited.

Or may be just a one time high lab value?
I would discuss these things with your physician.

Ok thanks

I will get those labs done and see where they come in at.

I will need to find a new DR to discuss it all with though. maybe the 5th one will be the lucky number.

Thanks,

J

 

[Stewie]

Finding a good HRT Doc is beyond frustrating to say the least.

Background:

Came off after extended use and tried to get my levels back up and could not. Felt like absolute shit during the time that i tried to get them back up. Only was able to get total test up to a level of 205.

Went through a few different docs, and during that time i settled in on 100mg per week. The doc that had me on that insisted that i have to come in and get the injections in the office, i tried to plead my case but finally had to leave and find another doc.

All of this was around 4 weeks worth of time from when i took my first shot. After this 4 week mark i started to feel like shit again, and was fairly sure it was estrogen related. I didnt want to mess up my new blood-work with this doc so i waited until i got the BW done ( which was today).

Well i was right and my estrogen was almost dbl normal ( Estrone, Serum).

I will attach the blood-work but here are the main things.

Total test: 766 ng/dl range -- 348-1197
Free Test: (high) 34.85 ng/dl range -- 5-21
Estradiol: 25.6 pg/ml range -- 7.6-42.6
Estrone, Serum (high) 124 pg/ml range -- 12-72

Vitamin B-12 (low) 188 pg/ml range -- 211-946


My thoughts on all this was to keep the test dosage at 100mg per week and add an anti estrogen to pull that back in line. I told him i like where my total test number is and i would like to keep that at or near that 700ish number. He said, " I dont care what the total test numbers are all i care about is the free test and your free test is too high as well as the estrogen. I am advising that we cut the test dosage in half to 50mg per week and aim to get your free test to 15ng/dl and the estrogen will come back in line."

Now all i really want to do is feel good again, been feeling like ass for way too long.

My question is, if you were me would you follow his advice of trying to aim for a free test of 15ng/dl and not worry at all what the total test comes in at? Backing down to 50mg a week will drastically lower my total test as i will be cutting that dosage in half from where i am at now.

Or would you stay at 100mg a week and add in some armidex or whatever to bring that estrogen back in the 20-30ish area?

I felt pretty good the first 4 weeks but after the estrogen started to build up is when i started feeling like shit again, so i am thinking since i felt good on 100mg per week before the estrogen built up then i am wanting to get back to that area of time when i felt good.

If i do what he wants to do it is going to be around 6 weeks of this until i see him again and i am not sure i want to risk feeling like ass for that long.

Also, he started me on B-12 injections once per month to get those levels up, and said that will probably help in making me feel better.

One last thing, he said that i have a Goiter Thyroid. Did an ultrasound and it was enlarged but he didn't see anything that looked to be of a concern as far as growths or anything. ( all my thyroid numbers are in the normal ranges)


I would appreciate anyone's advice on this one.

Thanks

I overlooked,this please post your thyroid labs.

 

[Stewie]

Finding a good HRT Doc is beyond frustrating to say the least.

Background:

Came off after extended use and tried to get my levels back up and could not. Felt like absolute shit during the time that i tried to get them back up. Only was able to get total test up to a level of 205.

Went through a few different docs, and during that time i settled in on 100mg per week. The doc that had me on that insisted that i have to come in and get the injections in the office, i tried to plead my case but finally had to leave and find another doc.

All of this was around 4 weeks worth of time from when i took my first shot. After this 4 week mark i started to feel like shit again, and was fairly sure it was estrogen related. I didnt want to mess up my new blood-work with this doc so i waited until i got the BW done ( which was today).

Well i was right and my estrogen was almost dbl normal ( Estrone, Serum).

I will attach the blood-work but here are the main things.

Total test: 766 ng/dl range -- 348-1197
Free Test: (high) 34.85 ng/dl range -- 5-21
Estradiol: 25.6 pg/ml range -- 7.6-42.6
Estrone, Serum (high) 124 pg/ml range -- 12-72

Vitamin B-12 (low) 188 pg/ml range -- 211-946


My thoughts on all this was to keep the test dosage at 100mg per week and add an anti estrogen to pull that back in line. I told him i like where my total test number is and i would like to keep that at or near that 700ish number. He said, " I dont care what the total test numbers are all i care about is the free test and your free test is too high as well as the estrogen. I am advising that we cut the test dosage in half to 50mg per week and aim to get your free test to 15ng/dl and the estrogen will come back in line."

Now all i really want to do is feel good again, been feeling like ass for way too long.

My question is, if you were me would you follow his advice of trying to aim for a free test of 15ng/dl and not worry at all what the total test comes in at? Backing down to 50mg a week will drastically lower my total test as i will be cutting that dosage in half from where i am at now.

Or would you stay at 100mg a week and add in some armidex or whatever to bring that estrogen back in the 20-30ish area?

I felt pretty good the first 4 weeks but after the estrogen started to build up is when i started feeling like shit again, so i am thinking since i felt good on 100mg per week before the estrogen built up then i am wanting to get back to that area of time when i felt good.

If i do what he wants to do it is going to be around 6 weeks of this until i see him again and i am not sure i want to risk feeling like ass for that long.

Also, he started me on B-12 injections once per month to get those levels up, and said that will probably help in making me feel better.

One last thing, he said that i have a Goiter Thyroid. Did an ultrasound and it was enlarged but he didn't see anything that looked to be of a concern as far as growths or anything. ( all my thyroid numbers are in the normal ranges)


I would appreciate anyone's advice on this one.

Thanks

I overlooked this,please post your thyroid labs.
If you have any liver panels pulled, this may help in some direction of your elevated Estrone, SHBG is produced by the liver,Estrone among other hormones are bound to SHBG.

Have you had any digestive issues?

 

[jaybird151]

I overlooked this,please post your thyroid labs.
If you have any liver panels pulled, this may help in some direction of your elevated Estrone, SHBG is produced by the liver,Estrone among other hormones are bound to SHBG.

Have you had any digestive issues?

sorry just saw your two posts above

The doc never ordered a full thyroid panel and he only pulled TSH.

I am getting additional blood-work done this week, doing these myself.

cortisol
DHEA
SHBG
Vit D
full thyroid panel

Then will be getting the blood-work done by him a few weeks later.


I have dropped my test dose down to 50mg a week ( going to do what he wants until i find a new doc or just do it all myself), feel worse than i did before which is not surprising at all.

Also started B-12 injections, he started me on 1 injection a month. Following what Alpha said above, i got 1 injection 5x this week and will do another one once per week for 4 weeks then maintain that at 1x per month.

 

[jaybird151]

Digestive issues?

Yes, when all this started however many months ago, I had a stomach virus which lasted longer than normal. Chronic diarrhea coupled with extreme brain-fog. The stomach issue faded out but the brain-fog and just out of it feeling never left.

Currently, i still have some diarrhea that comes and goes. The days that i do get it, it is usually just a few times in the morning and it is fine the rest of the day.

 

[smc252]

sorry just saw your two posts above

The doc never ordered a full thyroid panel and he only pulled TSH.

I am getting additional blood-work done this week, doing these myself.

cortisol
DHEA
SHBG
Vit D
full thyroid panel

Then will be getting the blood-work done by him a few weeks later.


I have dropped my test dose down to 50mg a week ( going to do what he wants until i find a new doc or just do it all myself), feel worse than i did before which is not surprising at all.

Also started B-12 injections, he started me on 1 injection a month. Following what Alpha said above, i got 1 injection 5x this week and will do another one once per week for 4 weeks then maintain that at 1x per month.

This doctor is fucking retarded fuck tart. Why doctors no longer use science, facts and listen to their customers/patients, I do not comprehend.

Without knowing free t3 and free t4, you have NO CLUE what the actual thyoid is doing.TSH IS A FUCKING PITUITARY HORMONE! That is like testing LH to blindly judge a mans testosterone levels, it makes no sense, ESPECIALLY if there is a goiter!

Honestly, I have been a victim of the range doctors for over 10 years. I have been told several times that 300ng/dl is normal for a 20-something year old man. Fuck that! Even at 100mg/wk I dont quite feel right and my estradiol is out of range. I too have thyroid issues, so I know how it ties into all of this. When I took .5mg of adex 2 or 3 times a week, my estradiol went from 60 to 20.0 and I felt like a rockstar. Now I am out of liquidex and my endo is a twat who is too minimalistic in her approach to medicine. If I know what worked, why the hell not listen? lol doctors :banghead:

Get tested on 50mg/wk and whine about it. Some doctors don't listen unless you fucking put up a fight.

On a side note, estrone should be in range, but estradiol is MUCH stronger and you should be glad you are not dealing with this.

Like others have said, your estrone likely ties into your thyroid or liver issues,; adrenal insuffiency and thyroid disease go hand-in-hand. Treat your adrenals first, then thyoid, then testosterone if needed. That is the newest approach to these hormonal issues. a 24-hour cortisol piss test means more than a blood test too, fyi.