Labs results doc wants me on test cream....HCG?

[rally]

Some have mentioned I was secondary hypogonad. My doc wants to put me on test cream I have the obvious reservations being 28 and single and one day wanting to have kids when I don't feel like **** all the time. Some of mentioned this HCG stuff. I get the theory behind it as it helps mimic LH and if you look at mine it is pretty low considering how low my testosterone is. Can I do HCG only and raise my Test? Or do I need to do the cream. Do I need to worry about making more Estrogens. How do you buy this stuff? Mail order only? How is it dosed? Is it something you take everyday or skip? How much and how quickly will it raise my testosterone because as my doc sees it he wants my free at about 200 and my understanding from others is my total needs to be about 800 for my age. So I have a significant rise I need to do. And if I really need to be on testosterone to make them rise that much and not be able to have kids I can do that to. Can you PM for a good source if you think it will do any good for me to start it? Do I need to lower my Estradiol? Will DIM work for this? Armidex is way to expensive for me. For the record I have been check and I am currently (before meds) fertile. Just a little concerned about this whole once I go on.......deal. I have some other issues such as low cortisol (which I am taking cortisol for, high reverse T3, low aldosterone, lowish DHEA and possible hypoT. Any ideas?

Testosterone Total 390 (250-1100 ng/dl)
Testosterone Free 66.7 (46-224 pg/ml)
Testosterone Bioavailable 151.7 (110-575 ng/dl)
SHBG 22 (7-49 nmol/l)
Albumin 5.0 (3.6-5.1)
Sed rate 1 (<=15 mm/h)

FSH 3.7 (1.6-8.0 mIU/ml)
LH 2.6 (1.5-9.3 mIU/ml)
Progesterone .8 (<1.4 ng/ml)
estradiol 39 (13-54 pg/ml

Thanks

[rally]

Also a previous doctor had given me compounded test cream but I never used it. What is a normal replacement dose? The prescription says Chrysin/Test TDB 40/50mg/.5 ML cream. How much is this? What is a normal dose?

[thenxtgrt1]

HCG monotherapy could possibly work for you. It definitely worked for me. Test raised dramatically. Keep a close eye on estrogen levels. HCG can cause it to spike. Arimidex only costs me about $45 (may be different with your insurance). Also, DIM isn't technically an aromatase inhibitor. Therefore, it may not get the job done.

[chilln]

Can I do HCG only and raise my Test? Or do I need to do the cream. Do I need to worry about making more Estrogens. How do you buy this stuff? Mail order only? How is it dosed? Is it something you take everyday or skip? How much and how quickly will it raise my testosterone because as my doc sees it he wants my free at about 200 and my understanding from others is my total needs to be about 800 for my age.


Dr Crisler created the following article which answers most of these questions:
http://musclechatroom.com/forum/showthread.php?t=34



So I have a significant rise I need to do.

And if I really need to be on testosterone to make them rise that much, and not be able to have kids, I can do that to.

Can you PM for a good source if you think it will do any good for me to start it?


You're getting way ahead of yourself. If your low testosterone is low due to a varicocele,
http://en.wikipedia.org/wiki/Varicocele
...then you may be able to get that corrected, with a one-time-only surgical procedure, and your testosterone should recover to higher levels of the procedure was reasonably successful at correcting or minimizing the problem.

If your testosterone is low due to stress related issues then you can correct that too without supplementing with any hormones, and without supplementing with arimidex.

If your testosterone is low due to insulin resistance, then you can correct that too, without supplementing with any hormones, and without supplementing with arimidex.

The test you used to measure E2 could be grossly inaccurate, because your E2 is below the threshold of accuracy, for the test method which was used.

You'll need to get your E2 measured again, but this time using a more accurate test. Eg; Quest's "Estradiol, Ultra Sensitive 30289X" test. You may discover that it's actually lower than 39 pg/mL, and that you don't need arimidex.

DIM rarely lowers E2. DIM lowers 16OH-E1 which lowers E3 (estriol). In a small minority of people, this feeds back and lowers E2.



Do I need to lower my Estradiol? Will DIM work for this? Armidex is way to expensive for me. For the record I have been check and I am currently (before meds) fertile. Just a little concerned about this whole once I go on.......deal. I have some other issues such as low cortisol (which I am taking cortisol for, high reverse T3, low aldosterone, lowish DHEA and possible hypoT. Any ideas?

Again, you're getting ahead of yourself.

You should always start out looking at your nutritional balance and your mental stressors.

hardasnails1973 explained it well in this post:
http://musclechatroom.com/forum/showpost.php?p=30909&postcount=3

...which is one of the responses to Shrike's post here:
http://musclechatroom.com/forum/showthread.php?t=2652

[rally]

Like I said before I do have wilson's syndrome (high reverse t3 on blood work) and possible hypoT, low cortisol. I suppose any of these could cause low Test. However I also have alot of low hormones which points to maybe being hypopitutatary. I know its been said before that I need the ultrasensitive however on a saliva test my estradiol was also elevated which points in the "I have elevated estrogen" direction.

[chilln]

Like I said before I do have wilson's syndrome (high reverse t3 on blood work)

I'm going blind. I performed a search, and this is the only thread you've posted on this forum. Where did you say this before ?


I know its been said before that I need the ultrasensitive

I assume from your post that when you say this, that you're referring to the general consensus among us, that the ultra sensitive test is the most reliable test to measure E2 (estradiol) in males.

Could you please confirm my understanding is correct ?



however on a saliva test my estradiol was also elevated which points in the "I have elevated estrogen" direction.

Saliva tests for testosterone are definitely bogus, for the reasons explained in my earlier post here:

http://musclechatroom.com/forum/showpost.php?p=12712&postcount=1

That means that saliva tests for estradiol are most likely bogus too, because males make estradiol from testosterone.

Ie: since the levels of testosterone in the salivary glands can never be representative of normal tissue, then so too will the levels of estradiol in the salivary gland never be representative of normal tissue.

You still need to discuss with your medical professional adviser to get an ultra sensitive E2 test done. That requirement has not changed.

###

Have you and your medical professional adviser ever confirmed that your insulin sensitivity is good, or that your physical and/or mental stressors are mild ? These two factors can also cause what you are describing, and they can be rectified without having to resort to supplementing with hormones.

[rally]

In my case my saliva labs coincide with my blood labs. (strange but true) I have had stress it started with a crash diet 4 years ago I think that is when I developed the high RT3 and low cortisol. The cortisol I am taking is greatly helping but my temps basal underarm still run about 96. Daily oral averages 98.0 I think this is mostly because of the high RT3. However there is no amount of physical mental stress that I can reduce at this point so scratch that idea! I feel hormonally sick.

(I said I had high RT3 in the original message)

[JanSz]

In my case my saliva labs coincide with my blood labs. (strange but true) I have had stress it started with a crash diet 4 years ago I think that is when I developed the high RT3 and low cortisol. The cortisol I am taking is greatly helping but my temps basal underarm still run about 96. Daily oral averages 98.0 I think this is mostly because of the high RT3. However there is no amount of physical mental stress that I can reduce at this point so scratch that idea! I feel hormonally sick.

(I said I had high RT3 in the original message)
Apparently you had done more tests thatn you posted here.

Post all tests that you had done in last few years.
post it by date

analyte name, value, units, range, name of laboratory

[rally]

This stuff was done in 12-18-08. I was on NO meds.


(taken at 9 am)
Vitamin D 35
Renin 2.4 (.65-5.0 ng/ml/h)
Aldosterone 7 (4-31 upright) and it was taken upright
Cortisol 17.2
DHEA-S 231 (110-510 mcg/dl)

ACTH 44 (this was done two weeks prior to all these tests and cortisol was 18.9)

Testosterone Total 390 (250-1100 ng/dl)
Testosterone Free 66.7 (46-224 pg/ml)
Testosterone Bioavailable 151.7 (110-575 ng/dl)
SHBG 22 (7-49 nmol/l)
Albumin 5.0 (3.6-5.1)
Sed rate 1 (<=15 mm/h)

FSH 3.7 (1.6-8.0 mIU/ml)
LH 2.6 (1.5-9.3 mIU/ml)
Progesterone .8 (<1.4 ng/ml)
estradiol 39 (13-54 pg/ml)
PSA .5 (<=4.0 ng/ml)
T3 Free 333 (230-420 pg/dl)

DHT 25 (25-75 ng/dl)
T3 Reverse 42 (11-32 ng/dl)

Na: 139
K: 4.3

FT4 1.2 (.8-1.8)
FT3 321 (230-420)
TSH 2.31 (.40-4.50

Saliva Cortisol

7-9 am .67 (.27-1.18)
11am-1pm .28 (.10-.41)
3pm-5pm .23 (.05-.27)
10pm-12am .03 (.03-.14)

DHEA 7am-9am 423 (71-640)

[chilln]

Since your E2 levels are likely to be a big deal, and when testosterone (total, free, bioavailable) is low, then arimidex is the most likely candidate to lower E2.

But you've already stated that you cannot afford arimidex to lower your E2.

Therefore you should definitively confirm that your E2 is high, using a test which we agree is going to give you a definitive result.

To definitively confirm that your E2 is high you will need to use a test which we all recognize as being a reliable test to measure a male's E2 levels (not a female's E2 levels). Ie: the Quest Ultra Sensitive 30289X.

To definitively confirm that your E2 is high you would not use any test which we all recognize as being unreliable when measuring a male's E2 levels. Eg: you would not use the standard E2 test for females, and you would not use salivary E2.



In my case my saliva labs coincide with my blood labs (strange but true)

I think you mean that your serum E2 lies at the same point within the reference range as your salivary E2 (approx 25% down from the top), and from this you have concluded that your E2 is therefore high.

I know for certain that your salivary E2 levels will not equal your serum total E2 levels (39 pg/mL).

###

Unfortunately the serum test you used is inaccurate, and the saliva test you used is not representative of either serum levels or cellular levels.

The fact that these two metrics lie at the same point within their reference ranges, is a fascinating statistic, but neither of them is definitive of your absolute serum E2 levels.

###

The reasons for the irrelevance of salivary E2 testing was discussed in my previous post within this thread.

###

The serum E2 test you used is inaccurate at this low end where the male E2 range lies. To address this problem, Quest spent considerable time and money developing the ultra-sensitive E2 test.

Please read page 72 (per the page number printed on the pages) of the following Quest Diagnostics Manual:
http://www.questdiagnostics.com/hcp/intguide/EndoMetab/EndoManual.pdf
...where it states that the ultra sensitive test was designed to detect E2 levels in women with menopause.

Male E2 levels should normally be around 20 pg/mL, which is close to the levels of women with menopause, ie under 10 pg/mL.

Normal women expect to see average E2 levels around 375 pg/mL - which is where the female test is most accurate. The female E2 test is least accurate around the 39 pg/mL mark (the lowest point during a female's monthly cycle, for an aging female still experiencing a menstrual cycle)

###

Conclusions (thus far) re E2:

If you want to take arimidex, then stick with your current E2 measurements, because that's where you're likely to be headed.

If you want to avoid having to take arimidex, then at least get your E2 measured via a test which we agree is going to tell you where your E2 is really at - and you may discover that your E2 is actually lower than it is, and that you don't need arimidex.



Also a previous doctor had given me compounded test cream but I never used it. What is a normal replacement dose? The prescription says Chrysin/Test TDB 40/50mg/.5 ML cream. How much is this? What is a normal dose?

There is no normal dose of Chrysin.

There is a sinister problem with Chrysin which is debilitating for males. This debilitation outweighs the positive effect of Chrysin's aromatase inhibition.

Chrysin is far less than optimum for male health because it also blocks the action of a high percentage of human 17β-hydroxysteroid dehydrogenase type 5.

17β-hydroxysteroid dehydrogenase type 5 is the enzyme responsible for the following conversions:
a) androstenedione <---> testosterone
b) androstenediol <--> androsterone

Since we males need these conversions to take place at their uninhibited levels, therefore we don't want chrysin in our systems.

reference:
"Phytoestrogens inhibit human 17β-hydroxysteroid dehydrogenase type 5"
http://gbic.biol.rug.nl/~rbreitling/publications/HSD5Inhibition.pdf

[rally]

No my saliva test for estradiol was over the reference range.

So what does CHR/TEST/ TDB 40/50MG/.5ML cream mean?

I am guessing 50 mg of testosterone per .5 ml of cream.

What is a normal dose of test in a cream of .5 ml for replacement. My doc said this was low just wondered how low and what is a normal replacement.

I'll see if my doc will order the ultrasensitive. (he should) However irregardless of that won't I need to be on test anyways. Or can I just get away with HCG? Or do I need to do both? How bad are my levels? Are they likely to be causing my issues?

[JanSz]

This stuff was done in 12-18-08. I was on NO meds.


(taken at 9 am)
Vitamin D 35
Renin 2.4 (.65-5.0 ng/ml/h)
Aldosterone 7 (4-31 upright) and it was taken upright
Cortisol 17.2
DHEA-S 231 (110-510 mcg/dl)

ACTH 44 (this was done two weeks prior to all these tests and cortisol was 18.9)

Testosterone Total 390 (250-1100 ng/dl)
Testosterone Free 66.7 (46-224 pg/ml)
Testosterone Bioavailable 151.7 (110-575 ng/dl)
SHBG 22 (7-49 nmol/l)
Albumin 5.0 (3.6-5.1)
Sed rate 1 (<=15 mm/h)

FSH 3.7 (1.6-8.0 mIU/ml)
LH 2.6 (1.5-9.3 mIU/ml)
Progesterone .8 (<1.4 ng/ml)
estradiol 39 (13-54 pg/ml)
PSA .5 (<=4.0 ng/ml)
T3 Free 333 (230-420 pg/dl)

DHT 25 (25-75 ng/dl)
T3 Reverse 42 (11-32 ng/dl)

Na: 139
K: 4.3

FT4 1.2 (.8-1.8)
FT3 321 (230-420)
TSH 2.31 (.40-4.50

Saliva Cortisol

7-9 am .67 (.27-1.18)
11am-1pm .28 (.10-.41)
3pm-5pm .23 (.05-.27)
10pm-12am .03 (.03-.14)

DHEA 7am-9am 423 (71-640)

Vitamin D 35
DHEA-S 231 (110-510 mcg/dl)

Testosterone Total 390 (250-1100 ng/dl)
SHBG 22 (7-49 nmol/l)
Albumin 5.0 (3.6-5.1)
FSH 3.7 (1.6-8.0 mIU/ml)
LH 2.6 (1.5-9.3 mIU/ml)

Progesterone .8 (<1.4 ng/ml)
estradiol 39 (13-54 pg/ml)
DHT 25 (25-75 ng/dl)

T3 Reverse 42 (11-32 ng/dl)
FT4 1.2 (.8-1.8)
FT3 321 (230-420)

Some have mentioned I was secondary hypogonad. My doc wants to put me on test cream I have the obvious reservations being 28 and single and one day wanting to have kids when I don't feel like **** all the time. Some of mentioned this HCG stuff.
================================================== ====================

You need good doctor.
So far your present doctor may play that role for you if he agrees to your requests.

Right now you know that you need to take Vit D and DHEA pills
Start with 6000iu Vit D and 100mg/day DHEA pills, latter do blood test, goal is:

VitD(50-100ng/mL(125-250)nmol/L
DHEAs(500-640)
================================================== ====================
You have to do good thyroid test. From what you posted, you missing antibodies and elements.
You will have to fight high RT3, it is done using Wilson's protocol. Basically one uses slow release T3 until his T4 and RT3 are v low or zero. I do not have more details on this. Google.
Supposedly the process lasts couple months and then you back to regular either no support or some support using Armour.
Currently your FreeT3 low, you are at 48% with your FreeT3, you want to be in upper 1/8 of range.
So after a sufficient course of T3 you will transfer to Armour.
But before you do anything with your RT3, do complete blood testing, you may be also lacking minerals, you may have antibodies.

Watch and support adrenals when you are either on T3 or Armour.
Make any dose changes slow.
With what you show now, you may be marginal with your Adrenals.
Before you start anything make sure that your DHEAs>500
I would even say that you should be on 25mg/day Cortef (10+5+5+5) at least during your use of T3.
When you done with RT3 and changing to Armour, you may want to reassess your use of Cortef.

Thyroid/adrenals tests (at Quest Diagnostics, blood drawn at Quest

7 • Iodine Panel - (2503)
8 Selenium
9 Copper, serum
10 Zinc

17 • Iron and Iron Binding Capacity (7573X) - (356N)
18 • Iron, Total (571X) - (24984P)
19 • Ferritin (457X) - (22764P)
20 • Transferrin (891X) - (30346P)
21 • Folate, RBC & Hematocrit - (1768N)
22 • Hemoglobin A1c (496X) - (45484P)
23 • Hemoglobin, Plasma (514X) - (7211P)

27 T3 Free
28 T4,Free
29 reverse T3 (rT3)
30 Ultrasensitive TSH
31 Thyroid Peroxidase and Thyroglobulin Antibodies (7260X)

37 Aldosterone
38 Cortisol Binding Globulin (Transcortin) (37371X)
39 Cortisol AM/PM
40 DHEA sulfate
41 Prolactin - (746X)


================================================== ====================
================================================== ====================

Your E2 is highish and DHT is low.
TT, LH & FSH are low, very good chance that you are Secondary (wanting to have kids).

You should really do good testing at this point.
Eliminate any glucose/insulin, cholesterol, metabolic problems.

If you are fat, bad diet and no exercise, you should do much more testing first plus change your life style.
If you are trim, eat good and in good shape otherwise, you may want to act now.

No matter what you do otherwise in this area, do not do less than 250iu HCG EOD EveryOtherDay.
Some will say E3D.
This is to support your testicles (remember you want to have kids).
Supply of HCG are erratic, do not start until you have at hand 6-9 months supply of HCG and 3months supply of syringes. HCG is best in small packages, 2000iu and less.
Stay on 250iu EOD and see what that does for you, test 2 months after starting HCG.
When actually trying to conceive, if there is some problem you may go as high as 1750iu/EOD (6000iu/week)
Without conception in mind your HCG dose will be someplace (250-600)iu/EOD
Overly high HCG dose will increase your E2 production.
You are already high on E2.
Bottom line, you want to have maximum HCG dose that will not increase E2 excessively.
You may have to control high E2 using Arimidex(pills)=Liquidex(liquid)=Anastroxole(liqui d).
Your maximum dose of Arimidex is 1.5mg/week
So Arimidex will tell you how much HCG to use, Arimidex will be limiting your HCG dose.

Using HCG you should get your TT higher.
It may be high enough or not.
You have to do blood testing periodically.
If it is not high enough, you will have to add external testosterone.
External can be either transdermal or injectable.
Testosterone applied on daily basis do not (usually) raise E2.
Transdermal testosterone (applied daily) raises DHT.
At this moment your DHT is low, if it is similar while you are on HCG then you will have to use some transdermal testosterone to raise it.
================================================== ====================
Testosterone related tests

42 FSH
43 LH
44 Progesterone, LC/MS/MS - (17183X)
45 Pregnenolone, LC/MS/MS (31493X)
46 Estradiol, Ultrasensitive, LC/MS/MS (30289X)
47 Estrone, LC/MS/MS (23244X)
48 Testosterone, Free, Bio/Total (LC/MS/MS) Code: 14966X
49 Dihydrotestosterone (204X)
========================================

Goals

E2(25-29)
DHT(60-90)
BAT(460-575) (BioAvailableTestosterone
=========================================

Good luck.


/

[chilln]

You will have to fight high RT3, it is done using Wilson's protocol.

You may want to substitute the words "it is done using Wilson's protocol" with "it may be able to be done with Wilson's protocol".

The reason I am bringing this to your attention is that this Wilson's protocol has not yet been brought to the attention of Dr Crisler via this forum, and I'm concerned that Dr Crisler may not necessarily agree that the protocol will provide reliable results (lower RT3 for a substantial period following treatment).

###

You may wish to raise this as a separate thread, in which case let's see if Dr Crisler chimes in. Until then, we should treat this Wilson's protocol article as experimental, rather than as a definitive therapy to address a special set of circumstances.

###

From the following statement I see you haven't tried this therapy yourself, so we should definitely consider this therapy as experimental, until we get better confirmation.


Basically one uses slow release T3 until his T4 and RT3 are v low or zero. I do not have more details on this. Google.
Supposedly the process lasts couple months and then you back to regular either no support or some support using Armour.

[JanSz]

You may want to substitute the words "it is done using Wilson's protocol" with "it may be able to be done with Wilson's protocol".

The reason I am bringing this to your attention is that this Wilson's protocol has not yet been brought to the attention of Dr Crisler via this forum, and I'm concerned that Dr Crisler may not necessarily agree that the protocol will provide reliable results (lower RT3 for a substantial period following treatment).

###

You may wish to raise this as a separate thread, in which case let's see if Dr Crisler chimes in. Until then, we should treat this Wilson's protocol article as experimental, rather than as a definitive therapy to address a special set of circumstances.

###

From the following statement I see you haven't tried this therapy yourself, so we should definitely consider this therapy as experimental, until we get better confirmation.

I have started new thread here:


http://musclechatroom.com/forum/showthread.php?t=2666

/
/

[rally]

You mentioned raising DHEA. For some reason DHEA on my saliva elevated, in the blood not so good you mentioned raising it about 500. How much would a 220 pound 6'3 male take to do this?

Thanks

[JanSz]

You mentioned raising DHEA. For some reason DHEA on my saliva elevated, in the blood not so good you mentioned raising it about 500. How much would a 220 pound 6'3 male take to do this?

Thanks

I am using (blood) DHEAs test at Quest to figure out my DHEA needs.

.