Should I be on TRT?

[garcia]

Hi all, my labs are as follows:

FSH 2.6 IU/L (1.5-12.4)
LH 5.7 IU/L (1.7-8.6)

Total T 11.2 nmol/L (9.9 - 27.8)
(=323 ng/dL)
SHBG 15 nmol/L (11-52)
Calculated Free T 90 pg/mL

Bioavailable T 5.59 nmol/L (2.0-9.0)
(= 161.1 ng/dL)

My question is should I be on TRT??

As a background I have stage 4 adrenal exhaustion (low cortisol, very low dhea), and have thyroid issues (high RT3).

Many thanks,
garcia

[Randall64]

How old are you?

[hardasnails1973]

How do you feel?
Are you over trained, undereating
Possible have zinc and selenium deficeincy effecting thyroid function

Being placed on TRT based upon numbers is ludicrous idea
If you feel great and T of 350-450 then your wasting time thinking about TRT.
Question is "why do you have adrenal issue?" Did you correct the cause of the problem rather then bandaiding it? This is problem with modern medicine treat symptoms never the cause.

[garcia]

I'm 36.
I feel absolutely lousy. I have major endocrine dysfunction and have been sick for many years now. Unable to work. Pretty much housebound. My diagnosis is CFS/ME.

I supp zinc & selenium regularly.

I know why I have adrenal issues (toxicity & infections). The problem is that to follow the protocols for a cure is very stressful on the adrenals. I'm not looking for a "cure", rather I'm looking for endocrine support so that I can undertake the cure.

I wanted to know if undertaking TRT seemed reasonable based on my labs, or whether it was crazy given my bio T isn't so low.

Any other interpretation of my labs (e.g. the low SHBG and implications) would be very welcome.

[hardasnails1973]

House bound
Been there done that. Out of work for 4 years. Told it was all in my head seen shrinks disproved it. I had infections as well horrible dysbiosis and leaky gut. Need to take care of this issue before even thinking about healing the adrenals. IT will be like trying to filling a bucket with hole in it with water without taking care of the holes. This is where traditional dr's are treating symptoms not causes. You supplement zinc, but is it getting absorbed? Is it the right type for your body..You need proper thyroid function to absorbed zinc hence why low thyroid causes low testosterone. You are taking zinc, but its not being uptake into the tissue due to low thyroid. Correcting thyroid will increase LH.. You could qualify for TRT or try to go after the cause which is infections depleted your adrenals and thyroid (join the crowd).

[garcia]

> Need to take care of this issue before even thinking about healing the adrenals.

Been there done that. I tried to take care of the issue for years. Nothing worked. Dysbiosis is a symptom not the disease.

> Correcting thyroid will increase LH.

I can't correct thyroid since my adrenals are fried, and before supping thyroid you need to get adrenal support in place.

I can't supp any meaningful level of h/c since my androgens are so low (in particular dhea), which means I get side effects from about 10mg onwards (e.g. hyperglycemia etc.).

I can't correct my dhea since even low amounts (e.g. 5mg) make me deeply depressed and send my already low levels of cortisol to zero.

I've been going after the cause - treating the infections for the last 2 years. Its been absolutely hellish. My adrenal fatigue has gone from bad to worse and I've gotten to the point where I can't even try and do that anymore.

[JanSz]

> Need to take care of this issue before even thinking about healing the adrenals.

Been there done that. I tried to take care of the issue for years. Nothing worked. Dysbiosis is a symptom not the disease.

> Correcting thyroid will increase LH.

I can't correct thyroid since my adrenals are fried, and before supping thyroid you need to get adrenal support in place.

I can't supp any meaningful level of h/c since my androgens are so low (in particular dhea), which means I get side effects from about 10mg onwards (e.g. hyperglycemia etc.).

I can't correct my dhea since even low amounts (e.g. 5mg) make me deeply depressed and send my already low levels of cortisol to zero.

I've been going after the cause - treating the infections for the last 2 years. Its been absolutely hellish. My adrenal fatigue has gone from bad to worse and I've gotten to the point where I can't even try and do that anymore.

Rocky road, no kiddig.

What other problems do you have, overweighted, sugar, ....?

I would say that you should support any part of your systems that you are able to support.

That would mean, yes use testosterone (in moderation) untill you figure out what it does for you.
================================================== ====

You probably have a tonns of tests.
Post as many of them as you can.
It would be a good idea to tie those tests with any changes in medications that you may have had at before making those tests.
================================================== ====

You may not know how you will react to testosterone,
start with Androgel, 5grams/day

Androgel is the best transdermal testosterone product,
also it is in and out within a day or so,
so if you may have a problem tolerating testosterone, Androgel should be the least obtrusive.

Because you have thyroid problem, you may not absorb Androgel sufficiently,
but it is a worth of trying.

You should take maximum tolerated amounts of

DHEA pills (up to 100mg/day)
Cortef (up to 30mg/day)
Androgel (up to 15grams/day)

since you have wery high RT3 it would be a good idea to try Cytomel-T3
you may want to have close ties with your doctor and order variety of size Cytomel pills. But only 5mcg now.

You would want to take them equally time spaced, about one dose every 3x/day

You will start with 5mcg/dose (15mcg/24hrs)
Any dose increases after 7 days on current dose.

Assume that with present discussion you will newer go higher than Cytomel-T3 75mcg/day
With proper doctor's guidance, it may go as high as 150mcg/day.
----------------------------------------------------------------
http://www.rxlist.com/cytomel-drug.htm
Cytomel
5 mcg debossed SKF and D14;
25 mcg scored and debossed SKF and D16;
50 mcg scored and debossed SKF and D17.
----------------------------------------------------------------

Read post #41 on this thread.
http://musclechatroom.com/forum/showpost.php?p=33636&postcount=41

If you are able to raise KYDD
he may be of good help to you.

He did not posted in a while, PM him after suitable amount of time.
http://musclechatroom.com/forum/search.php?searchid=116445
-------
http://musclechatroom.com/forum/showpost.php?p=35169&postcount=10

""Quote""
Finally she researched & asked Doc for DHEA Gelatin Troche. She wanted to avoid PEG (toxin & allergen) based Troches. She also insisted on NO flavourings & NO sweeteners (apparently some compounders use Aspartame).

The Troches work very well she has been on them for about a year now.
--------------------------------------------------------

There are also a total basics.

Get all available vitamin and minerals tests.
Supply where defficient.
Thougher when high on toxic eklements.

You may want to do a blood (serum and RBC) tests, also you may want to do Hair test.
-----------------

[garcia]

Thanks very much for the post JanSz!

> What other problems do you have, overweighted, sugar, ....?

Underweight by about 1 stone. Can not put on any weight. As weak as a kitten. Debilitating fatigue. Poor digestion. Dysbiosis, etc. etc. Sleep 11 hours a day.

> I would say that you should support any part of your systems that you are able to support.

I wholeheartedly agree with this philosophy!!

> You probably have a tonns of tests. Post as many of them as you can.

You can find a brief history / tests here:
http://forums.realthyroidhelp.com/viewtopic.php?f=11&t=11800&p=93113#p93113

> You should take maximum tolerated amounts of DHEA pills (up to 100mg/day) Cortef (up to 30mg/day)

Unfortunately I can't tolerate DHEA, despite my body needing it, because it makes me very depressed and drops my cortisol to zero. Also I can't tolerate more than 10mg cortef without getting lots of icky side effects (e.g. hyperglycemia), I suspect because my androgens are so low.

> since you have wery high RT3 it would be a good idea to try Cytomel-T3

Yes this is a good idea and I'm doing it, but I can only tolerate about 10-15mcg a day due to my adrenal fatigue. There is no way I could tolerate 75mcg a day - it would cause me to crash severely.

Thanks for the T3 post, I'd come across it a couple of months back when I was researching all this. I'm familiar with the t3 protocol for RT3 problems, and would dearly like to follow it, but I can't tolerate much in the way of t3 due to the adrenal fatigue.

(Incidentally from time to time when I've used t3 I've felt fantastic, got a big reduction in adrenal stress, but only transient).

I can't address my underlying health problems (mercury, chronic infection) because I don't have the necessary endocrine health to undertake the detox.

But my hormonal issues are a complete mess. How to sort out?

[JanSz]

Thanks very much for the post JanSz!

> What other problems do you have, overweighted, sugar, ....?

Underweight by about 1 stone. Can not put on any weight. As weak as a kitten. Debilitating fatigue. Poor digestion. Dysbiosis, etc. etc. Sleep 11 hours a day.

> I would say that you should support any part of your systems that you are able to support.

I wholeheartedly agree with this philosophy!!

> You probably have a tonns of tests. Post as many of them as you can.

You can find a brief history / tests here:
http://forums.realthyroidhelp.com/viewtopic.php?f=11&t=11800&p=93113#p93113

> You should take maximum tolerated amounts of DHEA pills (up to 100mg/day) Cortef (up to 30mg/day)

Unfortunately I can't tolerate DHEA, despite my body needing it, because it makes me very depressed and drops my cortisol to zero. Also I can't tolerate more than 10mg cortef without getting lots of icky side effects (e.g. hyperglycemia), I suspect because my androgens are so low.

> since you have wery high RT3 it would be a good idea to try Cytomel-T3

Yes this is a good idea and I'm doing it, but I can only tolerate about 10-15mcg a day due to my adrenal fatigue. There is no way I could tolerate 75mcg a day - it would cause me to crash severely.

Thanks for the T3 post, I'd come across it a couple of months back when I was researching all this. I'm familiar with the t3 protocol for RT3 problems, and would dearly like to follow it, but I can't tolerate much in the way of t3 due to the adrenal fatigue.

(Incidentally from time to time when I've used t3 I've felt fantastic, got a big reduction in adrenal stress, but only transient).

I can't address my underlying health problems (mercury, chronic infection) because I don't have the necessary endocrine health to undertake the detox.

But my hormonal issues are a complete mess. How to sort out?

1 Stone = 14 Pounds

do you have a hearthburn?

have you had Colonoscopy and Gastroscopy, if not ask for it

be happy that you are able to sleep 11 hrs/day
in your situation that ability helps.
.
.

[chilln]

> I would say that you should support any part of your systems that you are able to support.

I wholeheartedly agree with this philosophy!!


and



I can't address my underlying health problems (mercury, chronic infection) because I don't have the necessary endocrine health to undertake the detox.

But my hormonal issues are a complete mess. How to sort out?



Sounds to me like you're financially cash strapped, which is why you haven't already flown to Lansing where you can find a medical professional adviser, Dr Crisler, who will manage your issues.

The nasty hard truth about serious endocrine dysfunction (such as yours) is that it takes time to find a medical professional adviser, and big dollars to pay for labs and treatment.

There's nothing else really. You need to accept that a take action accordingly.

Eg: if you can't afford to get your endocrine issues rectified, you need to heal your body using low cost supplements and your body's current minimal resources. That will take years. If you don't have the funds then so be it.

[garcia]

> do you have a hearthburn?

no

> be happy that you are able to sleep 11 hrs/day
in your situation that ability helps.

Believe me it doesn't help. Not one bit. Its not that I am "able" to sleep 11 hours a day, rather that my adrenal fatigue is so severe that if I try and keep normal hours I crash.

> Sounds to me like you're financially cash strapped, which is why you haven't already flown to Lansing where you can find a medical professional adviser, Dr Crisler, who will manage your issues.

Although I'm not loaded with money, we are talking about my life here, so obviously I'd be willing to spend anything necessary if it had health benefits. I live in the UK, and am barely able to travel so flying is not really an option.

Are you saying that Dr C would be able to sort out my hormonal mess??

[JanSz]

> do you have a hearthburn?

no


Actually I was hoping for yes. But previously you have said: "Poor digestion. Dysbiosis,"

Assume that your problems are due to malabsorbtion. Work on improving your digestion.

Take
Betaine hydrochloride with Pepsin
Enzymes
Probiotics

Betaine HCl
http://www.lef.org/Vitamins-Supplements/Item06183/Betaine-HCl.html

Enhanced Super Digestive Enzymes with Probiotics
http://www.lef.org/Vitamins-Supplements/Item01273/Enhanced-Super-Digestive-Enzymes-with-Probiotics.html

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

[hardasnails1973]

Trust me I am very familiar with dysbiosis and bring the body back into balance when dealing with these types of issue. A lot of the people I deal with main issue is the gut and digestions. Once you get these cleared up alot of other hormonal , sleep issue resolve majority of the time depending on other variables biggest one being age. If you are over 28 then you are mostly going to need some TRT support no matter what natural supplements or minerals you take..

[JanSz]

Trust me I am very familiar with dysbiosis and bring the body back into balance when dealing with these types of issue. A lot of the people I deal with main issue is the gut and digestions. Once you get these cleared up alot of other hormonal , sleep issue resolve majority of the time depending on other variables biggest one being age. If you are over 28 then you are mostly going to need some TRT support no matter what natural supplements or minerals you take..

Would you like to help this chap with possibly more detailed guesses.
He is in UK, it is not likely that he will come to Lansing or PA to see proper help.

.
.

[chilln]

Hi all, my labs are as follows:

FSH 2.6 IU/L (1.5-12.4)
LH 5.7 IU/L (1.7-8.6)

Total T 11.2 nmol/L (9.9 - 27.8)
(=323 ng/dL)
SHBG 15 nmol/L (11-52)
Calculated Free T 90 pg/mL

Bioavailable T 5.59 nmol/L (2.0-9.0)
(= 161.1 ng/dL)

My question is should I be on TRT??

As a background I have stage 4 adrenal exhaustion (low cortisol, very low dhea), and have thyroid issues (high RT3).

Many thanks,
garcia


Obviously you have requested help from your medical professional adviser. Are you concerned that your medical professional adviser is hopeless ?

I accept that you are having these issues, and they are complex and inter-related, however are you getting the run-around from your existing medical professional advisers ?

Or are you trying to treat yourself with over-the-counter supps ?

Or are you trying to fix yourself because you have a lack of respect for medical professional advisers in general ?

###

There is a reason why your health has deteriorated to this point, before you started this thread, and I'm trying to uncover why this is so, because what has gone before greatly limits the solution options.

[hardasnails1973]

Would you like to help this chap with possibly more detailed guesses.
He is in UK, it is not likely that he will come to Lansing or PA to see proper help.

.
.

Dr john has international cleints :biggrin:
So it is something to consider..

[JanSz]

Dr john has international cleints :biggrin:
So it is something to consider..

I see clearly your point (behind Biggrin).
For a moment I thought that you do not have to pay rent or eat, my bad.
.
.

[chilln]

I see clearly your point (behind Biggrin).
For a moment I thought that you do not have to pay rent or eat, my bad.
.
.

This guy needs to find a medical professional adviser he can trust.

His problems are way more complex than you or I will ever be able to help him with, via a public forum, or your PMs.

We need to help him find a medical professional adviser, not try to treat him via remote control.

[JanSz]

This guy needs to find a medical professional adviser he can trust.

His problems are way more complex than you or I will ever be able to help him with, via a public forum, or your PMs.

We need to help him find a medical professional adviser, not try to treat him via remote control.

Well, he is located in UK, they must have some cutting edge doctors there.

Or at least doctors who would take directions from dr John and stick to them without adding their own opinion and be able to do this type of consulting work for long time.

Possibly someone from UK knows some promissing names.
.
.
.

[hardasnails1973]

And what did I orginally suggest? :thumbup1:

[LowT]

This thread caught my attention and I signed up from lurking to post (hello!).

Your results are very similar to mine. My serumT was 360 and my freeT was 11. I'm 29. I've also been underweight my whole life despite my best efforts including a strict diet and personal trainer. I sleep 10+ hours per night or else I'm worthless all day. Allergy and other testing show leaky gut symptoms, I've tried all sorts of HCL and enzymes to help with digestion and have seen a gastro. No help. Severe constipation.

I feel awful as do you.

Today is day 2 on TRT for me. I did not see Dr. Crisler as I just found this forum 2 days ago but saw a doctor that some here may be aware of.

He has me on a similar treatment, 2 hCG injections per week and a T cream each day.

Yesterday was my first day and I felt markedly better. Today I feel "OK", I'll see how it goes.

My doctor said that T replacement can sometimes normalize cortisol but there is a chance I will still need to supplement with cortef or similar.

It sounds like you may need to save the funds to make an excursion to the USA to see a real doctor...but there are others like you and I will try and update my results as well.

[garcia]

Thanks for all the replies guys, much appreciated.

I have a CFS doc in the UK. She was very responsive to the info I gave her about TRT. Though she wasn't confident enough to prescribe hcg initially, she did prescribe me T. I could hopefully get a consult with Dr C via her, so that shouldn't be a problem.

The problem for me is knowing whether Dr C is the best person for me to consult. Basically I wasnt someone to help me sort out my endocrine mess. I'm not sure whether that will include testosterone or not.

I say that because my initial experiements with TD test (testim) have not been positive!

My whole reason for looking into T was twofold:

1. when I first got sick I started lifting weights. It helped me big time. Unfortunately I'm too weak to work out now.

2. I started taking h/c recently and didn't do so well on it. I found out that one reason some people with CFS don't do well on h/c is because of low levels of androgens. My dhea levels are below range all day, and that was before I started taking h/c which will drop them even further. Unfortunately I can't supp dhea as it makes me very depressed and drops my already low h/c levels to zero. So in terms of androgens I thought maybe T could help.

Ok so my results with T have been disappointing. It didn't feel like testosterone is supposed to feel, if that makes sense. I have a rough idea what testosterone should feel like, from taking dhea and from working out. With dhea I would wake up happy, relaxed, oily skin, and with morning erections. I got none of that with Testim. Didn't make me feel any stronger, or anything.

I did get water retention. And emotional lability.

What is testosterone supposed to feel like (if anything)? Should I try a different form - there are the caps and the injections I could ask my doc for.

[garcia]

Hi lowT, many thanks for the post. Do keep us updated as to your progress. It sounds like the protocol is working well for you.

[chilln]

Thanks for all the replies guys, much appreciated.

I have a CFS doc in the UK. She was very responsive to the info I gave her about TRT. Though she wasn't confident enough to prescribe hcg initially, she did prescribe me T. I could hopefully get a consult with Dr C via her, so that shouldn't be a problem.

The problem for me is knowing whether Dr C is the best person for me to consult. Basically I wasnt someone to help me sort out my endocrine mess. I'm not sure whether that will include testosterone or not.

I say that because my initial experiements with TD test (testim) have not been positive!

My whole reason for looking into T was twofold:

1. when I first got sick I started lifting weights. It helped me big time. Unfortunately I'm too weak to work out now.

2. I started taking h/c recently and didn't do so well on it. I found out that one reason some people with CFS don't do well on h/c is because of low levels of androgens. My dhea levels are below range all day, and that was before I started taking h/c which will drop them even further. Unfortunately I can't supp dhea as it makes me very depressed and drops my already low h/c levels to zero. So in terms of androgens I thought maybe T could help.

Ok so my results with T have been disappointing. It didn't feel like testosterone is supposed to feel, if that makes sense. I have a rough idea what testosterone should feel like, from taking dhea and from working out. With dhea I would wake up happy, relaxed, oily skin, and with morning erections. I got none of that with Testim. Didn't make me feel any stronger, or anything.

I did get water retention. And emotional lability.

What is testosterone supposed to feel like (if anything)? Should I try a different form - there are the caps and the injections I could ask my doc for.

You sound like you will need the whole suite of hormones for several months until enough of your tissues have started to heal.

Ie: it sounds to me like you may be either temporarily hypopituitary - or worse: permanently hypopituitary.

Hypopituitary means your pituitary is releasing only low levels of pituitary hormones, resulting in low levels of the downstream hormones - which means low GH (growth hormone), low T (testosterone), low Cortisol, low thyroid hormone T3.

This is a serious hormone dysfunction.

Yes Dr Crisler can nail these types of issues, he's that good.

You would need to boost all of these for a while with the hope that your hypopituitary situation is only temporary.

Even if your hypopituitary situation is only temporary, it still requires a very skilled medical professional adviser to manage so many hormones in parallel during those first few months until you can back off some of those hormones.

If your hypopituitary situation is temporary, then you should recover your thyroid and your adrenal hormone production capability, but you won't recover your growth hormone or your testosterone production capability, back to the youthful values of your 20's.

###

In the end you will most likely be on HCG plus either transdermal testosterone or injected testosterone ester for the rest of your life. That's because the reduction in these hormones is genetic - and it happens to all males, not just some.

At your age (36) many males require both TRT and GH boost therapy, even though their health does not dwindle to as low as yours is now.

The best and healthiest way to boost T above your too-low-genetic-limit, is to supplement with HCG and T together.

At your age, you may still be able to boost your GH sufficiently with the older technology GH release peptides - but only during the day. If you accept that you should boost your GH overnight, then you'll need to work with one of the long-acting-but-still-experimental GH release peptides, or recombinant GH.

###

Even if you have to supplement several hormones, once they are in your system, the rest of your tissues will start to heal, and you will feel healthy once more.

ie: it should only take a month or so for you to start feeling the effects of boosting most of your under-performing hormones.

[JanSz]

http://forums.realthyroidhelp.com/viewtopic.php?f=11&t=11800&start=0&st=0&sk=t&sd=a&sid=81ddaf9e1ca18b3be382d7b53c61b923

Garcia's Log

http://forums.realthyroidhelp.com/viewtopic.php?f=11&t=11800&p=93113#p93113

RT3=0.57(0.14-0.54)

This is rather emergency situation.

Among other tests, you should test

TotalT4
TotalT3

================================================== =======
Any time that you are able to accept T3, take it.

.
.

[chilln]

http://forums.realthyroidhelp.com/viewtopic.php?f=11&t=11800&start=0&st=0&sk=t&sd=a&sid=81ddaf9e1ca18b3be382d7b53c61b923

Garcia's Log

http://forums.realthyroidhelp.com/viewtopic.php?f=11&t=11800&p=93113#p93113

RT3=0.57(0.14-0.54)

This is rather emergency situation.

Among other tests, you should test

TotalT4
TotalT3

================================================== =======
Any time that you are able to accept T3, take it.

.
.

This only shows that garcia is most likely hypopituitary (either temporary or permanently).

Until garcia boosts all his major hormones to more optimum levels, he's going nowhere fast.

And the realthyroidhelp forum is definitely NOT going to get his over that hurdle.

[garcia]

Many thanks for the reply Chilln & Jansz,

> Ie: it sounds to me like you may be either temporarily hypopituitary - or worse: permanently hypopituitary.

I've been thinking that may be a possibility for a while now. Do my FSH/LH results suggest hypo-P?
FSH 2.6 IU/L (1.5-12.4)
LH 5.7 IU/L (1.7-8.6)

> Yes Dr Crisler can nail these types of issues, he's that good.

Ok this was the type of endorsement I was looking for. I know I'm dealing with multiple hormones here, so its good to know Dr C can help here.

> You would need to boost all of these for a while with the hope that your hypopituitary situation is only temporary.

ok

> ie: it should only take a month or so for you to start feeling the effects of boosting most of your under-performing hormones.

Well after feeling this bad for so long, if I can start feeling better in a month I will be gobsmacked.

Should I be concerned about my poor response to Testim?

[chilln]

I've been thinking that may be a possibility for a while now. Do my FSH/LH results suggest hypo-P?
FSH 2.6 IU/L (1.5-12.4)
LH 5.7 IU/L (1.7-8.6)


Based on that your pituitary can make LH, but maybe not FSH.

It is very unusual that your FSH is so low when your LH is this high. The pituitary sends out both LH and FSH in approximately equal amounts each time the pituitary is triggered to do so (by a hormone called GnRH).

The half life of LH in serum is a few minutes, and the half life of FSH is around 90 minutes, when your testicles are operating normally. And for normal males, we see both an LH and FSH pulse between every 60 and 90 minutes.

So statistically speaking, a normal male should rarely see their serum LH measured high, because the likelihood of seeing high LH is very low.

But statistically speaking, a normal male should always see their serum FSH measured relatively higher than their serum FSH, because serum FSH lingers much longer than serum LH.

Since your LH was measured relatively high on the day, and since your serum FSH was measured relatively low on the day, this suggests either:

a) your phlebotomist (serum sample collector) fluked it and caught your serum just when your pituitary issued an LH pulse at the 60 to 90 minute mark, and your pituitary is not capable of making much FSH.

or

b) your pituitary is trying to ramp up your testosterone but your testicles are not delivering, and so it sends out LH and FSH pulses so frequently (say every 10 minutes) that it was highly likely that your phlebotomist caught your LH during a pulse. And your pituitary is not capable of making much FSH.

I suspect b) but you could still be a).

You can confirm whether you are a) or b) by one of two ways:

1) Measure your LH over 24 hours, rather than a once-per-day fluke, and show that it's high over 24 hours.

You would measure your 24 hour urinary LH and FSH test via collecting all your urine over 24 ours, and sending a small sample to Mayo Labs in Minnesota.

But you would need to be prepared to pay ~ USD$115 for the test, plus courier of the sample to Minnesota. You tape a small tube of urine to a frozen freezer pack, then wrap closed cell foam around that to keep it all cold, then put that in a FedEx 1 Kg bag, destination Minnesota USA.

2) Alternatively your medical professional adviser can try you on a short term Clomid test. Clomid blocks E2 (estradiol) receptors and this actually boosts LH even higher, and that should boost your testicular testosterone production too.

###

If your LH is continuously high, you should consider what could be causing your testicles to not produce testosterone, ie:

a) Lymes disease

b) Genetic deformity

c) Trauma injury

d) Varicocele (twisted/ knotted tubes in your scrotum), and that may be able to be reversed through surgery - but this surgery is usually only partially successful.

e) ...?

In the short term, until this issue is resolved (if it is ever resolved) you will need to supplement with several hormones which your testicles make, eg: testosterone, DHEA and pregnenolone.

The pregnenolone and DHEA will most likely metabolize into several other hormones, but if they do not, then you'll need to supplement with those too.


[B]

Should I be concerned about my poor response to Testim?


Yes in that it is a strong indicator that your thyroid hormones are way out of balance, because thyroid imbalance causes poor transdermal absorption.

Your medical professional adviser should have known this from your existing thyroid results. But then this is not yet common knowledge in the UK.

[JanSz]

This only shows that garcia is most likely hypopituitary (either temporary or permanently).

Until garcia boosts all his major hormones to more optimum levels, he's going nowhere fast.

And the realthyroidhelp forum is definitely NOT going to get his over that hurdle.

I cant figure out garcia's problems, he may as well be hypopituitary.

All I know is that his RT3 is way over top range.
---------------------------------------------------------------------
I am still searching, but it looks like:

High RT3 is due to high (level or activity) of Type 3 deiodinase

High Type 3 deiodinase is a sign of cancer (except in fetal tissue and placenta).


the last piece is even more bad news than the first.
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It looks like most of articles that I can google are very recent and accessable by ($$$$) subscription only.

lets google on:

Type 3 deiodinase

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[garcia]

Thanks chilln for the very detailed reply. It is much appreciated!

>It is very unusual that your FSH is so low when your LH is this high

Yes thats what I thought too

> a) your phlebotomist (serum sample collector) fluked it and caught your serum just when your pituitary issued an LH pulse

I'll let you in on a secret - I was the phlebotomist.

> I suspect b) but you could still be a)

I agree that b seems more likely.

Posting my urine to the US is going to be very expensive (esp with Fed ex), so I'm tempted to just repeat the blood test and that should tell us if the result is a fluke or more typical.

> thyroid imbalance causes poor transdermal absorption. Your medical professional adviser should have known this from your existing thyroid results. But then this is not yet common knowledge in the UK.

Well I'm advising my doc. I knew from reading this board that TD could be problematic for those with low thyroid. But I'm not sure if my problem was absorption, or other things, e.g. Too much DHT, Too much estrogen or even low shbg causing problems.

I don't think it was an absorption issue since I was getting effects, just not positive effects. In any case I've asked my doc to prescribe me capsules & also injections so that I can see if I do any better on those.

[chilln]

I don't think it was an absorption issue since I was getting effects, just not positive effects.


What were your serum test results after a few weeks of supplementation ?

[garcia]

What were your serum test results after a few weeks of supplementation ?

Basically I started the testim and felt worse. Stopped for a few days, felt better. Then tried it again and felt worse. So I decided to stop, rather than prolong the agony. Side effects included irritability, water retention & possible gyno (not 100% sure on this as it was only a few days).

Should I just treat empirically and try caps & injections?

[chilln]

Basically I started the testim and felt worse. Stopped for a few days, felt better. Then tried it again and felt worse. So I decided to stop, rather than prolong the agony. Side effects included irritability, water retention & possible gyno (not 100% sure on this as it was only a few days).


OK



Should I just treat empirically and try caps & injections?


No, you and your medical professional adviser should address other imbalances in your system first which do not cause you to feel worse straight up.

But once again you're trying to get a solution to a complex hormone problem on a forum, and that's not wise. You'll never be able to get anyone to read through your entire history and make a full assessment, using the short-question-and-short-answer forum mechanism.

What I can predict reliably is that as long as you continue to try to get forum solutions to your complex problem, then you will be ill. I'm not joking when I say that.

###

If you are going to get help from Dr Crisler (USA) while you are in the UK, then you'll need to discuss that ASAP with your medical professional adviser, rather than continue to try to get therapy solutions via a forum.

One thing we can do on a forum is help you learn how to improve an already half-reasonable hormone management protocol.

Another thing we can do is help you understand how to get started putting your medical professional advsier in touch with Dr Crisler.

Ie: before you ask your medical professional adviser to get in touch with Dr Crisler, I recommend that you first contact Dr Crisler's office and ask how does Dr Crisler prefer to work with a medical professional adviser in the UK, ie:

1) Is it mandatory that you are first examined by Dr Crisler in the USA (I do not think so).

2) What method of communication will be necessary - eg: I would assume phone only due to the fast interaction between people who can't type 100 words a minute, but who can talk at 100 words a minute.

3) What is the time limit on such calls ? In order to cap the call costs. Which means the International phone calls would be billed back to you. I assume your medical professional adviser does not yet use a low-cost internet VoIP provider like I do at home - where I only pay max 8 US cents per minute to call across the Alantic or Pacific at the worst of times.

4) How will time be scheduled for phone contact between your medical professional adviser and Dr Crisler ?

5) What labs would Dr Crisler expect to see from your medical professional adviser ?

6) What discussion of symptoms would Dr Crisler expect to see from your medical professional adviser ?