Hello from MInnesota

[jimithing]

Hi everyone,

My name is Cap, and Im a 37yo from Minneapolis area. Im a Registered Nurse with a private group of orthopaedic spine surgeons, been working in ortho and critical care for the last 10years. Im also a very active person, kettlebell instructor and very much into movement and strength training. Im currently using Wendler's 5-3-1 program with kettlebells for a lot of my accessory exercises. I eat pretty clean and follow a gluten and dairy free diet for the last 4 years. Earlier this year I began to just not feel right. I felt sluggish all the time, especially in the morning, my sleep was terrible, i would have random bouts of insomnia that would sometimes last all night. I also had noticed a much lower sex drive than I had in the last couple of years. In talking with a friend and co-worker at the gym he recommended getting my hormones tested and led me to a doctor that he has been to at Body Logic MD.

So back in April this year I had a pretty comprehensive lab panel done. My cortisol was essentially flat all day long. My total test was 434, free 74.2. Estradiol was 17. Everything else was in normal range that was tested (CBC, LH, DHEA, Prolactin, PSA, Albumin, HgbA1C, VitD, TSH, T4 and T3 free, cholesterol, CRP and a basic chem panel.

At that time my doctor and I decided I would take hydrocortisone 5mg 2 tabs am and 1 in mid day for adrenal fatigue. We also started HcG 500iu sublingual 1 tab 3x week to see if it would raise my testosterone.

It's now been 7 months later. I feel a little better, more energy now but still not totally normal. I think both meds are working judging by how I feel. My sex drive is somewhat better, Im making some better gains in the gym but not what i think i should be making based on how Im working out and eating. I had my follow up appt with my doc.

These are my labs in December this month. Testosterone is down to 363, with free at 64.9. estradiol is down to 12. My cortisol now is on the low end of normal (actually follows the normal curve now instead of being flat) and seems to have rebounded nicely with the steroid.

My doc now said I should stay on the hydrocortisone through the holiday season and then start to ween off of it and see how i feel. If i need to stay on it i'll stay on it longer.
He gave me a few options with the testosterone. 1) do nothing, keep taking the Hcg as is. 2) increase Hcg to 750iu every other day 3)clomid 4)sub-q testosterone 0.25ml 2x a week and go back to old dose of Hcg 500iu 3x week.

I started with increasing the Hcg and have now been doing that for a week. Im leaning towards the testosterone. But here is the kicker: My wife and I are trying to have a baby. She apparently isn't ovulating and is going to start on clomid in Jan so we can hopefully conceive. I don't want to mess with my sperm count or do anything that would mess up us trying to have a baby. Im thinking I'll keep as is on the Hcg and then once we are pregnant start with the testosterone.

Nelson I just ordered your book and look forward to reading it and learning more about this.

Any thoughts or comments would be greatly appreciated

thanks! Cap

 

[paco]

Hi Cap,

You and I have a similar story. My wife and I area also aiming to get pregnant, while at the same time trying to get me feeling better as a result of low testosterone, etc. My personal experience is that HCG has been more effective than clomid at helping me to feel somewhat better. I'm sure others will chime in, but at first glance, it seems to me that the dose of HCG you were recently on was insufficient for raising your testosterone levels, so it's good that you're trying a higher dose.

If you post all of your labs with ranges, or at least some of the most relevant ones like prolactin, estradiol, etc., you will get a more through response. For instance, it may help in surmising whether you are primary hypogonadal (testes not functioning) or secondary hypogonadal (HPT axis dysfunction). That will help to determine whether HCG and/or clomid have any chance of helping you instead of frank testosterone replacement therapy.

See some of my posts if you're interested in my story so far, and feel free to pm me if you'd like to share experiences. Your doctor seems like a good one. Keep working with him if you feel the same, as it's not easy to find a good doctor.

 

[Gene Devine]

It looks like your Doctor sort of knows what he doing but he's off the mark in my opinion.

Let me start off with this first; HCG can be administered one way and one way only and that is through subcutaneous injection. The molecular structure of HCG is such that it can not enter the blood stream via sublingual or transdermal application. You can trust me on that or do your own research and you will come to the same conclusion.

Again, in my opinion, I don't think you need hydrocortisone based on your cortisol levels and your symptoms and labs pointing to hypogonadism.

You said that your labs were all within normal range but we know that "normal" range is not "optimal" range so you can be very symptomatic and still present with "normal" labs. I would like to see your most recent blood work complete with ranges.

As you can see, the HCG is not working for you to increase endogenous testosterone because of the oral administration. You should know that even if you injected the HCG, which is the only efficacious method, as a mono therapy is rarely effective in increasing natural production.

Ruling out all other potential pathologies for your condition I think your best course of action is option #4 outlined above except that you need to inject the HCG and not take it orally.

You also need to monitor Estrogen as well, both before your TRT protocol to get a base line and 6 weeks after you start your testosterone supplementation.

I would encourage you to read all the stickies in the Testosterone forum and educate yourself on hormone replacement for men...it's a game changer when executed correctly.

 

[paco]

It looks like your Doctor sort of knows what he doing but he's off the mark in my opinion.

Let me start off with this first; HCG can be administered one way and one way only and that is through subcutaneous injection. The molecular structure of HCG is such that it can not enter the blood stream via sublingual or transdermal application. You can trust me on that or do your own research and you will come to the same conclusion.

Oh, I didn't see that he has you on sublingual HCG! Ditto to what Gene said...

 

[jimithing]

Thanks for the replies guys. I haven't spent much time on the site yet but I was surpised to see all the info on Hcg as being injectable. I'll definitely ask my doc about that. Is there really no research to say that sublingual Hcg is not effective? Does it just not absorb?

My other question was about fertility. It seems that what i've read or googled online says that taking hcg along with T you can maintain fertility. True?

Gene the hydrocortisone was for adrenal fatigue. My cortisol was essentially flatlined. Can you expand on why you don't agree with that. I think that is the one thing we did right in this whole thing and the cortisol has responded nicely with the hydrocortisone. I'll post all my labs and ranges too.

Labs April 2013

Albumin 2.6 (1.0-2.5)
Bilirubin 0.8 (0.2-1.2)
Alk Phos 62 (40-115)
AST 20 (10-40)
ALT 19 (9-60)

Hgb A1c 5.4 <5.7% of total Hgb

Vit D, 25-OH, total 52 (30-100)

TSH 1.33 (0.40-4.50)
T4, Free 1.0 (0.8-1.8)
T3 Free 3.4 (2.3-4.2)

Dihydrotestosterone, LC/MS/MS 35 (16-79)

CBC
WBC 4.7 (3.8-10.8)
RBC 4.82 (4.20.5.80)
Hgb 15.3 (13.2-17.1)
Hct 45.4 (38.5-50)
Mcv 94.1 (80-100)
Mch 31.7 (27-33)
Mchc 33.7 (32-36)

Lipid Panel
Chol, total 145 (125-200)
HDL Chol 42 (> or = 40)
Triglyceride 52 (<150)
LDL Chol 93 (<130)

Chol/HDLC Ratio 3.5 (< or = 5.0)
non/hdl chol 103 (target for non HDL chol is 30 mg/dl higher than LDL chol target

CRP 0.3 <1.0

Chem Panel

Glucose fasting 100 (65-99)

BUN 15 (7-25)
Creatinine 1.10 (0.60-1.35)
eGFR non-afr am 85 ( > or = 60)
Na 142 (135-146)
K+ 4.3 (3.5-5.3)
Chloride 107 (98-110)
Co2 24 (19-30)
Calcium 9.7 (8.6-10.3)
Protein, total 6.8 (6.1-8.1)
Albumin 4.9 (3.6-5.1)
Globulin 1.9 (1.9-3.7)

Estradiol, ultrasensitive
LC/MS/MS 17 (< or = 29)

DHEA sulfate 281 (110-370)
Insulin <2 (<23)

LH 3.3 (1.5-9.3)
Prolactin 6.4 (2.0-18.0)

PSA, total 0.7 (< or = 4.0)

Testosterone, total LC/MS/MS 434 (250-1100)
Testosterone, Free 74.2 (46.0-224)
Testosterone, bioavailable 162.2 (110-575.0)
Sex hormone binding globulin 23 (10-50)
Albumin, Serum 4.8 (3.6-5.1)

Cortisol saliva
morning 0.5 (3.7-9.5)
noon 0.4 (1.2-3.0)
evening 0.5 (0.6-1.9)
night 0.3 (0.4-1.0)


LABS DECEMBER 2013

Estradiol ultrasensitive LC/MS/MS 12 (< or = 29)

Testosterone, total LC/MS/MS 363 (250-1100)
Free Testosterone 64.9 (35.0-155)

Cortisol saliva test
Morning 4.8 (3.7-9.5)
noon 2.8 (1.2-3.0)
evening 1.6 (0.6-1.9)
night 0.5 (0.4-1.0)

 

[Nelson Vergel]

You should post that not here but here: http://www.excelmale.com/forums/58-Blood-Test

 

[jimithing]

Ok

I copied and pasted everything here

https://www.excelmale.com/forum/threads/1228-Recent-lab-work-and-some-questions

 

[Gene Devine]

As I see it, you appear to have adrenal fatigue as your Doctor diagnosed which is a good thing in that alone!

The hydrocortisone makes complete sense to help combat and get your cortisol levels back into the normalized levels.

Your Testosterone levels are low for a 37 year old and appears to be age related.

FT4 is a bit low and could come up but FT3 looks good.

E2 is low and better in the 20's.

Of the options that your Doc gave you, in my opinion, #4)sub-q testosterone 0.25ml 2x a week and go back to old dose of Hcg 500iu 3x week is your best and only real choice EXCEPT that you must inject HCG.

The molecular structure of HCG is such that it cannot pass through the skin or mucus membranes and get into the bloodstream. The oral versions you are taking come from the diet industry and they are totally useless.

 

[jimithing]

Thanks for the info. I have an email out to my doc about the Hcg and injection vs sublingual. Im interested to see what he says. I've googled sublingual Hcg and only find info on a liquid drop form. The stuff im taking is a triturate tablet from a compounding pharmacy.

Do you have specific info or studies i can provide my doc about sublingual not being effective? Also still looking for info on having kids while on T therapy. thanks

 

[jimithing]

So I heard back from my doc. He said the reason that he recommended the sublingual Hcg vs the injections was that it is cheaper (I pay about $60/month). The last time he checked on the injections it was about $100/month. He also said that he has seen benefits with his patients using it and a lot of the patients report that their symptoms improved using the sublingual.

He said he'd be happy to put me on the injections at twice weekly if that's what i wanted to try. How much do you guys pay for Hcg injections roughly?

 

[Nelson Vergel]

HCG is a peptide extremely sensitive to saliva. It does not absorb sublingually at all. This is a scam propelled by the HCG diet clinics.

 

[Gene Devine]

So I heard back from my doc. He said the reason that he recommended the sublingual Hcg vs the injections was that it is cheaper (I pay about $60/month). The last time he checked on the injections it was about $100/month. He also said that he has seen benefits with his patients using it and a lot of the patients report that their symptoms improved using the sublingual.

He said he'd be happy to put me on the injections at twice weekly if that's what i wanted to try. How much do you guys pay for Hcg injections roughly?

HCG has been used as a fertility drug for many many years and it NEVER been prescribed as a sublingual.

The sublingual market emerged when the craze of using HCG as part of diet came about.

As noted, the molecular size of HCG will not pass into the blood stream via sublingual or transdermal applications even when ultra micronized.

Talk to any pharmacist and or Doctor who is an expert in HRT and they will tell you the same.

Also, has it helped you? From what your labs say it hasn't done a thing for you which in my book is proof enough.

Try the injections for 3 months and see if your labs tell you a different story.

 

[jimithing]

HCG has been used as a fertility drug for many many years and it NEVER been prescribed as a sublingual.

The sublingual market emerged when the craze of using HCG as part of diet came about.

As noted, the molecular size of HCG will not pass into the blood stream via sublingual or transdermal applications even when ultra micronized.

Talk to any pharmacist and or Doctor who is an expert in HRT and they will tell you the same.

Also, has it helped you? From what your labs say it hasn't done a thing for you which in my book is proof enough.

Try the injections for 3 months and see if your labs tell you a different story.

That's exactly what i was thinking. Although I do feel somewhat better, but that could very well be the effect of the cortisol returning to normal from the steroid therapy. I emailed my doc back today saying I want to try the injections Hcg for a few months at least until my wife gets pregnant then at that time if things aren't changing I'll add in the T therapy too.

thanks for the replies everyone. Greatly appreciated. This is all new to me and frankly a little scary considering I haven't been on any prescription meds in years and this is potentially something I'd be on the rest of my life, at 37 that could be a very long time.

 

[Gene Devine]

That's exactly what i was thinking. Although I do feel somewhat better, but that could very well be the effect of the cortisol returning to normal from the steroid therapy. I emailed my doc back today saying I want to try the injections Hcg for a few months at least until my wife gets pregnant then at that time if things aren't changing I'll add in the T therapy too.

thanks for the replies everyone. Greatly appreciated. This is all new to me and frankly a little scary considering I haven't been on any prescription meds in years and this is potentially something I'd be on the rest of my life, at 37 that could be a very long time.

Yes, HRT is something you have to do for the rest of your life but you get up and brush you teeth every morning don't you?

HRT for the man that needs it is a game changer for so many reasons.

It's no reason to get scared; think of it as an exciting change to your life with huge benefits for YOU!!!

 

[jimithing]

Yes, HRT is something you have to do for the rest of your life but you get up and brush you teeth every morning don't you?

HRT for the man that needs it is a game changer for so many reasons.

It's no reason to get scared; think of it as an exciting change to your life with huge benefits for YOU!!!

Good point. Thanks Gene!

 

[jimithing]

Just an update I've started doing the HcG sub q injections 500units 3x week. Im hoping I respond to this alone we'll see. If I don't and once my wife is pregnant I will likely try the TRT.

I do need to find another compounding pharmacy to buy the HCG from as it's really expensive. I tried calling Empower but they don't have license to send to Minnesota. Anyone locally in my area have other ideas? PM me. thanks

 

[Gene Devine]

Just an update I've started doing the HcG sub q injections 500units 3x week. Im hoping I respond to this alone we'll see. If I don't and once my wife is pregnant I will likely try the TRT.

I do need to find another compounding pharmacy to buy the HCG from as it's really expensive. I tried calling Empower but they don't have license to send to Minnesota. Anyone locally in my area have other ideas? PM me. thanks

Try Defy Medical in Tampa...they are a trusted medical source for many here.

 

[jimithing]

Try Defy Medical in Tampa...they are a trusted medical source for many here.

Thanks Gene I will give them a call

 

[Vettester Chris]

Hi Cap, I just recently joined, but wanted to jump-in with a few thoughts ...


Not to get too complicated, but I'm of the opinion you need to go a little deeper on the thyroid. Just at a glance, your FT4 lab range value is 20%, your FT3 is at 52%. I am just one guy in a sea of some great minds here, but I'm of the opinion that 50% to 80% is the place to aim for on both labs.


Maybe in some cases, I wouldn't think too much about it, but when you mentioned your cortisol situation, it kind of turned a light on. Here's the thing, cortisol plays a crucial role with T3 at the cellular level. Without cortisol (and iron for that matter), the T3 picture might not be painted as it looks. Your T4, the storage part of the hormone, is doing what it's supposed to do, which is converting downstream to T3. However, again just as speculation, the T4 conversion rate is a bit excessive (IMO), and without the element of cortisol, you may be seeing higher level of Reverse T3 than desired, along with the potential risk of pooling your T3 if it can't effectively reach the receptors of your cells, or call it optimally. Maybe this is all a non-factor, now that you are on HC treatment. However, on your next round of labs can you run the RT3 and antibodies for your thyroid?


On your adrenals, did your physician look at the pituitary side of it with an ACTH assay, and also aldosterone? Just curious if Addison's or other issues could be contributing to this? Any BP issues? Also, take a look at your iron and ferritin on your next round. You will sometimes see a correlation with all of this factoring and contributing to the other(s). Hoping this doesn't complicate or frustrate matters, but just throwing out a few other angles of consideration.


Keep pluggin!
~Chris

 

[jimithing]

Hi Cap, I just recently joined, but wanted to jump-in with a few thoughts ...


Not to get too complicated, but I'm of the opinion you need to go a little deeper on the thyroid. Just at a glance, your FT4 lab range value is 20%, your FT3 is at 52%. I am just one guy in a sea of some great minds here, but I'm of the opinion that 50% to 80% is the place to aim for on both labs.


Maybe in some cases, I wouldn't think too much about it, but when you mentioned your cortisol situation, it kind of turned a light on. Here's the thing, cortisol plays a crucial role with T3 at the cellular level. Without cortisol (and iron for that matter), the T3 picture might not be painted as it looks. Your T4, the storage part of the hormone, is doing what it's supposed to do, which is converting downstream to T3. However, again just as speculation, the T4 conversion rate is a bit excessive (IMO), and without the element of cortisol, you may be seeing higher level of Reverse T3 than desired, along with the potential risk of pooling your T3 if it can't effectively reach the receptors of your cells, or call it optimally. Maybe this is all a non-factor, now that you are on HC treatment. However, on your next round of labs can you run the RT3 and antibodies for your thyroid?


On your adrenals, did your physician look at the pituitary side of it with an ACTH assay, and also aldosterone? Just curious if Addison's or other issues could be contributing to this? Any BP issues? Also, take a look at your iron and ferritin on your next round. You will sometimes see a correlation with all of this factoring and contributing to the other(s). Hoping this doesn't complicate or frustrate matters, but just throwing out a few other angles of consideration.


Keep pluggin!
~Chris

Hey Chris! Thanks for the input. Much appreciated. I posted all the labs that we did so no we didn't delve any further into potential thyroid issues. What you're saying makes sense to look into further, at least from what I remember from my endocrinology class in college 10+ years ago. So you're saying test t4 and t3 again as well as RT3 and antibodies? I'll ask about checking iron and ferritin too. Can you expand a little on what you're talking about or point me in the right direction on something to read?

No BP issues at all, my BP is pretty solid around 115/78. thanks