22 Years Old - Starting TRT - HELP ME NOT **** MY LIFE

[johndoesmith]

I would delight in training you if you decide to pursue the PA/NP pathway. It would be a decision I doubt you would regret! In fact, I am currently training a PA and a local urologist and soon, if things fall in place, potentially training and sharing protocols with a major university urology department and medical school. The knowledge is spreading and growing for the benefit of all!

I would love that, thank you. Unfortunately, it would be YEARS from now. 4 year bachelors, then 2-3 years PA schooling.

I am glad you're doing so to benefit all!

I am curious if you don't mind sharing some interesting patterns now for knowledge purposes!

 

[Dr Justin Saya MD]

I would love that, thank you. Unfortunately, it would be YEARS from now. 4 year bachelors, then 2-3 years PA schooling.

I am glad you're doing so to benefit all!

I am curious if you don't mind sharing some interesting patterns now for knowledge purposes!

Many little pearls (though not applicable to all):

Higher presenting LH = typically needs higher HCG dosing (longterm) to prevent testicular atrophy

Lower SHBG - smaller/more frequent EVERYTHING (T cyp, HCG, anastrozole)

Lower SHBG = generally more sensitive to E2 levels >35pg/mL

Higher progesterone = can tolerate higher E2 levels asymptomatically

Higher HgB/HCT in the setting of low baseline T levels = smoker, lives at high altitude, excess iron, or...VERY commonly SLEEP APNEA

Lower DHEA (in setting of anxiety/stress) - often "pregnenolone steal" with shunting to cortisol (especially if concurrent low-ish progesterone)

The list goes on and on, with many nuances of each!

Just arrived in Atlanta to take care of some business the next few days, so retiring for the night. Take care all and hope to talk soon Tarnation!

 

[johndoesmith]

Many little pearls (though not applicable to all):

Higher presenting LH = typically needs higher HCG dosing (longterm) to prevent testicular atrophy

Lower SHBG - smaller/more frequent EVERYTHING (T cyp, HCG, anastrozole)

Lower SHBG = generally more sensitive to E2 levels >35pg/mL

Higher progesterone = can tolerate higher E2 levels asymptomatically

Higher HgB/HCT in the setting of low baseline T levels = smoker, lives at high altitude, excess iron, or...VERY commonly SLEEP APNEA

Lower DHEA (in setting of anxiety/stress) - often "pregnenolone steal" with shunting to cortisol (especially if concurrent low-ish progesterone)

The list goes on and on, with many nuances of each!

Just arrived in Atlanta to take care of some business the next few days, so retiring for the night. Take care all and hope to talk soon Tarnation!

Thank you. That is really informative. Have a good night.

 

[tarnation]

Hey everyone, I wanted to post a quick update regarding my TRT Protocol. My endocrinologist agreed to change my 25mg/week to a 100mg test cyp per week (she said I can break it down into 50mg doses). She is however still against prescribing me HCG. I am planning on seeing two other endocrinologists before my consult with Defy (November 1st). I also got my thryoid levels checked as per Dr.Saya's request, and have posted the results down below. Can someone please help me intrepret these labs? Lastly, I am planning on starting the 100mg dose my endo prescribed starting from next week. Anyone have any experiences with what I can expect?

Thanks!

Thyroid:

THS: 3.36 (.51-6.27)
Thyroglobulin, Tumor Marker: 5.7 (1.8 - 4.0)
T3 Reverse, Serum: 30 (10-24)
DHEA-S 105 (89-457)
Free T3: 1.4 (2.0 - 4.4)
Progesterone: .358ng/ml
PSA Diagnostic: .174 (0.0 - 4.0)
Throxine Free 4: .96 (.93 -1.70)
Thyroperoxidase Ab, S: .7 (<9.0)

 

[Dr Justin Saya MD]

Hey everyone, I wanted to post a quick update regarding my TRT Protocol. My endocrinologist agreed to change my 25mg/week to a 100mg test cyp per week (she said I can break it down into 50mg doses). She is however still against prescribing me HCG. I am planning on seeing two other endocrinologists before my consult with Defy (November 1st). I also got my thryoid levels checked as per Dr.Saya's request, and have posted the results down below. Can someone please help me intrepret these labs? Lastly, I am planning on starting the 100mg dose my endo prescribed starting from next week. Anyone have any experiences with what I can expect?

Thanks!

Thyroid:

THS: 3.36 (.51-6.27)
Thyroglobulin, Tumor Marker: 5.7 (1.8 - 4.0)
T3 Reverse, Serum: 30 (10-24)
DHEA-S 105 (89-457)
Free T3: 1.4 (2.0 - 4.4)
Progesterone: .358ng/ml
PSA Diagnostic: .174 (0.0 - 4.0)
Throxine Free 4: .96 (.93 -1.70)
Thyroperoxidase Ab, S: .7 (<9.0)

You have hypothyroidism with basically 4 abnormal thyroid parameters (low free T3, low range free T4, elevated thyroglobulin Ab - indicating an autoimmune component although not very high, and high reverse T3 - this makes your hypothyroidism even worse as it is a non-functional "lost" conversion of T4 -> reverse T3).

It also appears you have poor adrenal function with very low DHEA for your age. Your endocrinologist didn't want to address these?

As I said previously, in a young male such as yourself, if suspicion warrants, it is best to investigate these other possible CONTRIBUTING factors PRIOR to commencing TRT...these factors have now been CONFIRMED to be abnormal, so I will echo my previous sentiment: I would NOT begin TRT at this point as it may be unnecessary and ultimately counterproductive for you. Your thyroid and adrenal function should be addressed FIRST (along with *possible* concurrent HPTA stimulation - Clomid, WHILE addressing the thyroid/adrenals) as these are confirmed abnormal and may be the root cause of your low testosterone.

It would be useful to have a salivary cortisol X 4 done prior to speaking with me to further address your adrenal function now that we know it seems suboptimal.

Edit: it appears they checked thyroglobulin (not thyroglobulin antibody as suggested) - this should be checked as well. Have the endocrinologist (2) that you plan to see thoroughly examine your thyroid for size (enlarged/goiter?) and nodules.

 

[tarnation]

You have hypothyroidism with basically 4 abnormal thyroid parameters (low free T3, low range free T4, elevated thyroglobulin Ab - indicating an autoimmune component although not very high, and high reverse T3 - this makes your hypothyroidism even worse as it is a non-functional "lost" conversion of T4 -> reverse T3).

It also appears you have poor adrenal function with very low DHEA for your age. Your endocrinologist didn't want to address these?

As I said previously, in a young male such as yourself, if suspicion warrants, it is best to investigate these other possible CONTRIBUTING factors PRIOR to commencing TRT...these factors have now been CONFIRMED to be abnormal, so I will echo my previous sentiment: I would NOT begin TRT at this point as it may be unnecessary and ultimately counterproductive for you. Your thyroid and adrenal function should be addressed FIRST (along with *possible* concurrent HPTA stimulation - Clomid, WHILE addressing the thyroid/adrenals) as these are confirmed abnormal and may be the root cause of your low testosterone.

It would be useful to have a salivary cortisol X 4 done prior to speaking with me to further address your adrenal function now that we know it seems suboptimal.



Edit: it appears they checked thyroglobulin (not thyroglobulin antibody as suggested) - this should be checked as well. Have the endocrinologist (2) that you plan to see thoroughly examine your thyroid for size (enlarged/goiter?) and nodules.

Thanks for the reply, Dr. The endocrinologist that I am seeing did examine my thyroid and nodules. She did not say anything about the size, so I am assuming that everything was normal. I will, however, bring it up during my next appointment with the different endo. My endo did mention my adrenal function, and ordered two cortisol tests. After reviewing the results, she determined that TRT was the proper action to take. On top of that, I have been taking a ton of caffeine to combat my fatigue and I believe that may have something to do with my sub-optimal adrenal function as well.

I've been experiencing low t symptoms for at least the past 13 years. During those 13 years, I have seen several doctors who have checked my thyroid levels, and none of them ever mentioned that my thyroid is the issue. As a result, I don't think that my thyroid levels are causing my low t levels (you obviously would know better about this than me).

Lastly, the first doctor who tried treating my low T tried using Clomid as treatment. However, after I started experiencing several uncomfortable symptoms, he decided to take me off and suggested I see an endo.

I hope you find that background info somewhat helpful, and I wonder if that changes your stance.

 

[Dr Justin Saya MD]

Thanks for the reply, Dr. The endocrinologist that I am seeing did examine my thyroid and nodules. She did not say anything about the size, so I am assuming that everything was normal. I will, however, bring it up during my next appointment with the different endo. My endo did mention my adrenal function, and ordered two cortisol tests. After reviewing the results, she determined that TRT was the proper action to take. On top of that, I have been taking a ton of caffeine to combat my fatigue and I believe that may have something to do with my sub-optimal adrenal function as well.

I've been experiencing low t symptoms for at least the past 13 years. During those 13 years, I have seen several doctors who have checked my thyroid levels, and none of them ever mentioned that my thyroid is the issue. As a result, I don't think that my thyroid levels are causing my low t levels (you obviously would know better about this than me).

Lastly, the first doctor who tried treating my low T tried using Clomid as treatment. However, after I started experiencing several uncomfortable symptoms, he decided to take me off and suggested I see an endo.

I hope you find that background info somewhat helpful, and I wonder if that changes your stance.

I have seen this play out countless times in guys in their 20's. I understand your longlasting symptoms /frustration and the poor care you've received up to this point. Saying they have "checked your thyroid levels and never mentioned the thyroid is an issue" means, with almost 99% likelihood, that they checked ONLY TSH and *maybe* total (not free) T4 and that's it! As you can see, you are a perfect example of a patient where the TSH can be very misleading to the vast majority of physicians/patients...we would have NEVER known you have hypothyroidism (as you DO) if we only checked the TSH and I didn't suggest you draw this more complete thyroid panel.

Low thyroid can not only cause many of the SAME symptoms as low testosterone, but can in fact CAUSE low testosterone itself.

 

[tarnation]

I have seen this play out countless times in guys in their 20's. I understand your longlasting symptoms /frustration and the poor care you've received up to this point. Saying they have "checked your thyroid levels and never mentioned the thyroid is an issue" means, with almost 99% likelihood, that they checked ONLY TSH and *maybe* total (not free) T4 and that's it! As you can see, you are a perfect example of a patient where the TSH can be very misleading to the vast majority of physicians/patients...we would have NEVER known you have hypothyroidism (as you DO) if we only checked the TSH and I didn't suggest you draw this more complete thyroid panel.

Low thyroid can not only cause many of the SAME symptoms as low testosterone, but can in fact CAUSE low testosterone itself.

First of all, I would like to say, I am really grateful that you suggested I get my full thyroid panel checked. I will DEFINITELY bring it up during my upcoming meeting with my endo. Is it possible for low testosterone/secondary hypogonadism to cause hypothyroidism?

 

[Dr Justin Saya MD]

First of all, I would like to say, I am really grateful that you suggested I get my full thyroid panel checked. I will DEFINITELY bring it up during my upcoming meeting with my endo. Is it possible for low testosterone/secondary hypogonadism to cause hypothyroidism?

If the secondary Hypogonadism was a reflection of hypothalamic and/or pituitary pathology (empty sella syndrome, pituitary adenoma, etc) then there can be a connection, but not cause and effect. Otherwise, it would be a stretch. You stated you've had low testosterone (or per our discussion above possibly low thyroid/adrenal) symptoms for 13 years? Aren't you 22yo...you've had symptoms since you were 9 years old?

 

[tarnation]

If the secondary Hypogonadism was a reflection of hypothalamic and/or pituitary pathology (empty sella syndrome, pituitary adenoma, etc) then there can be a connection, but not cause and effect. Otherwise, it would be a stretch. You stated you've had low testosterone (or per our discussion above possibly low thyroid/adrenal) symptoms for 13 years? Aren't you 22yo...you've had symptoms since you were 9 years old?

I have had low t symptoms (specifically brain fog/fatigue/lethargy) for as long as I can remember but I never paid much attention to them. Even as a child my parents frequently used to comment on my energy levels, telling me that kids my age should not be feeling tired.

Also, I don't know if you've gotten the chance to review the files I've sent over to your office. But my endo says that my hypogonadism is idiopathic but she "cannot exclude the possibility of partial empty sella".

Hope that is helpful

 

[Dr Justin Saya MD]

I have had low t symptoms (specifically brain fog/fatigue/lethargy) for as long as I can remember but I never paid much attention to them. Even as a child my parents frequently used to comment on my energy levels, telling me that kids my age should not be feeling tired.

Also, I don't know if you've gotten the chance to review the files I've sent over to your office. But my endo says that my hypogonadism is idiopathic but she "cannot exclude the possibility of partial empty sella".

Hope that is helpful

I only know your screen name, so haven't had a chance to review your forwarded records yet. Will look forward to reviewing prior to our consult. If she mentioned "cannot exclude partial empty sella" I'm assuming she ordered a pituitary MRI?

The fact you've had many of these symptoms SINCE CHILDHOOD is actually more evidence that they are likely predominantly (root cause) thyroid/adrenal related and perhaps now exacerbated by Hypogonadism. Put another way, Hypogonadism does NOT OCCUR during childhood (in fact by definition CANNOT occur until after puberty at the earliest). However, hypothyroidism and adrenal issues can and do occur occasionally in children.

Indeed your predominant symptoms of "brain fog, fatigue, lethargy" since CHILDHOOD scream out hypothyroidism, NOT hypogonadism...I think you've sold yourself on the Hypogonadism diagnosis already when in fact you are likely one of the *lucky* ones that instead has an identifiable and CORRECTABLE root cause.

We will have A LOT to discuss when we finally get to have a consult. Until then, again I would avoid the temptation of potentially prematurely jumping onto TRT. If I find it is indeed clinically needed, I will have no problem recommending it for you.

 

[tarnation]

Hey everyone, I wanted to give you guys a quick update on how my TRT regiment is going.

As you might know, I had a consult with Defy Medical (Dr. Saya), and I have to say that they are absolutely amazing. If anyone is on the fence about using Defy Medical - I would highly recommend you take the plunge and try them out. The thing that stood out most to me about Defy is their patient service and the expertise they have in the area. I can do a more in-depth review of the clinic if anyone would like but overall I have nothing but good things to say so far.

For those of you who are curious, Dr. Saya started me on 35 units of HCG and 60mg test cyp every 3.5 days, natural desiccated thyroid (1.5 grains a day), and some medication to bring my DHT levels back up. Since starting this protocol I feel 100x better - my energy levels, brain fog, and overall quality of life have improved tenfold. I recently got some labwork done, and I'll post that onto this thread as soon as I get the results.

I do, however, have a couple of questions I was hoping to get some insight on:

1. I had pre-existing very mild gyno before starting TRT and I am worried that the HCG + Testosterone will make the gyno get worse. I have noticed that my nipples are a lot more sensitive since starting this protocol and I can often feel a tingling sensation. After doing some research, I learned that a SERM, specifically raloxifene, can help reverse my gyno. I don't want to take an AI just yet because my lab-work has not come back yet, and I'd rather take the least amount of drugs that my body needs. I explained my situation to a medical assistant at Defy Medical, and she prescribed me 20mg of Tamoxifen every other day. So my question is: Should I take the Tamoxifen instead of the Raloxifene? I've read that Raloxifene is the most mild SERM as well as the most effective SERM for gyno reversal - so I am unsure why I was prescribed Tamoxifen instead?

2. I have noticed some testicular atrophy despite being on HCG. I have also noticed that my sperm volume and libido are still not back to normal levels. Is HCG simply not working for me, and do you think I should discuss just dropping it completely from my protocol during my next consult?

Thanks a lot guys!

 

[johndoesmith]

Hey everyone, I wanted to give you guys a quick update on how my TRT regiment is going.

As you might know, I had a consult with Defy Medical (Dr. Saya), and I have to say that they are absolutely amazing. If anyone is on the fence about using Defy Medical - I would highly recommend you take the plunge and try them out. The thing that stood out most to me about Defy is their patient service and the expertise they have in the area. I can do a more in-depth review of the clinic if anyone would like but overall I have nothing but good things to say so far.

For those of you who are curious, Dr. Saya started me on 35 units of HCG and 60mg test cyp every 3.5 days, natural desiccated thyroid (1.5 grains a day), and some medication to bring my DHT levels back up. Since starting this protocol I feel 100x better - my energy levels, brain fog, and overall quality of life have improved tenfold. I recently got some labwork done, and I'll post that onto this thread as soon as I get the results.

I do, however, have a couple of questions I was hoping to get some insight on:

1. I had pre-existing very mild gyno before starting TRT and I am worried that the HCG + Testosterone will make the gyno get worse. I have noticed that my nipples are a lot more sensitive since starting this protocol and I can often feel a tingling sensation. After doing some research, I learned that a SERM, specifically raloxifene, can help reverse my gyno. I don't want to take an AI just yet because my lab-work has not come back yet, and I'd rather take the least amount of drugs that my body needs. I explained my situation to a medical assistant at Defy Medical, and she prescribed me 20mg of Tamoxifen every other day. So my question is: Should I take the Tamoxifen instead of the Raloxifene? I've read that Raloxifene is the most mild SERM as well as the most effective SERM for gyno reversal - so I am unsure why I was prescribed Tamoxifen instead?

2. I have noticed some testicular atrophy despite being on HCG. I have also noticed that my sperm volume and libido are still not back to normal levels. Is HCG simply not working for me, and do you think I should discuss just dropping it completely from my protocol during my next consult?

Thanks a lot guys!

Hey man, glad to see you got the care you needed, couple of things I noticed.

1. How long has it been since you started TRT?
2. I imagine you mean 350 IU of hCG? 35 units is the measurement on the insulin syringe so I understand your confusion.
3. How long have you had the nipple sensitivity? Sometimes when starting TRT, the testosterone itself can cause transient nipple sensitivity, I had this, and it went away in about a week. It's not gyno it's just your body adjusting to the increase in hormone levels.

I wouldn't recommend just giving up on hCG just yet, let Dr saya know, it's possible there may be a need for dose adjustment.

 

[CoastWatcher]

Hey everyone, I wanted to give you guys a quick update on how my TRT regiment is going.

As you might know, I had a consult with Defy Medical (Dr. Saya), and I have to say that they are absolutely amazing. If anyone is on the fence about using Defy Medical - I would highly recommend you take the plunge and try them out. The thing that stood out most to me about Defy is their patient service and the expertise they have in the area. I can do a more in-depth review of the clinic if anyone would like but overall I have nothing but good things to say so far.

For those of you who are curious, Dr. Saya started me on 35 units of HCG and 60mg test cyp every 3.5 days, natural desiccated thyroid (1.5 grains a day), and some medication to bring my DHT levels back up. Since starting this protocol I feel 100x better - my energy levels, brain fog, and overall quality of life have improved tenfold. I recently got some labwork done, and I'll post that onto this thread as soon as I get the results.

I do, however, have a couple of questions I was hoping to get some insight on:

1. I had pre-existing very mild gyno before starting TRT and I am worried that the HCG + Testosterone will make the gyno get worse. I have noticed that my nipples are a lot more sensitive since starting this protocol and I can often feel a tingling sensation. After doing some research, I learned that a SERM, specifically raloxifene, can help reverse my gyno. I don't want to take an AI just yet because my lab-work has not come back yet, and I'd rather take the least amount of drugs that my body needs. I explained my situation to a medical assistant at Defy Medical, and she prescribed me 20mg of Tamoxifen every other day. So my question is: Should I take the Tamoxifen instead of the Raloxifene? I've read that Raloxifene is the most mild SERM as well as the most effective SERM for gyno reversal - so I am unsure why I was prescribed Tamoxifen instead?

2. I have noticed some testicular atrophy despite being on HCG. I have also noticed that my sperm volume and libido are still not back to normal levels. Is HCG simply not working for me, and do you think I should discuss just dropping it completely from my protocol during my next consult?

Thanks a lot guys!

It seems you want to make, or are considering, a lot of changes to your protocol. How long have you been on TRT and what labs can you post that will reflect its success? As for semen, not sperm, volume, that's something that many, if not most, men on TRT deal with.

 

[tarnation]

Thanks for taking the time to reply, my man.

1. I've been on TRT for 7 weeks now (only 4 weeks of Dr. Saya's protocol of HCG + 60mg of test cyp every 3.5 days)
2. Yes, I apologize - I meant 350 IU of HCG.
3. The nipple sensitivity isn't bad, it is only noticeable when I am outside in the cold. I've definitely had it for longer than a week though.

Do you have any insight on the protocol that Defy Medical prescribed for my gyno? They want me to start 20mg of Tamoxifen every other day. I've done some research and it seems like Raloxifene is the best SERM for gyno reversal, so I am unsure why they have started me on this medication instead.

Thanks as always brother <3

 

[tarnation]

Thanks for the reply brother - I appreciate it. I've been on TRT for 7 weeks now, although only 4 weeks with Defy Medical. My only concern is gyno that might be developing. That is why I was asking if Raloxifene should be taken instead of the suggested Tamoxifen.

 

[johndoesmith]

Thanks for taking the time to reply, my man.

1. I've been on TRT for 7 weeks now (only 4 weeks of Dr. Saya's protocol of HCG + 60mg of test cyp every 3.5 days)
2. Yes, I apologize - I meant 350 IU of HCG.
3. The nipple sensitivity isn't bad, it is only noticeable when I am outside in the cold. I've definitely had it for longer than a week though.

Do you have any insight on the protocol that Defy Medical prescribed for my gyno? They want me to start 20mg of Tamoxifen every other day. I've done some research and it seems like Raloxifene is the best SERM for gyno reversal, so I am unsure why they have started me on this medication instead.

Thanks as always brother <3

Sounds good then, thing is your energy and such could be from the thyroid or TRT. You are in for some MASSIVE changes man!

I don't know much about gyno, I trust defy to prescribe the right drug. They are VERY open minded and transparent, so ask them this very question, but I would take it as prescribed. They are not known for prescribing the wrong drug.

I imagine you're due for labs in a few weeks? You can possibly get them done sooner if you want for the gyno concerns I believe, maybe just basic ones.

 

[tarnation]

Hey everyone

As promised, here are my lab results. Any input would be greatly appreciated!

http://imgur.com/a/uFGDT

 

[Vettester Chris]

Tarnation, I know there's a lot of info posted, so sorry if I overlooked anything, BUT, have you ran the TPO anitbodies lab? I see the TgAb is in the mix, but TPO checks the enzyme marker for autoimmune, which is key and essential, as much so as the Ab protein marker.

I will go back through and read through the posts ... I see Dr. Saya has some comments on DHEA and the adrenals. No doubt that is also a factor with your thyroid productivity.

 

[tarnation]

Thanks for the reply, Vettester! I have not ran TPO antibodies lab. These were the labs that were requested by Defy Medical based off of my record. Do you recommend I get those labs done as well?