Eight Weeks on TRT - Feeling No Better

[Libra88]

So just got bloodwork done, here are the results


Order: CBC
Name Date Value Units Range Source
WBC 7/18/2017 3.87 K/uL 4.23-9.07 NIH Clinical Center
RBC 7/18/2017 4.87 M/uL 4.63-6.08 NIH Clinical Center
HGB 7/18/2017 15.10 g/dL 13.7-17.5 NIH Clinical Center
HCT 7/18/2017 46.00 % 40.1-51.0 NIH Clinical Center
MCV 7/18/2017 94.50 fL 79.0-92.2 NIH Clinical Center
MCH 7/18/2017 31.00 pg 25.7-32.2 NIH Clinical Center
MCHC 7/18/2017 32.80 g/dL 32.3-36.5 NIH Clinical Center
RDW 7/18/2017 13.30 % 11.6-14.4 NIH Clinical Center
Platelet Count 7/18/2017 155.00 K/uL 161-347 NIH Clinical Center
MPV 7/18/2017 10.40 fL 9.4-12.4 NIH Clinical Center
Nucleated RBC 7/18/2017 0.00 /100 WBC 0.0-0.2 NIH Clinical Center
Nucleated RBC Absolute 7/18/2017 0.00 K/uL 0.00-0.01 NIH Clinical Center

Order: Testosterone, Total and Free (calc)
Name Date Value Units Range Source
Sex Hormone Binding Globulin. 7/18/2017 22.00 nmol/L 13-71 NIH Clinical Center
Testosterone, Total. 7/18/2017 1043.00 ng/dL 262.0-1593.0 NIH Clinical Center
Albumin, Serum. 7/18/2017 4.50 g/dL 3.5-5.2 NIH Clinical Center
Testosterone, Free (calc). 7/18/2017 29.50 ng/dL 7.4-22.6 NIH Clinical Center

Order: Insulin-Like Growth Factor-1
Name Date Value Units Range Source
Insulin-Like Growth Factor-1. 7/18/2017 134.00 ng/mL 88-537 NIH Clinical Center
Notes:
Tanner Stages (Females): I 44-472; II 116-449; III 182-481;
IV 186-461; V 146-431.
Tanner Stages (Males) : I 53-256; II 96-462; III 197-533;
IV 165-476; V 159-537.

Order: Thyroxine, Free
Name Date Value Units Range Source
Thyroxine, Free. 7/18/2017 1.10 ng/dL 0.9-1.7 NIH Clinical Center

Order: Prolactin
Name Date Value Units Range Source
Prolactin. 7/18/2017 35.70 mcg/L 2.0-25.0 NIH Clinical Center

Order: Acute Care Panel
Name Date Value Units Range Source
Sodium. 7/18/2017 141.00 mmol/L 136-145 NIH Clinical Center
Potassium. 7/18/2017 4.70 mmol/L 3.4-5.1 NIH Clinical Center
Chloride. 7/18/2017 103.00 mmol/L 98-107 NIH Clinical Center
Total CO2. 7/18/2017 27.00 mmol/L 22-29 NIH Clinical Center
Creatinine 7/18/2017 1.24 mg/dL 0.67-1.17 NIH Clinical Center
eGFR (African-American) 7/18/2017 91.00 NIH Clinical Center
eGFR (non-African-American) 7/18/2017 78.00 NIH Clinical Center
Notes:
Unit : mL/min/1.73 sq.m
eGFR calculated using CKD-EPI equation
30-60 mL/min/1.73sq.m : Moderate decrease in GFR
15-29 mL/min/1.73 sq.m: Severe decrease in GFR
<15 mL/min/1.73 sq.m : Kidney failure
Please treat eGFR values > 90mL/min/1.73 sq.m with reserve due to increased
variability of results at higher eGFR values
Glucose. 7/18/2017 101.00 mg/dL 74-106 NIH Clinical Center
Urea Nitrogen. 7/18/2017 23.00 mg/dL 6-20 NIH Clinical Center

Order: Cortisol, Serum
Name Date Value Units Range Source
Cortisol, Serum. 7/18/2017 11.40 mcg/dL 5.0-25.0 NIH Clinical Center
Notes:
Reference Range for samples collected between 8:00 and 9:00 am.

Order: Luteinizing Hormone
Name Date Value Units Range Source
Luteinizing Hormone. 7/18/2017 <0.1 U/L NIH Clinical Center
Notes:
Follicular 1-12 U/L
Midcycle 17-77 U/L
Luteal 0-15 U/L
Postmenopausal 11-40 U/L
Adult Males 1-8 U/L

Order: Thyroid Stimulating Hormone
Name Date Value Units Range Source
Thyroid Stimulating Hormone. 7/18/2017 1.77 mcIU/mL 0.27-4.20 NIH Clinical Center
Notes:
Mass Spectrometry T3, T4 and Reverse T3 will be performed. If TSH > 6.0
mcIU/mL.

Order: Adrenocorticotropic Hormone
Name Date Value Units Range Source
Adrenocorticotropic Hormone. 7/18/2017 18.40 pg/mL 5.0-46.0 NIH Clinical Center

Order: Follicle Stimulating Hormone
Name Date Value Units Range Source
Follicle Stimulating Hormone. 7/18/2017 <0.1 U/L NIH Clinical Center
Notes:
Follicular 3-11 U/L
Midcycle 6-21-U/L
Luteal 1-9 U/L
Postmenopausal 22-153 U/L
Adult Males 1-11 U/L

Order: Prostatic Specific Antigen
Name Date Value Units Range Source
Prostatic Specific Antigen. 7/18/2017 0.90 ng/mL 0.00-3.99 NIH Clinical Center
Notes:
The testing method is a chemiluminescence assay manufactured by
Roche Diagnostics and performed on the Cobas 6000 analyzer.
Values obtained with different assay methods
may be different and cannot be used interchangeably.

Order: Growth Hormone
Name Date Value Units Range Source
Growth Hormone. 7/18/2017 0.10 ng/mL 0.00-3.00 NIH Clinical Center

 

[Libra88]

According to the blood work, my prolactin has gone higher after up dosing my cabergoline, and my CBC seems to be off, Dr. Saya or Dr. Calkins, if you are reading this what should I do about the prolactin levels and CBC?

 

[ERO]

I just bought Jarrow PS-100, I read that that can help with insomnia, sleep studies seem to be pretty expensive. Dr. Saya if you are reading this, do you have any sleep aid at Defy Medical that can help me sleep?

Try Magnesium Glycinate 400mg and some L-Glycene before bed. get the Glycene powder and use a teaspoonful in water. It is like 12 dollars a pound at Amazon. It tastes sweet so its easy to drink as well.

 

[Dr Justin Saya MD]

According to the blood work, my prolactin has gone higher after up dosing my cabergoline, and my CBC seems to be off, Dr. Saya or Dr. Calkins, if you are reading this what should I do about the prolactin levels and CBC?

Nothing very peculiar about the CBC. The MCV level could indicate you need more B vitamins (take a B complex).

I can't connect your screen name to your chart for full assessment, but refresh my memory of if you've had a pituitary MRI (to check for prolactinoma) and your current cabergoline dosage at the time of those labs.

 

[Libra88]

My full name is XXXXXXXXX...It is a prolactinoma, my protocol for the cabergoline is .75mg (one pill and a half) twice a week. My initial protocol prior to defymedical was .5mg twice a week in which my prolactin was at about 20ng/L. I am not sure if you recall, but you told me that the prolactin levels I had are just above normal and should be brought down, so you updosed the cabergoline .25mg(half a pill). That is when I told you that I had tried to raise my cabergoline dosage higher and it actually raised the prolactin instead of lower it.I then had an appointment with Dr. Calkins and he told me to updose another .25mg(half a pill) which is my current protocol and now my prolactin is at 35ng/L. So I am wondering if with your permission I can lower the cabergoline dosage back to my intial protocol of just .5mg(one pill) twice a week unless you know of an alternative. Thanks again for the response Dr. I really appreciate it!

 

[johndoesmith]

My full name is XXXXXXXXX...It is a prolactinoma, my protocol for the cabergoline is .75mg (one pill and a half) twice a week. My initial protocol prior to defymedical was .5mg twice a week in which my prolactin was at about 20ng/L. I am not sure if you recall, but you told me that the prolactin levels I had are just above normal and should be brought down, so you updosed the cabergoline .25mg(half a pill). That is when I told you that I had tried to raise my cabergoline dosage higher and it actually raised the prolactin instead of lower it.I then had an appointment with Dr. Calkins and he told me to updose another .25mg(half a pill) which is my current protocol and now my prolactin is at 35ng/L. So I am wondering if with your permission I can lower the cabergoline dosage back to my intial protocol of just .5mg(one pill) twice a week unless you know of an alternative. Thanks again for the response Dr. I really appreciate it!

I wonder if the dose increase just happens to coincide with an enlargement of the tumor. I really don't know much at all about prolactinomas, but it's certainly interesting that this is happening.

I mean no disrespect by that of course, not trying to make light of your condition, I just enjoy learning and the science behind all of this. I truly wish you the best with whatever your condition may be.

 

[Dr Justin Saya MD]

My full name is XXXXXXX...It is a prolactinoma, my protocol for the cabergoline is .75mg (one pill and a half) twice a week. My initial protocol prior to defymedical was .5mg twice a week in which my prolactin was at about 20ng/L. I am not sure if you recall, but you told me that the prolactin levels I had are just above normal and should be brought down, so you updosed the cabergoline .25mg(half a pill). That is when I told you that I had tried to raise my cabergoline dosage higher and it actually raised the prolactin instead of lower it.I then had an appointment with Dr. Calkins and he told me to updose another .25mg(half a pill) which is my current protocol and now my prolactin is at 35ng/L. So I am wondering if with your permission I can lower the cabergoline dosage back to my intial protocol of just .5mg(one pill) twice a week unless you know of an alternative. Thanks again for the response Dr. I really appreciate it!

Hi Libra-

That would be a paradoxical reaction and highly unusual. As johndoesmith alluded to, the concern would be that there is a coincidental enlargement of the prolactinoma (which by chance correlated with the timing of the increases in your cabergoline). The concern there would be a reduction in caber dosing *could* allow the prolactinoma to grow more quickly. I wouldn't decrease dosage currently for that reason. I recommend a repeat prolactin (fasting 12 hours with no ejaculation x 48hrs) and a repeat pituitary MRI to assess current size of prolactinoma. This will give us all of the info needed to guide any potential further dosage changes in cabergoline. Forward this thread to my office via email (info@defymedical.com with attn to medical team) and staff will arrange for you.

 

[Dr Justin Saya MD]

I edited out your name and DOB from previous posts.

 

[Millere]

what caused your prolactin issues?

 

[Libra88]

Dr. Saya I just got the results from my MRI and it shows no change in size of the tumor from last year. I haven't masturbated in 2 months, so I am not sure if a repeat bloodwork for prolactin would change much. One thing I would like to note and I feel could be the reason why I haven't had the full effects of the testosterone is because of porn addiction. I have been researching it and have found that it downregulates d2 dopamine receptors and also androgen receptors. So even if I have a testosterone reading of 1000ng/l, there aren't enough receptors to attach it too. This also could explain the "adrenal fatigue" I have been experiencing.

 

[Vince Carter]

of note to me is how you're all over the map here...Prolactin, then it's Adrenal, Sleep, Thyroid, Porn addiction (made up garbage), makes things very difficult to assess when you shotgun things like this, you never make much progress in eliminating one thing or another. A steady consistency is crucial, the way you're going about this you may find some resolution to your complaints but you won't know what that is because you're up down and all around everything giving nothing a chance to really work.

 

[Libra88]

It's been 6 months since I've started to your T. I just want to feel better, I apologize if I seem annoying. I just have a difficult case. As far as narrowing down to what I believe will help me "dial in", I believe it comes down to prolactin and estradiol. I will let my other doctors deal with the prolactin as they have upped the dose to lower it to normal levels. I am aware prolactin levels can fluctuate, but regardless, I believe it being at 35 when I didn't masturbate or eat or do anything is quite high. Other than the tumor growing(which the MRI has shown it has not changed in size since last year), the only other reason my prolactin may have gone higher could be because of my estradiol being higher than it should. My estradiol is at 27pg/ml. I am not sure if that is reasonable, I have heard optimal estradiol should be 20-22pg/ml. Again I am throwing things out there to see what you all think. I appreciate each and every response including Dr. Saya and Dr. Calkins.