Second Guessing Endo's Recommendations

maddiemak · Mar 11, 2016

Hello everyone!

I'm a newbie here and I am thoroughly enjoying all the great info on the site. A little background on me. Male, 43, 6'1", 230, exercise 3-4 times a week either running 5 miles for cardio or weights and a 2 mile run. Started TRT May of 2015 when my T level was 347. It started out great, then the nurse practitioner started adjusting my T shots (Testosterone cypionate) from 100mg to 80mg once a week and having me take Anastrozole (quarter tablet) once a week. I was taking HcG three times a week, but I don't remember the amount. Anyway, about November of last year, I started getting symptoms I had before I started TRT. The first four days after the shot were good, but after that I would get moody, lethargic, low libido, etc., so I stopped TRT in February 2016 cold turkey. I know, BAD idea! After finding this site I appears I just needed to try two shots per week. I was sent to an endocrinologist who drew my blood and spent a whopping five minutes feverishly banging away on his laptop as he rapid fire asked me questions. I explained what was going on, how bad I was feeling, etc. and all I heard was uh-huh, uh-huh, uh-huh.
My lab work came back this week and I was put on Metformin 500mg once a day. Now my total T is 276 and I'm feeling terrible again. I called his nurse and she advised that he wants me to stay on Metformin for three months and he was more concerned with my free T and that the Metformin should help that. Banging my head against the wall now that I ever stopped. I'm posting the results and I welcome any feedback. Thanks.

Vettester Chris · Mar 11, 2016

Glad you joined, and glad you posted up your situation! It's kind-a, sort-a speculation at this point, due to no labs noted at the time when you started to feel lousy! Here's a "possible" theory ... The amount of testosterone you were taking was by no means any amount that would take you over the top. I suspect maybe your E2 was OK or who knows, maybe a tad sub-optimal at the time of starting TRT. I'm not a fan at all of AI's like anastrozole, "Unless" it is absolutely needed!

My possible theory is that your small amount of weekly AI caught up with you, and when E2 levels got down to "x" serum value, you began to notice negative symptoms. Estrogen is our friend, and adequate amounts are needed in men to attain and maintain a good well being. One school of thought is to find that sweet zone of balance, where the amount of testosterone administered converts just enough downstream to where AI's and/or DHT prevention is needed. I went for over 3 years at/around 120mg week (split twice) without any need for an AI.

As you eluded to, Free Testosterone management is essential in my book, and that number/percentage should equally reviewed with the total serums. However, the free testosterone is going to be a relevant percentage of the total serum; meaning it's not going to ever really be anywhere that it should be with a 276ng/dl total serum value. IMO, Free test in the 14ng/dl to 23ng/dl could be a good range for most men. Even if your free test improves to 3%, you would still be below 8ng/dl. If you're pulling 2% or 3% from the well, then logically you need more water in the well to get an optimal amount ... Make sense?

CoastWatcher · Mar 11, 2016

Welcome to Excelmale! You are not receiving the care you are entitled to. But don't feel too badly about that, many, perhaps most, of us experienced the same thing when we initially began traveling Hormone Highway. Chris summarized, very well, the topics/questions that need to be dealt with (along with some possible answers). I have one more - are you open to exploring Defy Medical's treatment options? Let me say right off, I am not a patient, but respect their work. Two of the leading androgen specialists in the country comprise their medical staff. Frankly, the telemedicine model works. There is an answer to what you're dealing with. All the best.

maddiemak · Mar 11, 2016

Chris,

I guess I should have posted my lab work from when I was on TRT. Sorry about that. Here is what I have.

4/29/15
Testosterone: 347 ng/dL
Estradiol: 13.2 pg/mL
Prostate-Specific Ag: 1.2 ng/mL
Hemoglobin: 14.9 g/dL

5/22/15
Testosterone: 1150 ng/dL
Estradiol: 68.4 pg/mL
Prostate-Specific Ag: ?.? ng/mL
Hemoglobin: 15.2 g/dL
My once weekly T dose was lowered to 100mg and .5mg Anastrozole started 1/week

7/02/15
Testosterone: 1082 ng/dL
Estradiol: 33.2 pg/mL
Prostate-Specific Ag: 1.2 ng/mL
Hemoglobin: 15.2 g/dL
Dosage remains the same

8/28/15
Testosterone: 784 ng/dL
Estradiol: 17.6 pg/mL
Prostate-Specific Ag: ?.? ng/mL
Hemoglobin: ?.? g/dL
Dosage still 100mg IM Q week - hold Anastrozole

11/11/15
Testosterone: 880 ng/dL
Estradiol: 47.5 pg/mL
Prostate-Specific Ag: ?.? ng/mL
Hemoglobin: 15.5 g/dL
Dosage decreased to 80mg IM Q week. HGB is WNL. Continue Zinc 50mg PO daily for estradiol levels.

2/03/16
Testosterone: 830 ng/dL
Estradiol: 42.3 pg/mL
Prostate-Specific Ag: 1.4 ng/mL
Hemoglobin: 16.3 g/dL
Hold Zinc. Anastrozole to 0.5mg PO 2X/week.

At this point I was feeling so bad, I did not come back and they referred me to an endocrinologist.

CoastWatcher, I have contacted Defy, but the cost right now is a little intimidating with the monthly cost coming out of pocket.

Vettester Chris · Mar 11, 2016

Agree with CW to possibly look deeper at a specialized treatment center like Defy. As your opening title stated, you are 2nd guessing your endo's recommendations. If just for the sake of a 2nd opinion, it's always good to have another physician compare some notes. I have no idea why anyone is trying to spin Metformin as a viable treatment for low testosterone?!?! It's like all these stupid commercials advertising herbal supplements that will raise "free testosterone"! 1) Increasing free test really won't make any difference if the well is empty with the Total Serum!
2) Why is he concerned with Free Testosterone, yet I don't see a lab for it?

Again, to stress this, Free Testosterone will usually fall between 1% to 4% in men, and you can tighten that down to 2% to 3% when everything settles. The remainder of all that testosterone is tied up with SHBG and somewhat with Albumin. There's no way around that, it is how it plays out for everyone! So even if you're on the higher side, call it 3%, that's going to come off the bottom line of your Total Serum.

Your doctor doesn't get that and LOL he's a doctor, who by title is supposed to be miles ahead of all of us. For this reason, it is giving the A4M pros and places like Defy easy pickings, as at the end of the day the consumer is just really wanting factual answers and realistic solutions, not some dude full of himself acting like the Great Oz, pounding away on his keyboard!

Vettester Chris · Mar 11, 2016

Was your E2 a "sensitive", "ultra-sensitive" male specific assay? We need ranges chief.

maddiemak · Mar 12, 2016

Good question Chris about the E2 ranges. Honestly I don't know. Guess I should call the Great Oz and find out. LOL! Thanks for your help.

ERO · Mar 12, 2016

Honestly, I would not walk but RUN from this doc and call Defy Medical. Why waste time, money and energy on a guy that is already raising several red flags? If he was the mechanic that kept incorrectly diagnosing and repairing your car would you go back?