TRT with adrenal issues?

[EnduroMan]

Hi all, first post here,

I am wondering if anyone here would be able to help me in my case.

Firstly I am in my early 20s and an endurance athlete in the UK who has been diagnosed with osteopenia bordering on osteoporosis. I requested to have my test levels checked and unsurprisingly they were low at 9 on a normal range of 10-34. I'm not sure what that is in free or total T but know it is low. It was not easy to get my doctor to test this and it took quite some time and much nagging...

Now here is my dilemma, I had sufered from long term illness for years (CFS) had adrenal fatigue and low DHEA for years and boy did I suffer from it, ie not being able to work a full day without being shattered, anxiety, depression etc - a real struggle physically and mentally. I have the (saliva test) results and can post them if you wish to see them. I was never able to get this under control due to stress from various sources and still suffer from the symptoms mentioned above so life can be hard but I need to work for money.

My doc (GP) wants me to see an endo and says that I will need to be put on TRT, I realise that it may not be a good idea to do this as my adrenals are not functioning well but I fear that the endo will not understand this - the endocrinologists here are apparently not so professional and have to be watched like a hawk.

I am not new to the idea of HRT and have been reading the boards for years but I don't have a clue how it would be applicable to my case and if it would be a bad idea to jump on TRT with adrenal issues and the like.

I have used SERMs in the past and they worked to help me recover from training but did little else and I would prefer not to use them long term.


Thanks in advance for responses!

[EnduroMan]

Bump!

Below are my reaults from nearly 5 years ago.


ADRENAL STRESS PROFILE (Saliva)

Cortisol Levels

Sample 1 7:00-8:00am 19.6 Reference limits (12-22)
Sample 2 11:00am-12:00pm 3.6 Ref limits (4-8)
Sample 3 16:00-17:00pm 1.5 Ref limits (3-7)
Sample 4 23:00-00:00 0.2 Ref limits (1-3)

Total daily cortisol 24.9 Ref limits (20-40)

DHEA Levels

Sample 1 7:00-8:00am 0.28 Ref limits (0.5-1.0)
Sample 2 16:00-17:00pm 0.16 Ref limits (0.5-1.0)

DHEA : Cortisol ratio 1.1 Ref limits (1.3-5.0)


BTW Should I get another salivary cortisol test before I consider TRT?

Thanks

[zkt]

Adrenal insufficiency is well understood by the medical community. Testosterone isnt going to hurt your adrenal output. You will feeel betten - not worse. Give the guy a chance.

Originally Posted by EnduroMan

Hi all, first post here,

I am wondering if anyone here would be able to help me in my case.

Firstly I am in my early 20s and an endurance athlete in the UK who has been diagnosed with osteopenia bordering on osteoporosis. I requested to have my test levels checked and unsurprisingly they were low at 9 on a normal range of 10-34. I'm not sure what that is in free or total T but know it is low. It was not easy to get my doctor to test this and it took quite some time and much nagging...

Now here is my dilemma, I had sufered from long term illness for years (CFS) had adrenal fatigue and low DHEA for years and boy did I suffer from it, ie not being able to work a full day without being shattered, anxiety, depression etc - a real struggle physically and mentally. I have the (saliva test) results and can post them if you wish to see them. I was never able to get this under control due to stress from various sources and still suffer from the symptoms mentioned above so life can be hard but I need to work for money.

My doc (GP) wants me to see an endo and says that I will need to be put on TRT, I realise that it may not be a good idea to do this as my adrenals are not functioning well but I fear that the endo will not understand this - the endocrinologists here are apparently not so professional and have to be watched like a hawk.

I am not new to the idea of HRT and have been reading the boards for years but I don't have a clue how it would be applicable to my case and if it would be a bad idea to jump on TRT with adrenal issues and the like.

I have used SERMs in the past and they worked to help me recover from training but did little else and I would prefer not to use them long term.


Thanks in advance for responses!

[simpllyhuge]

some more labs would be nice.

[EnduroMan]

Thanks for replies guys, that is all the bloodwork that I have for now.

OK, I have just had the consultation with the endo today. He has requested more blood tests (of which I will post the results of as soon as I get them) and suggested that TRT may be the way forward for me pending the lab results.

The docs here (UK) seem to absolutely not advocate HCG use but I was thinking that a low dose 250iu x2 weekly may be wise to prevent testicular shrinkage if I do indeed undertake TRT. One point made that I had an issue with is that he said that natural production will return fully within days if I wish to come of it in future years to have kids which has never been my understanding thats for sure.

Over all i went better with him than I may have expected and he was clearly keen to help and listened well.

BTW One quick question. Does Androgel really spike DHT levels more than IM injections? I am more comfortable with injections personally and was just wondering if there is any real evidence to suggest that they may be superior in this regard.

Thanks very much!

[zkt]

"The docs here (UK) seem to absolutely not advocate HCG"
The real problem is that there has not been much in the way of clinical studies done regarding trt optimization. So the docs rely on the physiology they learned in medical school and their experience in residency.
I have been managing my own trt program for more than 2 years and study the medical texts. The first a8 mts i tried 125mgTE/w IM and little hcg. Then I stopped the T and waited for a month- felt tired, like shit, libido dead. Started hcg 10000iu/mth subq e3d for 2 mth and was back to where I was after stopping T. Now I do the same amount of T as befor and divide a 10000iu hcg into 6 or 8 weekly doses.
So in my experience Yes, hcg helps in mary areas. My balls were definitely shrinking on T olone. Restored now.
BUT we are not the same age and age matters in terms of rebound speed and long term effects. I dont need to consider the long term effects on the HPTA axis. You do and there is little substantitave evidence to go on.
Everyone here swears by hcg in modration and most docs specializing in trt advocate weekly low dose injections.
Were you, I upon starting trt with hcg I would estiblish baseline levels and monitor the following long term:
TSH
T4
T3
8am cortisol
glucose fasting random
T
E


Tell me more about the Dx of adrenal innsufficiency and CFS and how it has effected you please.

Originally Posted by EnduroMan

Thanks for replies guys, that is all the bloodwork that I have for now.

OK, I have just had the consultation with the endo today. He has requested more blood tests (of which I will post the results of as soon as I get them) and suggested that TRT may be the way forward for me pending the lab results.

The docs here (UK) seem to absolutely not advocate HCG use but I was thinking that a low dose 250iu x2 weekly may be wise to prevent testicular shrinkage if I do indeed undertake TRT. One point made that I had an issue with is that he said that natural production will return fully within days if I wish to come of it in future years to have kids which has never been my understanding thats for sure.

Over all i went better with him than I may have expected and he was clearly keen to help and listened well.

BTW One quick question. Does Androgel really spike DHT levels more than IM injections? I am more comfortable with injections personally and was just wondering if there is any real evidence to suggest that they may be superior in this regard.

Thanks very much!

[EnduroMan]

Hi ztk, thank you for your input.

As a teenager I missed most of secondary school due to CFS. I felt physically ill most of the time with pains, headaches and most of all overbearing fatigue. I also suffered from anxiety, stress, lack of confidence amongst other things. My doctor for years was Prof Leslie Findley who is one of the worlds leading experts in the field and we were frequently in touch. There are those who suffer from CFS worse than I did, some of them I had contact with and I was always grateful that things were not that bad for me.

I think during my teenage years I had been put through just about every CFS treatment there was lol. I think that without the good doctors that I had I could have been in a very bad state however it is still a very complex condition to treat and relatively little is really still known, I would now certainly consider myself as knowledgeable in my particular case as those treating me.

By (2003 aged 17) many of the symptoms of CFS had subsided and I could study and work hard without feeling the consequences and was very strong again physically. I was ill again in mid 2003 for a few months but things had got better again. Late 2003 through 2004 was good but from late 2004 things were not so good. Thinking I was overdoing things I heavily cut back on endurance training and was very careful to get plenty of rest and live as stress free life as I could. Several months went by and things were not getting any better. It was suggested by a nutritionist that I have an adrenal stress profile test ( the results of which are posted above).

Getting stress under control was not easy for me and I would describe myself as a constantly nervous/on edge person and antidepressants and the like never really solved the issue.

On the matter of blood tests, how often would people ideally monitor levels when on TRT? In the UK it is more difficult and expensive to get blood tests than in the USA with healthcheckusa and the like. One question I forgot to ask the Endo was how often he would be carrying out blood tests and what he would be checking.


Thanks again.

[Crazy Crew]

Originally Posted by EnduroMan

Thanks for replies guys, that is all the bloodwork that I have for now.

The docs here (UK) seem to absolutely not advocate HCG use but I was thinking that a low dose 250iu x2 weekly may be wise to prevent testicular shrinkage if I do indeed undertake TRT. One point made that I had an issue with is that he said that natural production will return fully within days if I wish to come of it in future years to have kids which has never been my understanding thats for sure.

Over all i went better with him than I may have expected and he was clearly keen to help and listened well.

BTW One quick question. Does Androgel really spike DHT levels more than IM injections? I am more comfortable with injections personally and was just wondering if there is any real evidence to suggest that they may be superior in this regard.

Thanks very much!

It takes at least a couple of weeks for your testes to shut down. I should think it would take that and probably more for them to restart. There have been may instances where men on test alone have produced offspring so don't consider this a birth control mechanism. If you do quit TRT your serum testosterone levels will return to the levels that you had before treatment.
---

In my case Androgel caused my DHT to spike to double the normal high levels. Some people definatly do over react to the gel.

[EnduroMan]

Originally Posted by Crazy Crew

In my case Androgel caused my DHT to spike to double the normal high levels. Some people definatly do over react to the gel.

Hi Crazy Crew, did you find that injecting test solved the issue of high DHT for you?

Thanks

[Crazy Crew]

In my case yes. Well maybe. I also started donating blood regularly at the time I switched to injectable T.. However everyone reacts differently.