urgent seeing doc tomorrow What should i do?

[flyboyiii]

Okay, i've been on TRT for 4 years now. 37yo W/M
im currently getting T shots weekly @ about 350-400 ui
taking HGH -- nutropin aq SC @.4 daily
synthroid - 50 mg daily
im have reactive hypoglycemia and hyper insulinism

my last levels were
90 min cortisol 29.2 previous test 24.9
total T (peak- day after my shot) 1063
(trough right before my next shot) 524
t-4 free 1.1 (0.8-1.8)
t-3 free 342 down from 370 (230-420)
IGF-1 295
sperm count 0, none nada (was previously low and what was there had good motility)

origionally was on T gel and was switched to IM a year and a half ago and my previous sperm count was 2 yrs ago.

Been wanting to start HCG 2x a week to retain fertility, but my DOC will only do all HCG or all T not both. I want to have the capibility of having kids in the future as i dont have any yet.

Swale does not recommend a Full HCG routine, as it causes other issues if used as sole TRT. As, levels would need to be well above the Safe 500ui limit.

i am having a testicular ultrasound Monday to see if they have shrunk any since my last ultrasound 2 yrs ago.

What would you guys recommend i do to get my fertility back?

thanks in advance!!

[flyboyiii]

well spoke with the Dr.
will be starting HMG begining of march when he returns from vacation. as he wants to monitor my progress thru blood work till we figure out what dosage is sufficent.
I Will be starting out at 150 ui daily.

Thanks to HEADDOC for his continued help and advice.

hmm 49 views today and no responses.. oh well

[JimRat]

You should be able to recover some fertility with the HMG. If you can, let me know how it compares price-wise to HCG....

[flyboyiii]

never taken the HCG or HMB, and its covered by my insurance 100% so i could only tell ya what it says on the reciept that the ins. company is paying. i doubt that would be considered a good price for people on here

[JanSz]

Originally Posted by flyboyiii

Okay, i've been on TRT for 4 years now. 37yo W/M
im currently getting T shots weekly @ about 350-400 ui
taking HGH -- nutropin aq SC @.4 daily
synthroid - 50 mg daily
im have reactive hypoglycemia and hyper insulinism

my last levels were
90 min cortisol 29.2 previous test 24.9
total T (peak- day after my shot) 1063
(trough right before my next shot) 524
t-4 free 1.1 (0.8-1.8)
t-3 free 342 down from 370 (230-420)
IGF-1 295
sperm count 0, none nada (was previously low and what was there had good motility)

origionally was on T gel and was switched to IM a year and a half ago and my previous sperm count was 2 yrs ago.

Been wanting to start HCG 2x a week to retain fertility, but my DOC will only do all HCG or all T not both. I want to have the capibility of having kids in the future as i dont have any yet.

Swale does not recommend a Full HCG routine, as it causes other issues if used as sole TRT. As, levels would need to be well above the Safe 500ui limit.

i am having a testicular ultrasound Monday to see if they have shrunk any since my last ultrasound 2 yrs ago.

What would you guys recommend i do to get my fertility back?

thanks in advance!!

You doctor telling you to go at this point with HMG is not optimal.
MRI useless, if you are using T without HCG you can bet money that you testis will shut down.
Below is my idea on how to deal with your situation.
================================================== ==================

If you want to have your own children, you need sperm.
Sperm is produced in testis.
Using testosterone shuts down testis.
Currently your testis are shut down, you did not need sperm test to figure that out.
I assume that you would prefer gradual transition from current to one where testis are operational.
HCG-500iu limit is a old wifes story.
One can go up to 10000iu/week for year or more with out damaging testis.
Clarify your current "T shots weekly @ about 350-400 ui "
I hope it is not 350-400mg/week
It cannot be, since a day after T shot your TT=1063
To revive your testis and to have better TRT in mean time (for the next two months) change your schedule to
EOD EveryOtherDay
Shots every day
one day T-shot
next day HCG-shot
T-shot size, recalculate from your current weekly shots
HCG-shot=250iu

On the end of two months period, I assume that your testis will be sufficiently recovered.
During following month reduce your T-shot size down to zero by end of the month.
Keep your HCG-shots at 250iu/EOD
Stay on (HCG only) for another month and then do testing at Quest Diagnostics, blood drawn at Quest, these tests:
42 DHEA sulfate
48 Estradiol, Ultrasensitive, LC/MS/MS (30289X)
50 Testosterone, Free, Bio/Total (LC/MS/MS) Code: 14966X
51 Dihydrotestosterone (204X)
--------------------------------------------------

These tests will tell you where you stand naturally (while inducing testicular production with HCG).

You should be (pretty much) fertile at this point.
This is starting point.
From this point you can put emphasis on
either fertility
or every day life.
===============================

If fertility is priority and you did not conceived till now
increase HCG up to 750iu/EOD for the next three months,
if that did not helped
for the next 3 months add 75iu HMG EOD
if that did not helped it is difficult, you have testicular biopsy in your future and need real high flying specialist
================================

if daily life is priority
there is always potential to increase HCG shots up to about 750iu/EOD, providing that you can control E2. To control E2 use arimidex=Liquidex=Anastrozole but no more than 1.5mg/day
After you optimized your HCG dose, if you still missing goal of BAT(460-575) you may start adding T-shots.

Goals
DHEAs(500-640)
E2(25-290
DHT(60-90)
BAT(460-575)
BAT-BioAvailableTestosterone
==============================================
.

[flyboyiii]

Originally Posted by JanSz

You doctor telling you to go at this point with HMG is not optimal.
MRI useless, if you are using T without HCG you can bet money that you testis will shut down.
Below is my idea on how to deal with your situation.
================================================== ==================

If you want to have your own children, you need sperm.
Sperm is produced in testis.
Using testosterone shuts down testis.
Currently your testis are shut down, you did not need sperm test to figure that out.
I assume that you would prefer gradual transition from current to one where testis are operational.
HCG-500iu limit is a old wifes story.
One can go up to 10000iu/week for year or more with out damaging testis.
Clarify your current "T shots weekly @ about 350-400 ui "
I hope it is not 350-400mg/week
It cannot be, since a day after T shot your TT=1063
To revive your testis and to have better TRT in mean time (for the next two months) change your schedule to
EOD EveryOtherDay
Shots every day
one day T-shot
next day HCG-shot
T-shot size, recalculate from your current weekly shots
HCG-shot=250iu

On the end of two months period, I assume that your testis will be sufficiently recovered.
During following month reduce your T-shot size down to zero by end of the month.
Keep your HCG-shots at 250iu/EOD
Stay on (HCG only) for another month and then do testing at Quest Diagnostics, blood drawn at Quest, these tests:
42 DHEA sulfate
48 Estradiol, Ultrasensitive, LC/MS/MS (30289X)
50 Testosterone, Free, Bio/Total (LC/MS/MS) Code: 14966X
51 Dihydrotestosterone (204X)
--------------------------------------------------

These tests will tell you where you stand naturally (while inducing testicular production with HCG).

You should be (pretty much) fertile at this point.
This is starting point.
From this point you can put emphasis on
either fertility
or every day life.
===============================

If fertility is priority and you did not conceived till now
increase HCG up to 750iu/EOD for the next three months,
if that did not helped
for the next 3 months add 75iu HMG EOD
if that did not helped it is difficult, you have testicular biopsy in your future and need real high flying specialist
================================

if daily life is priority
there is always potential to increase HCG shots up to about 750iu/EOD, providing that you can control E2. To control E2 use arimidex=Liquidex=Anastrozole but no more than 1.5mg/day
After you optimized your HCG dose, if you still missing goal of BAT(460-575) you may start adding T-shots.

Goals
DHEAs(500-640)
E2(25-290
DHT(60-90)
BAT(460-575)
BAT-BioAvailableTestosterone
==============================================
.

well i am under the care of a DR., who injects the testosterone weekly, who is 75 miles away one-way.. Who wont allow me to inject the T myself. Nor does he let his staff he does it himself.. he has lost 3 patients due to their Wives being RN's and injecting directly into a vein.

So i have no control of how much i take and how often.
I dont plan on trying to treat myself. If i do that my meds wont be covered by my insurance. and i dont know enough to do it anyway.
I dont see the purpose of me doing more lab work at my cost when im not going to have control of my dosing.

My job wont allow me to take cold medicine with out disqualifying me for work while im on the medicine. So basically i need to be on a perscription and it be documented, and be taken out of my job for a few weeks till they are sure there arent any adverse side effects that could affect my judgement, regardless if there are just replacing naturally produced hormones or not. So my hands are tied. they randomly do drug and steroid screening so anything that isnt perscribed and documented i would get hammered for.

HMG has both LH and FSH so why wouldnt you recommend that?
HCG has just LH
I have read on here that if they could afford it, people would like to be on HMG not HCG. so i dont understand your logic on that

[JanSz]

Originally Posted by flyboyiii

well i am under the care of a DR., who injects the testosterone weekly, who is 75 miles away one-way.. Who wont allow me to inject the T myself. Nor does he let his staff he does it himself.. he has lost 3 patients due to their Wives being RN's and injecting directly into a vein.

So i have no control of how much i take and how often.
I dont plan on trying to treat myself. If i do that my meds wont be covered by my insurance. and i dont know enough to do it anyway.
I dont see the purpose of me doing more lab work at my cost when im not going to have control of my dosing.

My job wont allow me to take cold medicine with out disqualifying me for work while im on the medicine. So basically i need to be on a perscription and it be documented, and be taken out of my job for a few weeks till they are sure there arent any adverse side effects that could affect my judgement, regardless if there are just replacing naturally produced hormones or not. So my hands are tied. they randomly do drug and steroid screening so anything that isnt perscribed and documented i would get hammered for.

HMG has both LH and FSH so why wouldnt you recommend that?
HCG has just LH
I have read on here that if they could afford it, people would like to be on HMG not HCG. so i dont understand your logic on that

Lets establish clearly your priorities.
Is fertily your priority now or this is a project for sometime in the future.

About HMG being better but more expensive than HCG.
The expensive part is true.
There is little experience with HMG, I have not seen anybody posting about it.
So when you will use it, please report on your experience.

Since you have to get injections from your doctor onece weekly, lets hope that it will work for you.

I am injecting testosterone for 2 years with this needles:
http://hocks.com/Merchant2/merchant....Category_Code=
BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16inch Short Needle--1/2 Unit Markings 100/b Price: $25.95

I have steady and expected results.
Note that those needles are the smallest that one can get.
.
Consider using testosterone pellets.
With your job being so demanding, it should provide long periods of steady results.
If you want to be happy with pellets, whaterwer time between pellets they will promise you,
cut that time in half, replace pelelts twice as often.
.
.

[flyboyiii]

i WONT do T pelets.
I am a Keloid scar former. (large thick raised scars)

he wont let me dose my own T.

Fertility is a long term thing for me not trying to concieve at this moment.

[JanSz]

Originally Posted by flyboyiii

i WONT do T pelets.
I am a Keloid scar former. (large thick raised scars)

he wont let me dose my own T.

Fertility is a long term thing for me not trying to concieve at this moment.

Keloid scar former. (large thick raised scars)
---
Explain how much prone are you to keloid scars.
How frequent injections are affecting you?
From point of view of scar formation, Is there a difference between shot done with thick long needle or short very thin needle?
Most likely your growth hormone is injected with short thin needle.
Diffrent body parts are affected diferently, not sure how to figure out better locations for shots.
---------
Assuming that you would change doctors, my plan calls for daily injections with short thin needle. That would be T & HCG on alternate days, well, plus another injection of GH.
That is 2 injections within every day.
But all those injections would be as small and easy as your current Nutropin (GH) injections.
Do you think that would present problem from scar formation point of view?

Possibly installing shunt could solve scar tissue problem.
----------
If your doctor lost three patients due to injections mishaps, think of changing doctors.
Also think
thick infrequent (weekly) shots with long leedle=lots of medicine that may get deep into your body.
Thin, short needle, little medicine at one time, very steady levels of medicine, medicine deposited shalow.
---------
Fertility maintenance = testicular size maintenance
3 HCG shots per week, 250iu should take care of that
Use of external testosterone without HCG equals sterilization (for sure)
---------------------------------
reactive hypoglycemia and hyper insulinism

frequent meals
forget about wheat, rye, potatos, rice, sugar
one of the types of reactive hypoglycemia is Hormonal Hypoglycemia
good hormonal testing, specially thyroid could possibly help
---------------------------------

It is hard to figure out much with practically no testing.
Take a look at my list of tests, post #44 between blue lines, here
Jan's BloodTest April13/2007 - Page 2

When you possibly change doctor, consider that list.

Good luck.
==============

[flyboyiii]

[quote=JanSz;615568]Keloid scar former. (large thick raised scars)
---
Explain how much prone are you to keloid scars.
How frequent injections are affecting you?
From point of view of scar formation, Is there a difference between shot done with thick long needle or short very thin needle?
Most likely your growth hormone is injected with short thin needle.
Diffrent body parts are affected diferently, not sure how to figure out better locations for shots.
---------
Assuming that you would change doctors, my plan calls for daily injections with short thin needle. That would be T & HCG on alternate days, well, plus another injection of GH.
That is 2 injections within every day.
But all those injections would be as small and easy as your current Nutropin (GH) injections.
Do you think that would present problem from scar formation point of view?

Possibly installing shunt could solve scar tissue problem.
----------
If your doctor lost three patients due to injections mishaps, think of changing doctors.
Also think
thick infrequent (weekly) shots with long leedle=lots of medicine that may get deep into your body.
Thin, short needle, little medicine at one time, very steady levels of medicine, medicine deposited shalow.
---------
Fertility maintenance = testicular size maintenance
3 HCG shots per week, 250iu should take care of that
Use of external testosterone without HCG equals sterilization (for sure)
---------------------------------
reactive hypoglycemia and hyper insulinism

frequent meals
forget about wheat, rye, potatos, rice, sugar
one of the types of reactive hypoglycemia is Hormonal Hypoglycemia
good hormonal testing, specially thyroid could possibly help
---------------------------------

It is hard to figure out much with practically no testing.
Take a look at my list of tests, post #44 between blue lines, here
Jan's BloodTest April13/2007 - Page 2

When you possibly change doctor, consider that list.

Good luck.
==============[/QUOTE
There arent many doctors in this area. and their all booked up. im happy to find a doctor that will actually treat symptoms. Him and i are working together. we have a good relationship. I truely believe that all of his patients should be on HCG or HMG, but i will be the first. i guess i will be the gueini pig as far as his practive is concerned with HCG + HMG. I hope all can get on these meds once he sees the results.

He did not lose3 patients do to his or his staffs actions. He lost them due to their wives insisting the could administer the T shots and they hit a vein. (did not pull on the siringe to check for blood prior to injecting the T. So me injecting my own T isnt going to happen. im not going thru and mood swings or anything, so im not concerned with weekly injections. I get reimbursed for mileage on my vehicle so all is good.

I Really dont want to experiment with this on my own. Thats what Doctors are trained and paid for. That why i have helth care insurance. Im not paying anything out of pocket till i retire, and when i do retire.. it will be less than $50 a month for co-pays. Im making sure everything is found and diagnosed now.

i dont scar from needles. i would scar from someone cutting me open to insert pellets. if it would last a lifetime.. i would do it.. however it doesnt, a probally never will.