Re: Hi everyone...new here with questions SM

[Guest guest]

I'll chip away a bit on item 4 the possible cause.

Medications can cause endocrine disruption.

Nor can it be assumed that once the medication is

discontinued the effect goes away. Some meds

cause an accumulation of estrogen which seems

to shut down the HPT axis rather permanently.

PPI meds i.e omeprazole

and oral anti-fungal meds come to mind though the list

endocrine disruptors is longer. Plus the

environment is contaminated with

all sorts of chemicals some of which is found

in cosmetics. The variouys parabens are estrogenic and are

widely found in such things as shampoo. Who

knows what certain pesticides do or the effects of certain

industrial chemicals.

He is really low!! He'll likely get osteoporosis

if he continues untreated.

>

> Hi! My husband and I have been experiencing sexual problems in our

> marriage for about 10 years. I have suspicioned over the years

that

> perhaps he had low testosterone. He never really took it

seriously.

> I began to feel sad, worried, filled with self doubts...wondering

if

> it were me (not attractive enough, too chubby, etc.). I feel like

> I've been married to my brother. I love my husband, but we have

not

> had a good, healthy sex life in over 10 years (not for lack of want

> on my part, which has been very difficult for me...him too I

suppose).

>

> Well, we just " celebrated " our 3-year anniversary of celibacy (woo

> hoo, what a celebration). I finally got fed up and told him we

> needed to figure out what was going on because I couldn't see

myself

> NOT having sex for the rest of my life (I'm 35 and he's 41). He

> reluctantly agreed to get checked.

>

> His testosterone level is 166. He goes back for a 2nd test (and a

> few more tests) in a week or so.

>

> Here are my questions:

> 1. For those of you who have/had similar testosterone levels, did

> testosterone treatment help improve your sex life, stamina,

strength,

> muscle mass, moods, etc.?

>

> 2. Is AndroGel just as effective as injections? I worry that he

> won't like the fluctuations in injections (high to low) and wonder

if

> gel would be a better choice for him.

>

> 3. What treatment have you found most helpful?

>

> 4. Finally, what can cause a man who had a normal healthy sex

drive

> to just lose it? I know it is low testosterone, but why would

> someone who was functioning fine just develop a low testosterone?

I

> guess my real question is, could it be a pituitary problem/tumor?

I

> know only imaging studies can answer that, but if a man does have a

> pituitary tumor and gets that treated, can his testosterone level

> return back to normal?

>

> Thanks so much for reading this and offering your advice.

>

> Felicia

>

[Guest guest]

I'll try to anwer two of your questions.

First, YES, Androgel or any other form of supplemental testosterone

will raise his T level and should definately increase his interest in

sex, firmness of erections, and ease and frequency of orgasm.

Injections work very very well, and if done on a weekly basis there

really is no felt up and down of T level as it is administered often in

smaller doses. Yes skin spread on like Androgel " work " for some people,

others have skin absorption problems. Androgel is also fantastically

expense, it is all advertising and profit at only one percent

testosteronce in a packet. If you insurance pays androgel ok,

otherwise consider injections, very cheap, or compounded testerestone

gel.

norton

[Guest guest]

Thanks Norton. I'll check into our insurance coverage. Anyone know a

good endocrinologist in Nebraska?

>

> I'll try to anwer two of your questions.

> First, YES, Androgel or any other form of supplemental testosterone

> will raise his T level and should definately increase his interest in

> sex, firmness of erections, and ease and frequency of orgasm.

> Injections work very very well, and if done on a weekly basis there

> really is no felt up and down of T level as it is administered often

in

> smaller doses. Yes skin spread on like Androgel " work " for some

people,

> others have skin absorption problems. Androgel is also fantastically

> expense, it is all advertising and profit at only one percent

> testosteronce in a packet. If you insurance pays androgel ok,

> otherwise consider injections, very cheap, or compounded testerestone

> gel.

> norton

>

[Guest guest]

Thanks for answering! He's on a lot of medication for psoriasis and

psoriatic arthritis (that now I'm beginning to wonder if might be a

combination of arthritis and osteoporitis as I didn't realize the

relationship between low testosterone and osteoporosis). Since he

has psoriasis, gel may not be the answer for him (might have poor

absorption of medication). When we talk to the endocrinologist we

can ask her about weekly injections.

I've been reading about E2. Is that estrogen that builds up from the

testosterone replacement therapy? Would an endocrinologist routinely

treat that too, or would we have to approach him about this aspect

and ask about one of the medications that you all take to lower the

E2?

Felicia

> >

> > Hi! My husband and I have been experiencing sexual problems in

our

> > marriage for about 10 years. I have suspicioned over the years

> that

> > perhaps he had low testosterone. He never really took it

> seriously.

> > I began to feel sad, worried, filled with self doubts...wondering

> if

> > it were me (not attractive enough, too chubby, etc.). I feel

like

> > I've been married to my brother. I love my husband, but we have

> not

> > had a good, healthy sex life in over 10 years (not for lack of

want

> > on my part, which has been very difficult for me...him too I

> suppose).

> >

> > Well, we just " celebrated " our 3-year anniversary of celibacy

(woo

> > hoo, what a celebration). I finally got fed up and told him we

> > needed to figure out what was going on because I couldn't see

> myself

> > NOT having sex for the rest of my life (I'm 35 and he's 41). He

> > reluctantly agreed to get checked.

> >

> > His testosterone level is 166. He goes back for a 2nd test (and

a

> > few more tests) in a week or so.

> >

> > Here are my questions:

> > 1. For those of you who have/had similar testosterone levels,

did

> > testosterone treatment help improve your sex life, stamina,

> strength,

> > muscle mass, moods, etc.?

> >

> > 2. Is AndroGel just as effective as injections? I worry that he

> > won't like the fluctuations in injections (high to low) and

wonder

> if

> > gel would be a better choice for him.

> >

> > 3. What treatment have you found most helpful?

> >

> > 4. Finally, what can cause a man who had a normal healthy sex

> drive

> > to just lose it? I know it is low testosterone, but why would

> > someone who was functioning fine just develop a low

testosterone?

> I

> > guess my real question is, could it be a pituitary

problem/tumor?

> I

> > know only imaging studies can answer that, but if a man does have

a

> > pituitary tumor and gets that treated, can his testosterone level

> > return back to normal?

> >

> > Thanks so much for reading this and offering your advice.

> >

> > Felicia

> >

>

[Guest guest]

Hi Felicia and welcome.

First it would help if you could post all his blood work with the ranges.

I lost my sex life after being on TRT for 7 yrs. I could not have sex with my

wife for 10 yrs. I did take care of her I used a pump and a ring but I could

not reach an orgasm. I have had low T for over 21 yrs. I read this when I

joined here and showed it to my DR.

http://www.lef.org/protocols/prtcls-txt/t-prtcl-130.html

After reading this I got my E2 checked got it down and got my sex life back. So

yes he can get his sex life back.

I was on Andorgel and feel it should be the first med a man tries. But only

after all this tests are done to show why his T levels are so low. If his Test

was done right and the DR. tested all of the tests on this cut and paste then he

should try Testim or Androgel first.

Phil

MY CURRENT BEST THOUGHTS ON HOW TO ADMINISTER TRT FOR MEN

-A RECIPE FOR SUCCESS-

-- Crisler, DO

We have already learned a practical bit about the various hormones

that make up the metabolic " symphony " which comprises our hormonal

milieu. We know where these hormones are produced, what modulates

their production, and the target tissues of their various and varied

actions. But we still need to integrate this knowledge into a

practical " recipe " , if you will, so the clinician may return to

his/her practice, and immediately begin screening for, and

successfully treating, male hypogonadism. In other words, how do you

actually administer Testosterone Replacement Therapy for men?

Should EVERY adult male patient who presents at your office be

automatically screened for hypogonadism? About half of all men over

the age of fifty are in fact hypogonadal (when tested for

Bioavailable testosterone—more on that later). Certainly the answers

to Medical History will lead the way toward suspicion of same, yet

the complaints related to this insidious condition are sensitive

without being specific. Clinical suspicion is further clouded

because there is no way to correlate either the number of individual

complaints, or the relative magnitude of each, to the severity of

the hypogonadotrophic state on laboratory assay. The number one

complaint which should hoist the proverbial red flag is Erectile

Dysfunction. This is also the symptom of hypogonadism which, aside

from all the seriously deleterious effects of same (coronary artery

disease, diabetes, osteoporosis, increased risk of cancer,

depression, dementia, etc.), is most likely to bring the patient to

actively seek TRT—and to remain compliant in your treatment regimen.

INITIAL LABWORK

Following a good Medical History, which laboratory assays should be

run as part of your initial hypogonadism workup? Following is my

list, but certainly other specialists in this area run expanded or

attenuated panels, per their experience and expertise. Of note,

there are several other tests which should be included to complete

the true comprehensive Anti-Aging Medicine workup (i.e.

homocysteine, fasting insulin, comprehensive thyroid study, etc.),

as this chapter is concerned solely with administering TRT. And as

always, the panel is tailored to the individual patient. Here they

are:

• Total Testosterone

• Bioavailable Testosterone (AKA " Free and Loosely Bound " )

• Free Testosterone (if Bioavailable T is unavailable)

• DHT

• Estradiol (specify the Extraction Method, or " sensitive " assay for

males)

• LH

• FSH

• Prolactin

• Cortisol

• Thyroid Panel

• CBC

• Comprehensive Metabolic Panel

• Lipid Profile

• PSA (if over 40)

• IGF-1 (if HGH therapy is being considered)

FOLLOW-UP LABS

Two weeks after initiating a transdermal, or five weeks after the

first IM injection:

• Total Testosterone

• Bioavailable Testosterone

• Free Testosterone (if Bioavailable T is still unavailable)

• Estradiol (specify the Extraction Method, or " sensitive " assay for

males)

• DHT (especially if patient is using a transdermal delivery system)

• FSH (3rd Generation—ultrasensitive assay this time)

• CBC

• Comprehensive Metabolic Panel

• Lipid Profile

• PSA (for more senior patients)

• IGF-1 (if GH Therapy has been initiated already)

INDIVIDUAL ASSAYS EXPLAINED

TOTAL TESTOSTERONE

This is the assay your patients will most focus on. It's also the

one physicians who do not understand TRT will use to deny patients

the testosterone supplementation they want, and need, when Total T

is at low-normal levels. Total T is important for titration of

dosing, but its relevance is reduced in older men (by virtue of

their increased serum concentrations of SHBG), in favor of:

BIOAVAILABLE TESTOSTERONE

Where we actually get the " bang " for the hormonal buck, so to speak.

This is the actual amount the body has available for use, as the

concentration of hormone available within the capillary beds

approximates the sum of the Free Testosterone plus that which is

loosely bound to carrier proteins, primarily albumin. If Bio T is

not readily available, Free T may be a second choice substitute, as

Bio T and Free T serum concentrations are well correlated.

DHT

This assay is especially important to draw, up-front and at follow-

up, if a transdermal testosterone delivery system is preferred by

the patient. I'll explain why later. DHT level may also help

indicate cause for ED symptoms.

ESTRADIOL

There are several reasons why this assay is VERY important, and

should not be ignored in ANY hypogonadism work-up (or subsequent

regimen). First, you definitely need to draw a baseline. Next,

elevated estrogen can, in and of itself, explain hypogonadal

symptoms. If E is elevated, controlling serum concentrations

(usually with an aromatase inhibitor, which prevents conversion of T

into E) may suffice in clearing the symptoms of hypogonadism. And

finally, rechecking it after beginning the initial dose of

testosterone will give the astute physician valuable information as

to how the patient's individual hormonal system functions, as well

as making sure estrogen does not elevate inappropriately secondary

to the testosterone supplementation.

I don't waste time and money drawing estrone and estriol. E2 is the

player of interest here. Unless you specify a `sensitive' assay for

male patients, the lab will run the Rapid Estradiol for fertility

studies in females, which is useless for our purpose here. Quest

Diagnostics calls this their Estradiol by Extraction Method.

Some practitioners believe that it is only the T/E ratio which is

significant, and therefore, as long as E " appropriately " rises with

elevations in T, all is well. However, the absolute concentration of

E is of concern, too, especially in light of new information

pointing to elevated estrogen as cause, or adjunctively encouraging,

several serious disease processes, including prostate and colon

cancer.

LH

As everyone knows, it is LH which stimulates the Leydig cells of the

testes to produce testosterone. A caveat, however: LH has a half-

life of only about 30 minutes. When you combine this fact with the

absolute pulsatile nature of its pituitary release, care must be

taken to not place too much weight upon a single draw. A luxury

would be to acquire serial draws, say, twenty minutes apart.

However, such would be both inconvenient and probably prohibitively

expensive for the patient. The most important reason to assay the

gonadotrophins is to differentiate between primary and secondary

(hypogonadotrophic) hypogonadism.

FSH

The eight hour half-life of this hormone makes it a better marker

for gonadotrophin production. It is also less an acute phase

reactant to varying serum androgen and estrogen levels than LH.

Greatly elevated FSH levels could signal a gonadotrophin-secreting

pituitary tumor.

Of note, I run FSH (but not LH) on the follow-up labs, the new third

generation ( " sensitive " ) assay, to determine the magnitude of HPTA

suppression secondary to androgen therapy. It also provides valuable

information for those patients undergoing TRT who are interested in

the state of their fertility.

PROLACTIN

A very important hormone, and must not be overlooked on initial work-

up. Approaching five percent of hypogonadotrophic hypogonadism is

associated with hyperprolactinemia, due to inhibition of

hypothalamic release of LHRH. Its serum concentration must be

maintained within physiological range (meaning neither too high nor

too low). Greatly elevated hyperprolactinemia, or hyperprolactinemia

plus a Total Testosterone less than 150ng/dL, equals a trip to an

Endocrinologist for an MRI of the sella turcica.

CORTISOL

True Anti-Aging medicine must be well-familiarized with the ins and

outs of this hormone, the only one our bodies cannot live without.

Elevated levels can cause secondary (hypogonadotrophic)

hypogonadism. I try controlling elevated cortisol with

Phosphatidylserine, 300mg QD, with good results. It is just as

important to watch for depressed cortisol levels, as well. The assay

of choice for that condition is a 24-hour urine.

THYROID PANEL

I have, for my own convenience, omitted the specifics of the

obligatory thyroid function panel you certainly will want to run.

Hypothyroidism mimics hypogonadism in several of its effects.

CBC

This is just good medicine. Ruling out anemia is important, of

course, as it may be a cause for the fatigue which brought the

patient into your office. You also want to establish baseline H & H,

for those rare cases where polycythemia becomes a problem (and we

are reminded smokers are at increased risk for polycythemia). Above

18.0/55.0 TRT is withheld, and therapeutic phlebotomy recommended.

CMP

Again, just good medicine. Baseline for sodium (which may elevate

initially secondary to androgen supplementation) is important. We

also want to see LFT's, as elevations in same secondary to androgen

supplementation are listed as a possible side effect in the product

literature (although I have yet to see this actually happen). I like

the BUN/creatinine ratio as a marker for hormonal hemo-

concentration, and also it gives me a hint of how compliant the

patient will be (because I always tell them to make sure to drink

plenty of water while fasting for the test).

Lipid Panel

This is drawn to provide your bragging rights when you drop the CHOL

30 points, thanks to your own good administration of TRT. You should

expect to see lowered TRIG and LDL's, too. Be advised, this will not

happen if you choose to elevate their androgens above the top

of " normal " range, i.e. providing what amounts to an anabolic

steroid cycle. Of course, this would no longer constitute TRT, as

the practitioner would then be choosing to damage the health and

well-being of the patient.

HDL does frequently drop a bit, but that is believed to be due to

increased REVERSE cholesterol transport; so much of the plaque is,

after being scavenged from the lining of the CV system by HDL, now

being chewed up by the liver. Androgens also elevate hepatic lipase,

and this may have an effect. The important thing to keep in mind is

that TRT inhibits foam cell formation.

PSA

For all patients over 40. Even though prostate CA is rare in men

under the age of fifty, we don't want it happening on our watch, do

we? At this time, rises in PSA above 0.75 are a contraindication to

TRT (until follow-up by a Urologist). You may find that, at the

initiation of TRT in older men, when serum androgen levels are

accelerating, PSA may, too. This is especially true when transdermal

delivery systems are employed, because they more greatly elevate

DHT. Once T levels have stabilized, PSA drops back down to roughly

baseline. You won't really see gross elevations in PSA secondary to

TRT administration in younger patients. New TRT patients need to be

cautioned, and reminded, to abstain from sexual relations prior to

the draw, as they may now be enjoying greatly elevated amounts of

same.

I get a PSA up front on my over 40 patients, at the one month follow-

up in my more senior patients, and every six months after that. DRE

(Digital Rectal Exam) is recommended twice per year as well,

although the American Academy of Clinical Endocrinologists

backs " every six to twelve months " in their 2002 Guidelines for

treating hypogonadotrophic patients with TRT.

IGF-1

For those who are considering the addition of GH to their Anti-Aging

regimen. IGF-1 will rise from testosterone supplementation, and vice

versa. Let's grab a baseline now, before that happens.

THINGS TO LOOK OUT FOR:

CO-MORBIDITIES. Currently, only breast and active prostate cancer

are absolute contraindications for TRT. Patients with serious

cardiac, hepatic or renal disease must be monitored carefully due to

possible edema secondary to sodium retention. Also, TRT may

potentiate sleep apnea in some chronic pulmonary disease patients,

although studies have also shown it can actually ameliorate the

symptoms of sleep apnea.

DRUG INTERACTIONS. TRT decreases insulin or oral diabetic medication

requirements in diabetic patients. It also increases clearance of

propranolol, and decreases clearance of oxyphenbutazone in those

receiving such medications. TRT may increase coagulation times as

well.

TESTOSTERONE DELIVERY SYSTEMS

Now we have to decide, TOGETHER with our patient, what form of

testosterone delivery system we will START with. There are two basic

subsets of same—transdermals and injectables. Here are the current

options:

TESTOSTERONE GELS AND CREAMS

The only way to go, in my professional opinion, if physician and

patient prefer a transdermal delivery system. They are easy to

apply, well absorbed, and rapidly establish stable serum androgen

levels (usually by the end of the second day). I recommend all

practitioners first try a testosterone gel for their TRT patients.

Much is made of the risk posed by accidental transferal of

testosterone to others, such as children or sexual partners. Simply

covering with a T-shirt has been shown to block transfer of the

hormone. The testosterone sinks into the skin within an hour, which

acts as the actual reservoir for the hormone's delivery. One may

then shower, or even swim, without worry. I remind my patients that

most of us have neither the time, nor the opportunity, for romance

until evening (given the recommended early morning application), and

a quick shower is always nice to " freshen up " then anyway.

Gels and creams, like all transdermal delivery systems, provide a

bigger boost in DHT levels, compared to injectable testosterone

preparations. This can be a double-edged sword. As DHT is

responsible for all the things of manhood, the transdermals are

better at treating ED than the injectables. However, issues of hair

loss and possible prostate morbidity (a contentiously debatable

point, to be sure) then come into play. Either way, please make sure

to monitor DHT with the transdermals. I'm just not comfortable with

gross elevations in DHT, and prefer to avoid adding finasteride

whenever possible.

Some have reported an increase in hair growth over the application

area(s). All physicians who administer TRT must be prepared to

disappoint their patients at this time by pointing out, sadly, this

same effect cannot be achieved on the scalp.

TESTOSTERONE PATCHES

These can be quite effective, but are inconvenient to use.

Approaching 2/3's of your patients will develop a contact dermatitis

from them at some point. Another drawback is that some patients

report they are constantly aware of their placement, and the patches

are embarrassingly obvious to other gentlemen in certain public

places, such as in the locker room.

The scrotal application variety is the most inconvenient. To see

what I would be putting my patients through, I tried them. After

just a couple days, I'd had more than enough. Men do not generally

enjoy shaving their scrotum, and the patches just do not stay on

well anyway. Applying a hair dryer to the patch, as they must be

warmed first, is also an annoyance. If you go to the gym during the

day, they look strange affixed to the genitals, and must be removed,

then reapplied, to shower. They do not stick well in the first

place, and even less so once they have been reapplied. Of the two

options, I found only the type with the extra adhesive had any

chance of remaining in place. The scrotal variety causes the largest

increases in DHT—which can be good or bad, as previously explained.

TESTOSTERONE PELLETS

In my opinion, their use is absolutely Stone Age. Sure, they can

provide extra revenue by virtue of a billable office based

procedure. However, needlessly exposing patients to the risks ALL

surgeries pose—hemorrhage and infection—is unwarranted. And the area

of insertion will be much tenderer than that following a mere IM

injection. But the real issue which selects against pellet

implantation is concerned with dosing. Let's say you establish

a " usual " initial dose for the pellets. As will be described in the

next section, there is absolutely no way to predict, up front, how a

patient will react to a given dose of testosterone, regardless of

the delivery system. So you bury these pellets in your patient's

backside, and (hopefully) draw follow-up labs in a month or so. What

are you to do if the total testosterone ends up greatly exceeding

the top of normal range (meaning the patient hyper-responded to the

treatment)? Now you must make a much wider incision to remove them,

or a portion of them (and who knows how many to take out?). With

their very long half-life, SOMETHING must be done, lest you risk

actually damaging the health of the patient by elevating

testosterone levels into what might be considered a bodybuilding

steroid cycle. And what if the pellets do not elevate T enough? You

must bring them back in to implant more, and it's difficult to sell

them on this idea, since they probably are not yet feeling the

advantages of TRT enough yet to motivate them into undergoing

another surgical procedure. It just doesn't make sense, to my way of

thinking.

Testosterone pellets do have some benefit in that selected patients

may believe it more convenient to come in every month or six weeks,

and then be done with it for a while. Also, because they release T

in a slow, steady rate, the pellets are less likely to induce

increases in aromatase activity.

TESTOSTERONE INJECTION

I'll start out by describing the drawbacks of IM testosterone. They

are inconvenient for patients who do not wish to give themselves

their own injections, as they must then make weekly trips to your

office for same. Why IM test MUST be dosed weekly will be described

in detail in another section. Some patients, as you well know, just

hate shots (although I have noticed several who had initially

claimed this, but admitted, once they had come to enjoy the benefits

of TRT, actually came to look forward to their weekly injection).

And no doubt, an invasive delivery system brings more risk than, for

instance, a testosterone gel or cream (the other best choice for

TRT).

When considering dosing of testosterone cypionate, it is important

to remember that, due to the weight of the cypionate ester, a 100mg

injection delivers, at best, 70mg of testosterone. This is important

to keep in mind when comparing the effects of a 100mg weekly

injection of test cyp to the 35mg total dose provided by Androgel

5gms QD over the same period.

HCG

Many practitioners consider this incredible hormone treatment of

choice for hypogonadotrophic (secondary) hypogonadism. Such

certainly makes sense, as supplementing with a LH analog indeed

increases testosterone production in patients who do not

concurrently suffer primary hypogonadism. But often, upwards of

1000IU per day must be given to achieve the desired serum T level.

Even then, for some unexplained reason, while serum T levels may be

adequately elevated, the patients simply do not report realization

of the benefits of TRT, when HCG is administered as sole TRT. You

also run the risk of inducing LH insensitivity at that dosage, and

therefore may actually cause primary hypogonadism while attempting

to treat secondary hypogonadism. HCG, especially at higher doses,

also dramatically increases aromatase activity, thus inappropriately

elevating estrogens. Personally, I recommend never giving more than

500IU of HCG at a time.

A real benefit of HCG is that it will prevent testicular atrophy. I

do not think we should ignore the aesthetics of that consideration.

Your patients will feel the same way.

OTHER MEDICATIONS

I occasionally hear of physicians trying to use a SERM (Selective

Estrogen Receptor Modulator) such as Clomid or Nolvadex, or even an

Aromatase Inhibitor (AI), such as Arimidex, as sole " TRT " . All have

been shown to elevate LH, and therefore Total Testosterone levels.

However, patients report no long-term subjective benefits from these

strategies, and the studies thus far reported no long-term changes

in lean body mass, fatigue levels, libido, etc. An added risk of

using an AI is of driving estrogen levels too low, with deleterious

consequences for the lipid profile, calcium deposition, libido, etc.

Finally, Deca-Durabolin (Nandrolone) has no place in TRT. It has a

nasty side effect profile, including uncontrollable progesterone-

like effects (including gynocomastia) and risk of long-term

impotence.

THE MEAT AND POTATOES OF TRT

Now we will delve into the general strategy for administering TRT.

The decision is made, TOGETHER with the patient, which of the

various testosterone delivery systems is to be tried first. Be

prepared to make adjustments, and try other application methods. You

just don't know which will be best for each particular patient until

you try. Besides the simple fact the patient may have a personal

preference, or a logistical consideration (i.e.

inability/unwillingness to self-inject) for a given application,

every-body reacts differently to hormonal manipulation. Some hyper-

respond to a given initial dose, others show hardly any bump in

serum T levels on same. Yet when you switch to a different delivery

system, on initial dosing, they may convert to supraphysiological

androgen levels. The same is true of the subjective benefits from

TRT. I have patients who love testosterone gel because it

successfully treated their ED (the expected outcome because of

dramatically increased DHT production), others get more from IM

testosterone cypionate. My experience thus far has taught me two

lessons: (1) You don't know how a patient will react to a given

dose/system until you try and (2) NOTHING surprises me anymore.

There simply is no way to predict how a particular patient will

respond—not Medical History (i.e. number or severity of symptoms),

body weight, baseline hormone levels, even anabolic steroid history.

I have had very slight gentlemen barely elevate on 100mg of test cyp

per week, and massively muscled former steroid athletes who went to

nearly two times the top of " normal " range on the same dosage (they

had similar baselines). Likewise, one man may see only a modest

increase in DHT on 5gms of Androgel, another may become quite

supraphysiological on same.

I start my guys out on either testosterone cream/gel 5mgs QD or

testosterone cypionate 100mg per week. The IM test cyp must be

administered in weekly injections, as opposed to taking twice the

dosage every other week. Some physicians even dose every third or

fourth week, producing wide swings in serum androgen levels. This

puts the patient on an emotional roller coaster, increases the risk

of developing polycythemia, greatly accentuates aromatase activity,

and actually leaves them lower than they were when they started for

the last half of the cycle. In order to get the serum androgen

concentration to a stable level more quickly, I " frontload " 200mg

the first injection (unless converting over from a gel/cream).

No other medications which manipulate hormone levels are provided

until follow-up labs are returned. For IM test cyp patients, the

second panel is run following the fifth injection. I also keep in

mind the coordination of the injection with the lab draw, as peak

serum levels are attained at about the 48 hour point, then fall to

about 35% at the one week point. However, by the end of the fifth

week, the pharmacodynamics of testosterone cypionate (half life is 5-

8 days) are such that relatively stable serum levels are now being

produced via weekly injections.

Transdermals can be rechecked in two weeks. They produce stable

serum levels, as previously mentioned, for most by the end of the

second or third day. Logistically, it makes sense to send the

patient for follow-up labs after a fortnight, as there is then time

to get the labs back, and bring the patient in, before the initial

30-day supply of the medication runs out. This is better if an

adjustment in dosage is mandated by the follow-up labs, or to

convert to IM dosing should the patient produce too much DHT. It

would be a shame to have the patient refill a script for 5gms of

Androgel, when they, by their labs, are going to have their dosage

reduced to 2.5gms per day because they hyper-responded to the

initial dose, or waste money when what they reallyneed is to be

converted to test cyp.

The question of which testosterone delivery system is to be tried

first (IM or transdermal) is one which brings much confusion amongst

beginning practitioners of TRT. I would, when possible, always start

out a patient on a testosterone cream or gel. Ease of application,

avoidance of intrusion by injection, and increased probability of

successful ED treatment make this so. Also, stable serum levels are

attained quickly, determination of successful treatment is more

forthcoming (although the manufacturer of this product recommends at

least a couple months as adequate trial of therapy). If the labs AND

patient's answers to follow-up subjective report lead to a change to

IM testosterone, the conversion is an easy one to make. Simply apply

the gel, give the shot, then D/C the gel. However, if a patient is

started out on IM test cyp, for instance, yet the patient still does

not feel " right " (and thus you may want to try a transdermal

delivery system to better raise DHT levels), how are you, given the

pharmacodynamics of the testosterone ester, going to safely and

successfully dose the conversion to a transdermal?

Dosing changes are made, TOGETHER with the patient, once follow-up

labwork is back AND the patient is interviewed regarding their

subjective reports of changes in libido, sexual performance,

fatigue, strength, mental outlook, etc. Often they will tell you

they felt " incredible " the first couple of weeks (and bursting with

libido), but they don't feel quite as good now, but still much

better than before they started the TRT. This is because subjective

findings are the best while serum androgen levels are accelerating.

Adjunctive to this phenomenon is the fact their HPTA was not yet

being suppressed, so their endogenous production was higher then

than it would be by the end of the month. TRT patients are always

HPTA suppressed to greater or lesser degree.

Much weight is placed upon the patient's subjective findings, as

they are not likely to remain compliant in the TRT program unless

they feel noticeably better, irrespective of the less obvious long

term improvements in CV health, bone density, decreased risk of

dementia and cancer, etc. Certainly, if the patient reports they are

quite happy at a Total Testosterone level of 600ng/dL, I feel there

is little reason to increase their dosage. As an Osteopath, I am

loath to provide ANY medication, or increase in dosage, without

proven need. As a practical limit, the top of " normal " range for

Total Testosterone provides a ceiling, more or less, above which we

can expect to find the benefits of TRT beginning to reverse

themselves. Actions following androgen receptor binding dramatically

improve health and happiness as we go from the hypogonadal state to

the top of " normal " range, but beyond that the Lipid Profile and

level of insulin sensitivity, for instance, are damaged.

Changes in IM dosing are made in small increments, as response to

same is not linear. It is convenient and practical to increase, or

decrease IM dosing by 20mg at a time, as this is one " tick mark " on

the side of the syringe (for the 200mg/mL concentration). For

Androgel patients, we are more limited by their provided dosing

whereas we can only either drop down to 2.5gms, or add an extra pack

each day (at which time BID dosing may be considered) to reach the

7.5gm, or even 10gm, per day dose. More flexibility is provided

through compounded products for those committed to employment of

transdermal testosterone delivery systems.

Another risk of jumping the dosage too much is that, should serum

androgen levels greatly exceed the top of " normal " range, the

patient risks becoming " spoiled " at that level. They would then feel

the subjective benefits steroid athletes report, and it would be

difficult to get the patient then to be happy at a more moderate—and

proper—dose. It is likely you would also therefore produce elevated

estrogen activity as well, and further muddy the waters with respect

to how the patient feels—and looks (due to emotional changes and

even water retention issues from the elevated estrogen). It is far

better to make changes in dosing conservatively.

Once the method and dosing is set, by laboratory assay AND

subjective report from the patient, then you may address any side

effects due to elevated estrogen levels which have occurred. I do

not use an AI initially, even when E2 is elevated, because some

patients will actually see a drop in estrogen over baseline on

follow-up. We would have otherwise added an unnecessary (and

relatively expensive) medication. Should the patient develop

any " nipple issues " secondary to accelerating serum androgen levels

and/or elevated estrogen, you cannot start them on a SERM right away

because doing so will invalidate your estradiol assay at follow-up.

Of note, males can experience said " nipple issues " even while

estrogen levels are within physiological range, due to changes in

hormone levels. A drug of the class SERM is treatment of choice in

this case, until symptoms subside.

If a patient has " nipple issues " , even while estrogen is within

normal range, I add a SERM, emergently. I prefer Nolvadex over

Clomid, and Evista is probably best of all for antagonizing estrogen

(although much more expensive). Clomid often induces untoward visual

effects (i.e. " tracers " ), and can cause emotional lability by virtue

of its estrogen agonistic effects at the more peripheral (emotion)

brain sites. I do like my patients to keep some Nolvadex on hand,

should they experience nipple swelling or sensitivity, so they may

begin 40mg per day until the symptoms abate, and then taper to 20 mg

QD for a few days, then 10mg for a few more, then finally 5mg QD to

taper off.

My TRT male patients who suffer E2 elevations above the top of

normal range are placed on 0.25mg of Arimidex every third day. If

that is not enough, I use the same dose EOD. It is possible to cut

the tiny 1mg tabs into quarters, but here a gel or cream

preparation, compounded to convenient dosing, makes a lot of sense.

A month later I recheck E2, and make further adjustment if

necessary. It is important to not lower estrogen too far, which is

easy to do with an AI, as doing so has disastrous effects on the

Lipid Profile, bone deposition, etc. I prefer to maintain E in mid-

range.

So now let's say we have the patient in a state where Total

Testosterone is in the upper quartile of " normal " range,

Bioavailable Testosterone is nicely elevated, with E2 safely in

check. At this point I offer the patient my HCG protocol. I add in

250-500IU of HCG, on day five, and day six of the week, for those

who use the IM injection. In other words, the two days prior to

their shot. For those using a transdermal delivery system, every

third day. For the IM patients, this compensates for the drop off in

serum androgen levels by the half-life of the test cyp. But the main

reason is to stave off atrophy of the testicles, by directly

stimulating them with the LH analog.

Patients all report they feel dramatically better once the HCG

regimen is initiated (and they were properly tuned up on

testosterone before they started it). HCG, as a LH analog, increases

the activity of the P450 SCC enzyme, which converts CHOL to

pregnenolone. Thus all three hormonal pathways are stimulated in

patients who may be either entirely, or very nearly, HPTA

suppressed. It is my belief this may be a factor in the heightened

sense of well-being my patients report throughout the week—far in

excess of what a minimal dose of HCG would produce by virtue of

induced testosterone production.

Many TRT practitioners add in HCG for a short course every few

months, to re-stimulate the testes. My opinion is that it is far

better to keep them up to form and function all along the way. The

physicians who intermittently use HCG also use it as a " break " in

TRT, much the same way hormonally-supplemented athletes manage the

typical anabolic steroid cycle. TRT should not be " cycled " . Once I

get my patients properly tuned up, I want them to stay that way.

They also erroneously believe this allows the HPTA to recover, when

it clearly does not. The HCG-induced testosterone production is

every bit as suppressive of the HPTA as the TRT, and the

supplemented testosterone is still at suppressive serum levels

during that time, anyway.

Once the patient is all set, I like to run follow-up labs every six

months. It is important to monitor the general health and well-being

of the patient, but also insure compliance with treatment protocols

and continued effectiveness of same.

**************************************************

**

My hope is that the preceding diatribe will gainfully assist the

practitioner in implementing Testosterone Replacement Therapy

regimens for their qualifying patients. Be prepared, however, to

blush as they shower you with accolades following their vast

improvements in health and happiness. You may even receive thank you

notes from their wives!

Please watch for coming articles and books by Crisler, DO on

this, and other, continuing subjects related to anti-aging.

Copyright Crisler, DO 2004. This article may, in its entirety

or in part, be reprinted and republished without permission,

provided that credit be given to its author, with copyright notice

and www.AllThingsMale.com clearly displayed as source. Written

permission from Dr. Crisler is required for all other uses.

Dr. Crisler may be reached at:

Doctor@...

MT_Wannabe <felicia1970_1@...> wrote:Hi! My husband and I have been

experiencing sexual problems in our

marriage for about 10 years. I have suspicioned over the years that

perhaps he had low testosterone. He never really took it seriously.

I began to feel sad, worried, filled with self doubts...wondering if

it were me (not attractive enough, too chubby, etc.). I feel like

I've been married to my brother. I love my husband, but we have not

had a good, healthy sex life in over 10 years (not for lack of want

on my part, which has been very difficult for me...him too I suppose).

Well, we just " celebrated " our 3-year anniversary of celibacy (woo

hoo, what a celebration). I finally got fed up and told him we

needed to figure out what was going on because I couldn't see myself

NOT having sex for the rest of my life (I'm 35 and he's 41). He

reluctantly agreed to get checked.

His testosterone level is 166. He goes back for a 2nd test (and a

few more tests) in a week or so.

Here are my questions:

1. For those of you who have/had similar testosterone levels, did

testosterone treatment help improve your sex life, stamina, strength,

muscle mass, moods, etc.?

2. Is AndroGel just as effective as injections? I worry that he

won't like the fluctuations in injections (high to low) and wonder if

gel would be a better choice for him.

3. What treatment have you found most helpful?

4. Finally, what can cause a man who had a normal healthy sex drive

to just lose it? I know it is low testosterone, but why would

someone who was functioning fine just develop a low testosterone? I

guess my real question is, could it be a pituitary problem/tumor? I

know only imaging studies can answer that, but if a man does have a

pituitary tumor and gets that treated, can his testosterone level

return back to normal?

Thanks so much for reading this and offering your advice.

Felicia

[Guest guest]

Hi Philip! Thank you so much for your wonderfully informative post

and for sharing your story with me. It makes me very hopeful. I'm

so pleased that treatment worked for you and your wife. As a woman I

know how I have felt over the years, but now I am beginning to

understand how he must feel as well...probably depressed and

feeling " less " than a man. That makes me so sad for him...but,

fortunately now we are taking steps in the right direction.

So far he has only had one early morning testosterone, but he goes in

in a week to get the rest of the tests, so when we get those results,

I will post them here.

Thanks again..bye for now,

Felicia

Hi! My husband and I have

been experiencing sexual problems in our

> marriage for about 10 years. I have suspicioned over the years

that

> perhaps he had low testosterone. He never really took it

seriously.

> I began to feel sad, worried, filled with self doubts...wondering

if

> it were me (not attractive enough, too chubby, etc.). I feel like

> I've been married to my brother. I love my husband, but we have

not

> had a good, healthy sex life in over 10 years (not for lack of want

> on my part, which has been very difficult for me...him too I

suppose).

>

> Well, we just " celebrated " our 3-year anniversary of celibacy (woo

> hoo, what a celebration). I finally got fed up and told him we

> needed to figure out what was going on because I couldn't see

myself

> NOT having sex for the rest of my life (I'm 35 and he's 41). He

> reluctantly agreed to get checked.

>

> His testosterone level is 166. He goes back for a 2nd test (and a

> few more tests) in a week or so.

>

> Here are my questions:

> 1. For those of you who have/had similar testosterone levels, did

> testosterone treatment help improve your sex life, stamina,

strength,

> muscle mass, moods, etc.?

>

> 2. Is AndroGel just as effective as injections? I worry that he

> won't like the fluctuations in injections (high to low) and wonder

if

> gel would be a better choice for him.

>

> 3. What treatment have you found most helpful?

>

> 4. Finally, what can cause a man who had a normal healthy sex

drive

> to just lose it? I know it is low testosterone, but why would

> someone who was functioning fine just develop a low testosterone?

I

> guess my real question is, could it be a pituitary problem/tumor?

I

> know only imaging studies can answer that, but if a man does have a

> pituitary tumor and gets that treated, can his testosterone level

> return back to normal?

>

> Thanks so much for reading this and offering your advice.

>

> Felicia

>

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Hi! My husband and I have

been experiencing sexual problems in our

> marriage for about 10 years. I have suspicioned over the years

that

> perhaps he had low testosterone. He never really took it

seriously.

> I began to feel sad, worried, filled with self doubts...wondering

if

> it were me (not attractive enough, too chubby, etc.). I feel like

> I've been married to my brother. I love my husband, but we have

not

> had a good, healthy sex life in over 10 years (not for lack of want

> on my part, which has been very difficult for me...him too I

suppose).

>

> Well, we just " celebrated " our 3-year anniversary of celibacy (woo

> hoo, what a celebration). I finally got fed up and told him we

> needed to figure out what was going on because I couldn't see

myself

> NOT having sex for the rest of my life (I'm 35 and he's 41). He

> reluctantly agreed to get checked.

>

> His testosterone level is 166. He goes back for a 2nd test (and a

> few more tests) in a week or so.

>

> Here are my questions:

> 1. For those of you who have/had similar testosterone levels, did

> testosterone treatment help improve your sex life, stamina,

strength,

> muscle mass, moods, etc.?

>

> 2. Is AndroGel just as effective as injections? I worry that he

> won't like the fluctuations in injections (high to low) and wonder

if

> gel would be a better choice for him.

>

> 3. What treatment have you found most helpful?

>

> 4. Finally, what can cause a man who had a normal healthy sex

drive

> to just lose it? I know it is low testosterone, but why would

> someone who was functioning fine just develop a low testosterone?

I

> guess my real question is, could it be a pituitary problem/tumor?

I

> know only imaging studies can answer that, but if a man does have a

> pituitary tumor and gets that treated, can his testosterone level

> return back to normal?

>

> Thanks so much for reading this and offering your advice.

>

> Felicia

>

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

How long has he had arthritis and psoriasis? There is a good

correlation between low T and autoimmune diseases. Men tend to have

a higher incidence when their T levels are even borderline low.

Prednisone or one of its many related drugs will also have the

tendency to suppress normal testosterone production. Afer all it is

a steroid and the body cuts off production of steroids if they are

supplied via a pill or injection.

To answer your question about how a man can lose his sex drive. It

is possible for a man to get by on borderline low testosterone levels

for a long time. But that does come to an end at some point. It is

hard to say without knowing the entire history and I am not a

doctor. Pituitary tumors are not common. It is very common for an

intact pituitary to not function correctly. That is what I live

with. My pituitary never worked properly. So my growth was stunted

and I am hypogonadal.

I became very sick at a level of 388. Doctors in my part of town

call that healthy and normal. If you refer to the T levels by age

chart in the files section, no man under the age of 90 should be

below 500. What is restoring my health is a 125mg testosterone

injection once a week. I do my own injections and if I calculated

the costs, it is about $3 a week. Insurance is not paying for any of

it. A weekly injection does not cause me any problems as far as

fluctuations. That was a common issue when doctors use once or twice

a month injections. Therefore smearing the name of testosterone

replacement. Such a treatment causes an overdose the first week

after the injection and a deficieny until it is time for the next one.

If your man is that low, Androgel may or may not work. I also think

about the preexisting skin problem. Because Androgel is formulated

in a thickened alcohol base. That is probably not a wise thing to

rub onto already irritated skin. That leaves injections as the best

option. The injection is not that bad to take. In fact, I look

forward to my next injection every week.

The reason why I look forward to weekly injections is because of what

it does for me. My joints and bones no longer ache. I have lots of

energy to get through the day. I am reversing decades of being

underweight and lacking muscle mass. My appetite is good, after

going through all of my life eating like a bird. Lastly, I now have

a sex drive. I am now a firm believer that if a man is not hungry

and horny, there is something wrong, do not let any doctor convince

you otherwise. I wish you and your husband the best. Having low

testosterone from the time I was 13 took a lot of things away from

me. He is lucky to have a caring wife such as you.

>

> Hi! My husband and I have been experiencing sexual problems in our

> marriage for about 10 years. I have suspicioned over the years

that

> perhaps he had low testosterone. He never really took it

seriously.

> I began to feel sad, worried, filled with self doubts...wondering

if

> it were me (not attractive enough, too chubby, etc.). I feel like

> I've been married to my brother. I love my husband, but we have

not

> had a good, healthy sex life in over 10 years (not for lack of want

> on my part, which has been very difficult for me...him too I

suppose).

>

> Well, we just " celebrated " our 3-year anniversary of celibacy (woo

> hoo, what a celebration). I finally got fed up and told him we

> needed to figure out what was going on because I couldn't see

myself

> NOT having sex for the rest of my life (I'm 35 and he's 41). He

> reluctantly agreed to get checked.

>

> His testosterone level is 166. He goes back for a 2nd test (and a

> few more tests) in a week or so.

>

> Here are my questions:

> 1. For those of you who have/had similar testosterone levels, did

> testosterone treatment help improve your sex life, stamina,

strength,

> muscle mass, moods, etc.?

>

> 2. Is AndroGel just as effective as injections? I worry that he

> won't like the fluctuations in injections (high to low) and wonder

if

> gel would be a better choice for him.

>

> 3. What treatment have you found most helpful?

>

> 4. Finally, what can cause a man who had a normal healthy sex

drive

> to just lose it? I know it is low testosterone, but why would

> someone who was functioning fine just develop a low testosterone?

I

> guess my real question is, could it be a pituitary problem/tumor?

I

> know only imaging studies can answer that, but if a man does have a

> pituitary tumor and gets that treated, can his testosterone level

> return back to normal?

>

> Thanks so much for reading this and offering your advice.

>

> Felicia

>

[Guest guest]

On Sat, 05 Nov 2005 04:05:45 -0000, you wrote:

>Hi! My husband and I have been experiencing sexual problems in our

>marriage for about 10 years. I have suspicioned over the years that

>perhaps he had low testosterone. He never really took it seriously.

>I began to feel sad, worried, filled with self doubts...wondering if

>it were me (not attractive enough, too chubby, etc.). I feel like

>I've been married to my brother. I love my husband, but we have not

>had a good, healthy sex life in over 10 years (not for lack of want

>on my part, which has been very difficult for me...him too I suppose).

>

>Well, we just " celebrated " our 3-year anniversary of celibacy (woo

>hoo, what a celebration). I finally got fed up and told him we

>needed to figure out what was going on because I couldn't see myself

>NOT having sex for the rest of my life (I'm 35 and he's 41). He

>reluctantly agreed to get checked.

>

>His testosterone level is 166. He goes back for a 2nd test (and a

>few more tests) in a week or so.

>

>Here are my questions:

>1. For those of you who have/had similar testosterone levels, did

>testosterone treatment help improve your sex life, stamina, strength,

>muscle mass, moods, etc.?

it should greatly increase his libido and ability. But make sure he

gets an E2 test at this next visit. Libido is largely a function of

the balance between E2 and T. With T values this low his E2 levels

are also likely low. But it may be (particularly if he is overweight)

that is body is converting his precious T to E2.

In any case, E2 is an essential first test. Post his test results back

here when they come in, all of them with the associated " normal "

ranges for each test.

>2. Is AndroGel just as effective as injections? I worry that he

>won't like the fluctuations in injections (high to low) and wonder if

>gel would be a better choice for him.

Shots seem to be the preferable therapy. I say that as an Androgel

user. Androgel is way more expensive than shots,. if he takes shots

weekly instead of every two weeks he shouldn';t see much in the way of

fluctuations.

>

>3. What treatment have you found most helpful?

>

>4. Finally, what can cause a man who had a normal healthy sex drive

>to just lose it? I know it is low testosterone, but why would

>someone who was functioning fine just develop a low testosterone? I

>guess my real question is, could it be a pituitary problem/tumor? I

>know only imaging studies can answer that, but if a man does have a

>pituitary tumor and gets that treated, can his testosterone level

>return back to normal?

There are a thousand ways to end up with low T. Don't worry about

pituitary tumors. There responsible for a small percentage of the

cases they are almost never malignant and they respond well to

medicine, and surgery for them is also simple and effective. Take a

deep breath and relax. I know that's hard. I was pretty up tight when

they told me they were looking for a tumor. In my case they'd already

looked for bone cancer and liver cancer first.

Low T can be caused by many many things. For overweight guys, fat

sometimes facilitates the conversion of T to E@. Some people can take

medicine to block this conversion and get their T levels back to

normal with that simple approach. Others have sleep apnea which

results in oxygen deprivation to the brain. The pituitary regions are

so small that the loss of a small patch that might go unnoticed

elsewhere int he brain can have profound impacts. others have had

migraines result in similar things, a blow to the head. Or the balls

may stop working from an infection or injury or chemical exposure.

The important thing is it all treatable. And getting his T levels up

will do so much more than bring back his libido. it will increase his

energy, focus and ambition. (With these levels I assume he's fairly

lethargic and low ambition and ambivalent about most things.) Go to

the library or Amazon.com etc and get a copy of Shippen's book, " The

Testosterone Syndrome " . It will answer many questions. He should get

in addition to the E2 test, prolactin tests, bone density tests, and

thyroid function tests.

You've found a place of friends and help. Come back often. Talk with

here, another wife who's been thrum this. Hang in there. You're

on the way to a big improvement.

>

>Thanks so much for reading this and offering your advice.

>

>Felicia

- - - -

Just another albino black sheep

[Guest guest]

On Sat, 05 Nov 2005 17:07:26 -0000, you wrote:

>Thanks for answering! He's on a lot of medication for psoriasis and

>psoriatic arthritis (that now I'm beginning to wonder if might be a

>combination of arthritis and osteoporitis as I didn't realize the

>relationship between low testosterone and osteoporosis).

If some of those are steroids (prednisone?) that could be a cause of

hormone disruption.

- - - -

Just another albino black sheep

[Guest guest]

I don't recommend seeing a Endo they should know every thing about low t but

don't you may find a good Dr. that knows about treating low T and he could be

any kind of Dr. Go to the files section here and read " Finding a Dr. " .

Phil

MT_Wannabe <felicia1970_1@...> wrote:

Thanks Norton. I'll check into our insurance coverage. Anyone know a

good endocrinologist in Nebraska?

>

> I'll try to anwer two of your questions.

> First, YES, Androgel or any other form of supplemental testosterone

> will raise his T level and should definately increase his interest in

> sex, firmness of erections, and ease and frequency of orgasm.

> Injections work very very well, and if done on a weekly basis there

> really is no felt up and down of T level as it is administered often

in

> smaller doses. Yes skin spread on like Androgel " work " for some

people,

> others have skin absorption problems. Androgel is also fantastically

> expense, it is all advertising and profit at only one percent

> testosteronce in a packet. If you insurance pays androgel ok,

> otherwise consider injections, very cheap, or compounded testerestone

> gel.

> norton

>

[Guest guest]

If your Endo will Check his E2 I will be shocked. And I believe most of his

problems will be a lot better going on T meds and keeping his E2 down. My Dr.

checks new men he sees for both Low T and high E2 if there E2 is high then he

treats the high E2 first and most of the time there T levels go back up. Men

over 40 have higher levels of E2 Estradiol then women going though the change.

Here are some links on it.

http://www.smart-drugs.com/ias-estrogen.htm

http://www.medibolics.com/ArimidexBoostsTestosterone.htm

http://www.lef.org/protocols/prtcls-txt/t-prtcl-130.html

I keep my E2 down using an OTC supplement called Indolplex/DIM with TMG and

Zinc.

http://www.ritecare.com/prodsheets/PHY-15336.html

http://www.myvitanet.com/tmgtr75120ca.html

http://www.myvitanet.com/zincop100cnt.html

Indolplex/DIM converts the bad E2 into good E's and the TMG helps to flush out

the E's keeping the Total E in the normal range.

Phil

MT_Wannabe <felicia1970_1@...> wrote:

Thanks for answering! He's on a lot of medication for psoriasis and

psoriatic arthritis (that now I'm beginning to wonder if might be a

combination of arthritis and osteoporitis as I didn't realize the

relationship between low testosterone and osteoporosis). Since he

has psoriasis, gel may not be the answer for him (might have poor

absorption of medication). When we talk to the endocrinologist we

can ask her about weekly injections.

I've been reading about E2. Is that estrogen that builds up from the

testosterone replacement therapy? Would an endocrinologist routinely

treat that too, or would we have to approach him about this aspect

and ask about one of the medications that you all take to lower the

E2?

Felicia

> >

> > Hi! My husband and I have been experiencing sexual problems in

our

> > marriage for about 10 years. I have suspicioned over the years

> that

> > perhaps he had low testosterone. He never really took it

> seriously.

> > I began to feel sad, worried, filled with self doubts...wondering

> if

> > it were me (not attractive enough, too chubby, etc.). I feel

like

> > I've been married to my brother. I love my husband, but we have

> not

> > had a good, healthy sex life in over 10 years (not for lack of

want

> > on my part, which has been very difficult for me...him too I

> suppose).

> >

> > Well, we just " celebrated " our 3-year anniversary of celibacy

(woo

> > hoo, what a celebration). I finally got fed up and told him we

> > needed to figure out what was going on because I couldn't see

> myself

> > NOT having sex for the rest of my life (I'm 35 and he's 41). He

> > reluctantly agreed to get checked.

> >

> > His testosterone level is 166. He goes back for a 2nd test (and

a

> > few more tests) in a week or so.

> >

> > Here are my questions:

> > 1. For those of you who have/had similar testosterone levels,

did

> > testosterone treatment help improve your sex life, stamina,

> strength,

> > muscle mass, moods, etc.?

> >

> > 2. Is AndroGel just as effective as injections? I worry that he

> > won't like the fluctuations in injections (high to low) and

wonder

> if

> > gel would be a better choice for him.

> >

> > 3. What treatment have you found most helpful?

> >

> > 4. Finally, what can cause a man who had a normal healthy sex

> drive

> > to just lose it? I know it is low testosterone, but why would

> > someone who was functioning fine just develop a low

testosterone?

> I

> > guess my real question is, could it be a pituitary

problem/tumor?

> I

> > know only imaging studies can answer that, but if a man does have

a

> > pituitary tumor and gets that treated, can his testosterone level

> > return back to normal?

> >

> > Thanks so much for reading this and offering your advice.

> >

> > Felicia

> >

>

[Guest guest]

If he gets on the right program you will have a new man on your hands.

Phil

MT_Wannabe <felicia1970_1@...> wrote:

Hi Philip! Thank you so much for your wonderfully informative post

and for sharing your story with me. It makes me very hopeful. I'm

so pleased that treatment worked for you and your wife. As a woman I

know how I have felt over the years, but now I am beginning to

understand how he must feel as well...probably depressed and

feeling " less " than a man. That makes me so sad for him...but,

fortunately now we are taking steps in the right direction.

So far he has only had one early morning testosterone, but he goes in

in a week to get the rest of the tests, so when we get those results,

I will post them here.

Thanks again..bye for now,

Felicia

Hi! My husband and I have

been experiencing sexual problems in our

> marriage for about 10 years. I have suspicioned over the years

that

> perhaps he had low testosterone. He never really took it

seriously.

> I began to feel sad, worried, filled with self doubts...wondering

if

> it were me (not attractive enough, too chubby, etc.). I feel like

> I've been married to my brother. I love my husband, but we have

not

> had a good, healthy sex life in over 10 years (not for lack of want

> on my part, which has been very difficult for me...him too I

suppose).

>

> Well, we just " celebrated " our 3-year anniversary of celibacy (woo

> hoo, what a celebration). I finally got fed up and told him we

> needed to figure out what was going on because I couldn't see

myself

> NOT having sex for the rest of my life (I'm 35 and he's 41). He

> reluctantly agreed to get checked.

>

> His testosterone level is 166. He goes back for a 2nd test (and a

> few more tests) in a week or so.

>

> Here are my questions:

> 1. For those of you who have/had similar testosterone levels, did

> testosterone treatment help improve your sex life, stamina,

strength,

> muscle mass, moods, etc.?

>

> 2. Is AndroGel just as effective as injections? I worry that he

> won't like the fluctuations in injections (high to low) and wonder

if

> gel would be a better choice for him.

>

> 3. What treatment have you found most helpful?

>

> 4. Finally, what can cause a man who had a normal healthy sex

drive

> to just lose it? I know it is low testosterone, but why would

> someone who was functioning fine just develop a low testosterone?

I

> guess my real question is, could it be a pituitary problem/tumor?

I

> know only imaging studies can answer that, but if a man does have a

> pituitary tumor and gets that treated, can his testosterone level

> return back to normal?

>

> Thanks so much for reading this and offering your advice.

>

> Felicia

>

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Dear Retrogrouch: Thank you so much for writing. This has been very

helpful and reassuring...I was stressing that he might have a brain

tumor.

My husband is overweight (about 100 pounds) and has sleep apnea as

well (on CPAP). I never realized that could contribute to his T

problems.

Yes, he has all of those symptoms you listed below...has had them for

years. Not understanding why, I've been very frustrated and

irritated over the years with him...thinking he was just lazy,

selfish, unloving, etc. Now having read tons on the internet I

understand a lot more about it. It is sort of a relief to finally

have " an answer. " I guess the first step in correcting it.

He had a cortisone shot a couple days ago, so his rheumatologist says

he has to wait 12 days to get his new set of T tests...but I will be

sure to post the results once the come back.

Thank you for telling me about (Hi !). Of course I

don't wish this on anyone, but it IS nice to know that I'm not all

alone.

I will get that book you suggested. My husband is really shy about

all of this, but I know he wants to learn more and would appreciate

reading the book too.

Take care,

Felicia

> >1. For those of you who have/had similar testosterone levels, did

> >testosterone treatment help improve your sex life, stamina,

strength,

> >muscle mass, moods, etc.?

>

> it should greatly increase his libido and ability. But make sure he

> gets an E2 test at this next visit. Libido is largely a function of

> the balance between E2 and T. With T values this low his E2 levels

> are also likely low. But it may be (particularly if he is

overweight)

> that is body is converting his precious T to E2.

>

> In any case, E2 is an essential first test. Post his test results

back

> here when they come in, all of them with the associated " normal "

> ranges for each test.

>

> >2. Is AndroGel just as effective as injections? I worry that he

> >won't like the fluctuations in injections (high to low) and wonder

if

> >gel would be a better choice for him.

>

> Shots seem to be the preferable therapy. I say that as an Androgel

> user. Androgel is way more expensive than shots,. if he takes shots

> weekly instead of every two weeks he shouldn';t see much in the way

of

> fluctuations.

> >

> >3. What treatment have you found most helpful?

> >

> >4. Finally, what can cause a man who had a normal healthy sex

drive

> >to just lose it? I know it is low testosterone, but why would

> >someone who was functioning fine just develop a low testosterone?

I

> >guess my real question is, could it be a pituitary problem/tumor?

I

> >know only imaging studies can answer that, but if a man does have

a

> >pituitary tumor and gets that treated, can his testosterone level

> >return back to normal?

>

> There are a thousand ways to end up with low T. Don't worry about

> pituitary tumors. There responsible for a small percentage of the

> cases they are almost never malignant and they respond well to

> medicine, and surgery for them is also simple and effective. Take a

> deep breath and relax. I know that's hard. I was pretty up tight

when

> they told me they were looking for a tumor. In my case they'd

already

> looked for bone cancer and liver cancer first.

>

> Low T can be caused by many many things. For overweight guys, fat

> sometimes facilitates the conversion of T to E@. Some people can

take

> medicine to block this conversion and get their T levels back to

> normal with that simple approach. Others have sleep apnea which

> results in oxygen deprivation to the brain. The pituitary regions

are

> so small that the loss of a small patch that might go unnoticed

> elsewhere int he brain can have profound impacts. others have had

> migraines result in similar things, a blow to the head. Or the balls

> may stop working from an infection or injury or chemical exposure.

>

> The important thing is it all treatable. And getting his T levels up

> will do so much more than bring back his libido. it will increase

his

> energy, focus and ambition. (With these levels I assume he's fairly

> lethargic and low ambition and ambivalent about most things.) Go to

> the library or Amazon.com etc and get a copy of Shippen's book, " The

> Testosterone Syndrome " . It will answer many questions. He should

get

> in addition to the E2 test, prolactin tests, bone density tests, and

> thyroid function tests.

>

> You've found a place of friends and help. Come back often. Talk with

> here, another wife who's been thrum this. Hang in there.

You're

> on the way to a big improvement.

> >

> >Thanks so much for reading this and offering your advice.

> >

> >Felicia

>

>

> - - - -

> Just another albino black sheep

>

[Guest guest]

Hi! He's had it for at least the last few years...probably longer as

he has had aches and pains as long as I remember...I just thought the

poor man was falling apart. He's 41 and I tease him that I need to

trade him in for two 20 year olds.

Thank you for your very informative post and for your kind words.

I've learned so much in the short time I've been a member of this

board and will be fully armed when we see the endo (whenever that

might be!! But I guess we've waited 10 years, so what's another

month or so??

G'night!

Felicia

> >

> > Hi! My husband and I have been experiencing sexual problems in

our

> > marriage for about 10 years. I have suspicioned over the years

> that

> > perhaps he had low testosterone. He never really took it

> seriously.

> > I began to feel sad, worried, filled with self doubts...wondering

> if

> > it were me (not attractive enough, too chubby, etc.). I feel

like

> > I've been married to my brother. I love my husband, but we have

> not

> > had a good, healthy sex life in over 10 years (not for lack of

want

> > on my part, which has been very difficult for me...him too I

> suppose).

> >

> > Well, we just " celebrated " our 3-year anniversary of celibacy

(woo

> > hoo, what a celebration). I finally got fed up and told him we

> > needed to figure out what was going on because I couldn't see

> myself

> > NOT having sex for the rest of my life (I'm 35 and he's 41). He

> > reluctantly agreed to get checked.

> >

> > His testosterone level is 166. He goes back for a 2nd test (and

a

> > few more tests) in a week or so.

> >

> > Here are my questions:

> > 1. For those of you who have/had similar testosterone levels,

did

> > testosterone treatment help improve your sex life, stamina,

> strength,

> > muscle mass, moods, etc.?

> >

> > 2. Is AndroGel just as effective as injections? I worry that he

> > won't like the fluctuations in injections (high to low) and

wonder

> if

> > gel would be a better choice for him.

> >

> > 3. What treatment have you found most helpful?

> >

> > 4. Finally, what can cause a man who had a normal healthy sex

> drive

> > to just lose it? I know it is low testosterone, but why would

> > someone who was functioning fine just develop a low

testosterone?

> I

> > guess my real question is, could it be a pituitary

problem/tumor?

> I

> > know only imaging studies can answer that, but if a man does have

a

> > pituitary tumor and gets that treated, can his testosterone level

> > return back to normal?

> >

> > Thanks so much for reading this and offering your advice.

> >

> > Felicia

> >

>

[Guest guest]

Thanks Phil...I'll definitely read that file!

Felicia

> >

> > I'll try to anwer two of your questions.

> > First, YES, Androgel or any other form of supplemental

testosterone

> > will raise his T level and should definately increase his

interest in

> > sex, firmness of erections, and ease and frequency of orgasm.

> > Injections work very very well, and if done on a weekly basis

there

> > really is no felt up and down of T level as it is administered

often

> in

> > smaller doses. Yes skin spread on like Androgel " work " for some

> people,

> > others have skin absorption problems. Androgel is also

fantastically

> > expense, it is all advertising and profit at only one percent

> > testosteronce in a packet. If you insurance pays androgel ok,

> > otherwise consider injections, very cheap, or compounded

testerestone

> > gel.

> > norton

> >

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Kewl!!

Hi! My husband and I have

> been experiencing sexual problems in our

> > marriage for about 10 years. I have suspicioned over the years

> that

> > perhaps he had low testosterone. He never really took it

> seriously.

> > I began to feel sad, worried, filled with self doubts...wondering

> if

> > it were me (not attractive enough, too chubby, etc.). I feel

like

> > I've been married to my brother. I love my husband, but we have

> not

> > had a good, healthy sex life in over 10 years (not for lack of

want

> > on my part, which has been very difficult for me...him too I

> suppose).

> >

> > Well, we just " celebrated " our 3-year anniversary of celibacy

(woo

> > hoo, what a celebration). I finally got fed up and told him we

> > needed to figure out what was going on because I couldn't see

> myself

> > NOT having sex for the rest of my life (I'm 35 and he's 41). He

> > reluctantly agreed to get checked.

> >

> > His testosterone level is 166. He goes back for a 2nd test (and

a

> > few more tests) in a week or so.

> >

> > Here are my questions:

> > 1. For those of you who have/had similar testosterone levels,

did

> > testosterone treatment help improve your sex life, stamina,

> strength,

> > muscle mass, moods, etc.?

> >

> > 2. Is AndroGel just as effective as injections? I worry that he

> > won't like the fluctuations in injections (high to low) and

wonder

> if

> > gel would be a better choice for him.

> >

> > 3. What treatment have you found most helpful?

> >

> > 4. Finally, what can cause a man who had a normal healthy sex

> drive

> > to just lose it? I know it is low testosterone, but why would

> > someone who was functioning fine just develop a low

testosterone?

> I

> > guess my real question is, could it be a pituitary

problem/tumor?

> I

> > know only imaging studies can answer that, but if a man does have

a

> > pituitary tumor and gets that treated, can his testosterone level

> > return back to normal?

> >

> > Thanks so much for reading this and offering your advice.

> >

> > Felicia

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

It is also not normal for a man to have aches and pains all the

time. I saw in your reply to another post that your husband is

overweight. There are two things that can cause a weight gain, low

testosterone and cortisone type medications. I think you will find

that having adequate levels of testosterone are very important to a

man's overall health. I define adequate as over 600, closer to 800.

When you two finally see that endo, be warned that they will test him

for everything under the sun, then find all the excuses in the world

not to treat him. It is the experience of this group that an endo is

only good for treating diabetes. They do not or will not treat low

testosterone. Or if they will, will do a very half-done job of it.

I am treating myself right now, following the protocol of Dr.

Crisler. If you have the means to see him in Michigan, I highly

suggest you go. I do not have the means to see him, but his

knowledge has helped me tremendously. If your husband follows his

protocol, it is safe to say that you can forget about trading him in

for a twentysomething stud. His program works.

>

> Hi! He's had it for at least the last few years...probably longer

as

> he has had aches and pains as long as I remember...I just thought

the

> poor man was falling apart. He's 41 and I tease him that I need to

> trade him in for two 20 year olds.

>

> Thank you for your very informative post and for your kind words.

> I've learned so much in the short time I've been a member of this

> board and will be fully armed when we see the endo (whenever that

> might be!! But I guess we've waited 10 years, so what's another

> month or so??

>

> G'night!

>

> Felicia

>

[Guest guest]

Your last sentence had me grinning. I assure I was just joking

with him...lol. Thank you for your advice about the endo. I will

definitely take it to heart. I looked at the link Phil suggested

about chosing a doctor. I found a few in our city that I will call

after we get back his test results. Thanks again,

Felicia

> >

> > Hi! He's had it for at least the last few years...probably

longer

> as

> > he has had aches and pains as long as I remember...I just thought

> the

> > poor man was falling apart. He's 41 and I tease him that I need

to

> > trade him in for two 20 year olds.

> >

> > Thank you for your very informative post and for your kind

words.

> > I've learned so much in the short time I've been a member of this

> > board and will be fully armed when we see the endo (whenever that

> > might be!! But I guess we've waited 10 years, so what's another

> > month or so??

> >

> > G'night!

> >

> > Felicia

> >

>

[Guest guest]

Second that on endos only treating diabetes...mine couldn't even manage

my lack of a thyroid gland adequately, let alone hypogonadism. My

Internal Medicine doc did a better job than the endo, but not much.

Interestingly, with one exception, the best doctors I've received

treatment from have been DO's, not MD's. I think Dr is a DO...he

recently posted a DO has the same medical training as an MD, plus about

25% more training as they learne skeletal structure things. Maybe the

extra education makes them more open to new treatments...?

> Re: Hi everyone...new here with questions SM

>

>

>It is the experience of this group that an endo is

>only good for treating diabetes. They do not or will not treat low

>testosterone. Or if they will, will do a very half-done job of it.

>I am treating myself right now, following the protocol of Dr.

>Crisler. If you have the means to see him in Michigan, I highly

>suggest you go. I do not have the means to see him, but his

>knowledge has helped me tremendously. If your husband follows his

>protocol, it is safe to say that you can forget about trading him in

>for a twentysomething stud. His program works.

[Guest guest]

Good when you call drill them good ask if the Dr. tests and treats a lot of men

with low T and if he treats secondary men with HCG. Also ask if the Dr. tests

for and treats High E2 Estradiol you will know when you find a good one. Don't

wast money seeing one that does not know about this.

Phil

MT_Wannabe <felicia1970_1@...> wrote:

Your last sentence had me grinning. I assure I was just joking

with him...lol. Thank you for your advice about the endo. I will

definitely take it to heart. I looked at the link Phil suggested

about chosing a doctor. I found a few in our city that I will call

after we get back his test results. Thanks again,

Felicia

> >

> > Hi! He's had it for at least the last few years...probably

longer

> as

> > he has had aches and pains as long as I remember...I just thought

> the

> > poor man was falling apart. He's 41 and I tease him that I need

to

> > trade him in for two 20 year olds.

> >

> > Thank you for your very informative post and for your kind

words.

> > I've learned so much in the short time I've been a member of this

> > board and will be fully armed when we see the endo (whenever that

> > might be!! But I guess we've waited 10 years, so what's another

> > month or so??

> >

> > G'night!

> >

> > Felicia

> >

>

[Guest guest]

On Mon, 07 Nov 2005 02:52:55 -0000, you wrote:

>Dear Retrogrouch: Thank you so much for writing. This has been very

>helpful and reassuring...I was stressing that he might have a brain

>tumor.

>

>My husband is overweight (about 100 pounds) and has sleep apnea as

>well (on CPAP). I never realized that could contribute to his T

>problems.

>

>Yes, he has all of those symptoms you listed below...has had them for

>years. Not understanding why, I've been very frustrated and

>irritated over the years with him...thinking he was just lazy,

>selfish, unloving, etc. Now having read tons on the internet I

>understand a lot more about it. It is sort of a relief to finally

>have " an answer. " I guess the first step in correcting it.

>

>He had a cortisone shot a couple days ago, so his rheumatologist says

>he has to wait 12 days to get his new set of T tests...but I will be

>sure to post the results once the come back.

>

>Thank you for telling me about (Hi !). Of course I

>don't wish this on anyone, but it IS nice to know that I'm not all

>alone.

>

>I will get that book you suggested. My husband is really shy about

>all of this, but I know he wants to learn more and would appreciate

>reading the book too.

>

>Take care,

>

>Felicia

Be advised that when he starts on T he will likely get a surge of

energy and libido. In my case I wanted to get everything up and

running " properly " again in every aspect of my life.

This proved a problem for my wife. After a few years of the sort of

history you mentioned of anger and frustration with him for lack of

ambition, energy and lethargy, a lot of attitude had developed over

time. There was a lot of resentment, and a lot of passive aggressive

stuff from her end that with low T I just let roll by. But when well I

bounced back with my own resentment and anger and wanted a lot of

things fixed in our relationship and with her and right away!

Be forewarned, the bounce back is not all joy and libido. I recommend

some marital therapy as he starts on T. There's a lot of baggage this

condition accumulates and it took a good year or more for my wife to

let go her frustration and hang it on the illness instead of my

personal failings. She could do it intellectually but not emotionally.

And having energy drive and ambition I didn't have the patience to put

up with it. I wanted things fixed in all aspects of my life.

A good counselor and we worked it out and things are great, but you

can read here about spouses who left here AFTER the therapy and health

improvements. It changes things a lot, and even positive change can

prove hard in places. And the baggage for both is immense. Forewarned

is forearmed. Recognize it coming and your half way home.

- - - -

Just another albino black sheep

[Guest guest]

Thank you...I think you're absolutely right. I love my husband but

have dreamed about leaving him over the years. (I don't sound like

such a supportive wife anymore, do I?) There is a lot of resentment,

and I think counseling is an excellent suggestion. I know as a

defense mechanism over the years I've been pretty b*tchy at

times...and said nasty comments that I'm sure were very demasculating

and hurtful. Although I'm looking forward to getting his low T

treated, I also think it's going to feel very awkward to have sex

with him after all these years. Half of me can't wait...half of me

doubts I want to. I appreciate your words very much. They have

given me a lot to think about.

> Be advised that when he starts on T he will likely get a surge of

> energy and libido. In my case I wanted to get everything up and

> running " properly " again in every aspect of my life.

>

> This proved a problem for my wife. After a few years of the sort of

> history you mentioned of anger and frustration with him for lack of

> ambition, energy and lethargy, a lot of attitude had developed over

> time. There was a lot of resentment, and a lot of passive aggressive

> stuff from her end that with low T I just let roll by. But when

well I

> bounced back with my own resentment and anger and wanted a lot of

> things fixed in our relationship and with her and right away!

>

> Be forewarned, the bounce back is not all joy and libido. I

recommend

> some marital therapy as he starts on T. There's a lot of baggage

this

> condition accumulates and it took a good year or more for my wife to

> let go her frustration and hang it on the illness instead of my

> personal failings. She could do it intellectually but not

emotionally.

> And having energy drive and ambition I didn't have the patience to

put

> up with it. I wanted things fixed in all aspects of my life.

>

> A good counselor and we worked it out and things are great, but you

> can read here about spouses who left here AFTER the therapy and

health

> improvements. It changes things a lot, and even positive change can

> prove hard in places. And the baggage for both is immense.

Forewarned

> is forearmed. Recognize it coming and your half way home.

>

> - - - -

> Just another albino black sheep

>

[Guest guest]

Now that was some dam good advice. I was so sick I could not work my Dr.'s at

the time after much testing told me I suffered from Major Depression. After 5

yrs. and not any better the Dr. treating me for this told my wife and work I

liked being this way and will never change. I found out I had low T just after

that. But the damage was done. My wife turned into a monster lashing out at me

from every angle. One morning she through a knife on the foot of the bed and

told me " why don't you just kill your self " . Believe me our marriage got ugly

fast I was feeling better from being on TRT and fighting back big time. I could

not get past all the bad things she said to me when I was to sick to get to

work. No need to go into them. But we did end up in a divorce. The last straw

was when I asked her to see a marriage counselor and she told me I was nuts and

if I did not like the way she was treating me don't let the door hit me in the

ass. So I left and it got very ugly the things

she was saying about me in the divorce papers I could not believe. But when

the time came to sign the divorce papers her lawyer asked mine what would it

take for me to get back with my wife. Hell that was easy go into see a

counselor. This yr. we have been married 40 yrs. So if things we sore between

you and your husband get some help.

Phil

retrogrouch@... wrote:

On Mon, 07 Nov 2005 02:52:55 -0000, you wrote:

>Dear Retrogrouch: Thank you so much for writing. This has been very

>helpful and reassuring...I was stressing that he might have a brain

>tumor.

>

>My husband is overweight (about 100 pounds) and has sleep apnea as

>well (on CPAP). I never realized that could contribute to his T

>problems.

>

>Yes, he has all of those symptoms you listed below...has had them for

>years. Not understanding why, I've been very frustrated and

>irritated over the years with him...thinking he was just lazy,

>selfish, unloving, etc. Now having read tons on the internet I

>understand a lot more about it. It is sort of a relief to finally

>have " an answer. " I guess the first step in correcting it.

>

>He had a cortisone shot a couple days ago, so his rheumatologist says

>he has to wait 12 days to get his new set of T tests...but I will be

>sure to post the results once the come back.

>

>Thank you for telling me about (Hi !). Of course I

>don't wish this on anyone, but it IS nice to know that I'm not all

>alone.

>

>I will get that book you suggested. My husband is really shy about

>all of this, but I know he wants to learn more and would appreciate

>reading the book too.

>

>Take care,

>

>Felicia

Be advised that when he starts on T he will likely get a surge of

energy and libido. In my case I wanted to get everything up and

running " properly " again in every aspect of my life.

This proved a problem for my wife. After a few years of the sort of

history you mentioned of anger and frustration with him for lack of

ambition, energy and lethargy, a lot of attitude had developed over

time. There was a lot of resentment, and a lot of passive aggressive

stuff from her end that with low T I just let roll by. But when well I

bounced back with my own resentment and anger and wanted a lot of

things fixed in our relationship and with her and right away!

Be forewarned, the bounce back is not all joy and libido. I recommend

some marital therapy as he starts on T. There's a lot of baggage this

condition accumulates and it took a good year or more for my wife to

let go her frustration and hang it on the illness instead of my

personal failings. She could do it intellectually but not emotionally.

And having energy drive and ambition I didn't have the patience to put

up with it. I wanted things fixed in all aspects of my life.

A good counselor and we worked it out and things are great, but you

can read here about spouses who left here AFTER the therapy and health

improvements. It changes things a lot, and even positive change can

prove hard in places. And the baggage for both is immense. Forewarned

is forearmed. Recognize it coming and your half way home.

- - - -

Just another albino black sheep

[Guest guest]

Phil,

Good to hear a story with a happy ending!

My wife gets frustrated because I'm tired all the time and doesn't think I help

around the house enough. Then on top of that we have 5 kids running around,

can get tense here sometimes. I am doing daily HCG right now, has perked up my

libido but still no relief from the muscle/joint pain and fatigue.

Dave

philip georgian <pmgamer18@...> wrote:

Now that was some dam good advice. I was so sick I could not work my Dr.'s at

the time after much testing told me I suffered from Major Depression. After 5

yrs. and not any better the Dr. treating me for this told my wife and work I

liked being this way and will never change. I found out I had low T just after

that. But the damage was done. My wife turned into a monster lashing out at me

from every angle. One morning she through a knife on the foot of the bed and

told me " why don't you just kill your self " . Believe me our marriage got ugly

fast I was feeling better from being on TRT and fighting back big time. I could

not get past all the bad things she said to me when I was to sick to get to

work. No need to go into them. But we did end up in a divorce. The last straw

was when I asked her to see a marriage counselor and she told me I was nuts and

if I did not like the way she was treating me don't let the door hit me in the

ass. So I left and it got very ugly the things

she was saying about me in the divorce papers I could not believe. But when the

time came to sign the divorce papers her lawyer asked mine what would it take

for me to get back with my wife. Hell that was easy go into see a counselor.

This yr. we have been married 40 yrs. So if things we sore between you and your

husband get some help.

Phil

retrogrouch@... wrote:

On Mon, 07 Nov 2005 02:52:55 -0000, you wrote:

>Dear Retrogrouch: Thank you so much for writing. This has been very

>helpful and reassuring...I was stressing that he might have a brain

>tumor.

>

>My husband is overweight (about 100 pounds) and has sleep apnea as

>well (on CPAP). I never realized that could contribute to his T

>problems.

>

>Yes, he has all of those symptoms you listed below...has had them for

>years. Not understanding why, I've been very frustrated and

>irritated over the years with him...thinking he was just lazy,

>selfish, unloving, etc. Now having read tons on the internet I

>understand a lot more about it. It is sort of a relief to finally

>have " an answer. " I guess the first step in correcting it.

>

>He had a cortisone shot a couple days ago, so his rheumatologist says

>he has to wait 12 days to get his new set of T tests...but I will be

>sure to post the results once the come back.

>

>Thank you for telling me about (Hi !). Of course I

>don't wish this on anyone, but it IS nice to know that I'm not all

>alone.

>

>I will get that book you suggested. My husband is really shy about

>all of this, but I know he wants to learn more and would appreciate

>reading the book too.

>

>Take care,

>

>Felicia

Be advised that when he starts on T he will likely get a surge of

energy and libido. In my case I wanted to get everything up and

running " properly " again in every aspect of my life.

This proved a problem for my wife. After a few years of the sort of

history you mentioned of anger and frustration with him for lack of

ambition, energy and lethargy, a lot of attitude had developed over

time. There was a lot of resentment, and a lot of passive aggressive

stuff from her end that with low T I just let roll by. But when well I

bounced back with my own resentment and anger and wanted a lot of

things fixed in our relationship and with her and right away!

Be forewarned, the bounce back is not all joy and libido. I recommend

some marital therapy as he starts on T. There's a lot of baggage this

condition accumulates and it took a good year or more for my wife to

let go her frustration and hang it on the illness instead of my

personal failings. She could do it intellectually but not emotionally.

And having energy drive and ambition I didn't have the patience to put

up with it. I wanted things fixed in all aspects of my life.

A good counselor and we worked it out and things are great, but you

can read here about spouses who left here AFTER the therapy and health

improvements. It changes things a lot, and even positive change can

prove hard in places. And the baggage for both is immense. Forewarned

is forearmed. Recognize it coming and your half way home.

- - - -

Just another albino black sheep