Re: Re: Article from USA Pituitary Foundation on TRT

[Guest guest]

Hi there

Many thanks for your very interesting email. I wont comment on the whole email

today so as

to allow any others to respond first - however, I was interested by your

thoughts and

comments.

In response to this quote:

" " " And this is another guideline set that assumes

the Doctor is god. I'd suggest the patient should have

more choice as to their treatment and its risks. " " "

Patient involvement and Expert patients is a must for 21st Century Medicine.

A study ca 10 years ago in Sweden divided patients at a hospital into 2

groups. Group 1 tradition " non involvement by patients " and group 2 a more

modern every decision shared between patient and medical team and risks

and decision making accepted by patient and doctor as shared. Yes, you've

got it: Group 2 patients went home significantly earlier feeling

recovered/better than the patients treated on traditional lines.

Once again thanks for your views which I will respond to in more details

later.

Best wishes - Have a good weekend!

On 2 Sep 2006 at 4:26, betaine_hcl wrote:

> I am not empressed by the their recommendations.

> First, is the arbitrary so-called threshold of

> 300 ng/dl that set as the laborary finding.

> There is evidence that the bottom end threshold

> is some higher than this.

>

> Second, they underweight the risks of the status quo / none treatment.

>

> Third, they blame testosterone therapy for their own clinical

> failures. By this I mean the common failure to monitor and treat

> estrogen levels in men prescribed testosterone; as well as, excessive

> long shot frequencies often used and thus too large of testosterone

> depots thus resulting in greater estrogen production, and both

> periods of supraphysiologic testosterone near the time

> of the shot and excessive lows end of cycle.

> An example of such an excessively long cycle is the 14 day shot cycle

> imposed by the Docs on their patients prescribed testosterone

> enahthate and testosterone cypionate.

> And then these Docs list the peaks and valleys of serum T as an

> disadvantage of this modality of treatment???!!!

>

> Further the goal of keeping testosterone in a range

> of 350 ng/dl to 700 ng/dl is also dubious. The value

> of 350 ng/dl might be acceptable as a therapeutic nadir/

> low at end of cycle. I'd think an average mid cycle range

> should be 600 to 800 ng/dl.

>

> And this is another guideline set that assumes

> the Doctor is god. I'd suggest the patient should have

> more choice as to their treament and its risks.

>

> And this document fails to consider HCG and fails preview

> inplications of when (and If) Androxal come to the med market.

> Which hopefully will provide a softer choice for those

> in the slightly greater than 300 ng/dl catagory

> ( this assumes I take this red line in the

> sand as accurate....I don't)

>

> And these mathematically challenged physicians seem to

> think their one clinical threshold has more than one significant

> figure. In other words, I see little difference if one is has 50

> ng/dl plus or minus their " threshold " . That is to say a value of 350

> ng/dl should be considered for treatment without too much hesitation.

> Moreover, there are different parameters with different testosterone

> thresholds per patient/victim as I've posted before.

>

> Conservative medical practice doesn't serve to advance medical

> practice and should NOT be seen as a complete good. Ideology

> when it opposes an idea will demand ever higher standards of proof.

>

> These are my one step ahead thoughts.

> I have some two steps ahead thoughts but they are

> at least three generations into the future given

> the glacial pace of medical advancement.

> Where Bhasin (one of the author of this guideline paper)

> sees dynamic progress, I see

> current research and current practice decades

> behind were it should have been developed to by now.

>

> As example of two step ahead thinking, I'll point out

> that there is that there is evidence that suggests

> that a restored testosterone level combined with perhaps

> 2000 to 4000 IU of supplemental vitamin D3 can be a prostate cancer

> preventative (depending on sun exposure and season).

> And in this context, it is amazing to me,

> that the so-called authorities still have a wait and see

> view on the merits of selenium supplementation for

> prostate cancer prevention, I've been taking

> for forty years on the basis of animal research and

> now human research. This is relevant because

> the Endos always trot out their concern that the

> additional testosterone MIGHT risk the prostate.

> I doubt they often ever express concern to their patients about

> the patient's ratio of estrogen to testosterone

> or the aforementioned Se amd vitamin D status nor even exposure

> to PCAA and PAHs some needlessly consume.

>

> Anyway that is how I currently see things from what I gather.

>

>

>

>

>

> .

> >

> > Dorset, England 1st September 2006

> >

> > The PNA have contacted me to ask me to read the article listed

> below on current " good

> > practice " on TRT. Perhaps members gere could read and respond

> either here or duect to

> > the authors?

> > http://media.pituitary.org/newsletter/aug2006/articles.htm

> >

> >

[Guest guest]

ADDENDUM to my earlier email reply:

I have just read this recent BMJ article on wrong prescribing which also

involves USA

agreement. Although this may not address the wrong prescribing you and I

discuss, as in

your last email, non-the-less it is a start, I hope!

__________

http://bmj.bmjjournals.com/cgi/content/short/333/7566/459?etoc

BMJ 2006;333:459-460 (2 September)

A prescription for better prescribing

Many medical students are unprepared for skilled prescribing

The fiFirst 150 words of the full text of this article appear below.

It's that time of year again. The new junior members of staff have arrived

and the old

anxiety emerges-are they well trained? In particular, are they properly

trained in

practical drug therapy and prescribing? We believe they may not be.

In July we drew attention, yet again, to what we and many others perceive to

be a

serious problem in British medicine-poor prescribing.w1 w2 We emphasised

that

deficiencies are not confined to the United Kingdom, and three days later

the Institute

of Medicine in the United States independently expressed similar concerns.w3

The

chairman of the medical academic staff committee of the British Medical

Association

later concurred,w4 and the Healthcare Commission urged the NHS to improve

prescribing.w5

Evidence of poor prescribing in the UK is abundant. Effective treatments,

such as

angiotensin converting enzyme inhibitors for heart failure1 and statins for

hyperlipidaemia,2 are often underprescribed. . . .

______________________________________________

On 2 Sep 2006 at 4:26, betaine_hcl wrote:

> I am not empressed by the their recommendations.

> First, is the arbitrary so-called threshold of

> 300 ng/dl that set as the laborary finding.

> There is evidence that the bottom end threshold

> is some higher than this.

>

> Second, they underweight the risks of the status quo / none treatment.

>

> Third, they blame testosterone therapy for their own clinical

> failures. By this I mean the common failure to monitor and treat

> estrogen levels in men prescribed testosterone; as well as, excessive

> long shot frequencies often used and thus too large of testosterone

> depots thus resulting in greater estrogen production, and both

> periods of supraphysiologic testosterone near the time

> of the shot and excessive lows end of cycle.

> An example of such an excessively long cycle is the 14 day shot cycle

> imposed by the Docs on their patients prescribed testosterone

> enahthate and testosterone cypionate.

> And then these Docs list the peaks and valleys of serum T as an

> disadvantage of this modality of treatment???!!!

>

> Further the goal of keeping testosterone in a range

> of 350 ng/dl to 700 ng/dl is also dubious. The value

> of 350 ng/dl might be acceptable as a therapeutic nadir/

> low at end of cycle. I'd think an average mid cycle range

> should be 600 to 800 ng/dl.

>

> And this is another guideline set that assumes

> the Doctor is god. I'd suggest the patient should have

> more choice as to their treament and its risks.

>

> And this document fails to consider HCG and fails preview

> inplications of when (and If) Androxal come to the med market.

> Which hopefully will provide a softer choice for those

> in the slightly greater than 300 ng/dl catagory

> ( this assumes I take this red line in the

> sand as accurate....I don't)

>

[Guest guest]

The otherday I helped my wife clean house the temp in the house was 62 and I was

soaking wet from sweat. I can't take the heat like I use to now if I get into

the car I keep the door open and turn on the air then get out and let the car

cool down or I can't breathe. Working out side this summer is very hard for me

this yr. The heat tears me down. Your posting on your Sodium my last time it

was tested it was 141 range 132-149mmol/L and Potassium was 5.2 range

3.5-5.5mmol/L. You know I can't help but think that as I age my pituitary is

getting worse and this is why I am having these problems with low Cortisol,

DHEA, IGF-1, Thyroid and Glucose. I am beck up to the weight I was the first of

last yr. so I have gained 65 lbs. back. I can't exercise and watching what I

eat is not doing it. I have no use for any Endo's both my wife and myself have

had it with them they are useless. I have just looked at a test results that is

screaming Pituitary Problems for the last Endo

I seen. This Dr. had me off T meds for 90 days and I was going through hell he

gets the tests back and tells me I am primary. Dam near everything he tested

was low normal now that I know what I know about this and it's not much I can

see a problem with the Pituitary. So to me anyone seeing an Endo is wasting

there time and money. I read sites I have found everyday and all of them say

the same dam thing Endo's are not good Dr.'s. I know that has to be some that

or up on this but 90% of them are not.

Phil

wetrey72 <wetrey72@...> wrote:

I know this article predates my run in with doctors in August 2005,

however, this spells out the smug and sactimonious attitude of the

medical community towards a man who needs TRT. Because I test above

300 ng/dl and below 400 ng/dl. I have all the symptoms of

hypogonadism, yet according to their rules I am not to be treated.

Pmgamer18, I am the guy love_en on the mesomorphosis forum. I am the

one who is forced to treat myself. I am getting my health back no

thanks to doctors. I am the one who is doing damn good. The next

thing I need to deal with is my adrenal insufficiency. At one time,

I though all was well, then I realized that an ACTH stim did not

double my baseline number. It only brought me up from 26 to 38.

Every year, my dumb doctor draws an electrolyte panel on me. My

sodium is always low and my potassium is always high. I crave salt

and indulge that craving. I even ate a bag of pretzels the day

before one of my blood draws to see if my sodium would come up.

Nothing, sodium still came back low. Just when I think I am ok, fall

in Hawaii humbles me. For those of you who do not know, the months

of August through December can be extremely hot and humid.

The so-called experts that have actively doubted, dismissed, and set

up for failure any TRT regime, also failed to include two more

factors why TRT produces equivocal results. Hypothyroidism and

adrenal insufficiency are two conditions that can make the management

of testosterone levels difficult, as well as not produce the results

expected. It is a fact that hypothyroidism and adrenal insufficiency

affects libido, as well as ED negatively. Their policy on diagnosing

and treating these conditions is as flawed as their policy about

hypogonadism. Which is dreadfully incompetent, as well as dangerous

to the health of the many patients who appear with symptoms, yet are

turned away with " your levels are within reference range, your

problem is psychiatric, here is some Prozac. Next please! " I am not

making this up either. The supposedly top endocrinologist in

Honolulu could not do any better than offer me Cialis and Prozac.

That is after I told him my main complaints were fatigue, weakness

and bone pain. That is why I never fail to rip endos a new one every

time they are mentioned.

>

> Dorset, England 1st September 2006

>

> The PNA have contacted me to ask me to read the article listed

below on current " good

> practice " on TRT. Perhaps members gere could read and respond

either here or duect to

> the authors?

> http://media.pituitary.org/newsletter/aug2006/articles.htm

>

>

>

> Extract below:

> FEATURED NEWS AND ARTICLES

> FOR AUGUST

>

> Endocrine News June 2006 Article:

>

> TESTOSTERONE THERAPY

> FOR ANDROGEN DEFICIENT MEN

> New Clinical Guideline from the Endocrine Society

> By Kristiansen, Editor

>

> Prescribing testosterone therapy for male patients can be a

controversial issue that

> leaves many physicians unclear if they are indeed giving optimal

treatment and

> whether they are treating the right patients. To help clarify best

practices in this field

> and provide guidance for the evaluation and treatment of male

androgen deficiency,

> The Endocrine Society has developed a guideline, Testosterone

Therapy in Adult Men

> with Androgen Deficiency Syndromes, which was recently published in

The Journal of

> Clinical Endocrinology & Metabolism.

>

>

> " The document represents a conservative, well-thoughtout, evidence-

based approach that practitioners will

> find useful, " says Shalender Bhasin, M.D., chair of the androgen

guideline task force. " The guideline may

> invite debate, yes. And that is quite reasonable, given that the

field is so controversial. "

>

> Controversial Issue

> Controversy arises because the available data are not sufficient to

answer many key questions. " Because

> there is so much debate, one can infer that the data are not very

good-and that is the case, " Dr. Bhasin

> says. " What is striking is that most studies have been off-label

trials, and they have not been randomized,

> clinical trials, because it´s a relatively new field

>

>

>

> Have a good weekend,

>

>

>

>

>

> _________________________________________

> Randle

>

>

>

[Guest guest]

Hey Phil - sorry to hear the news. Isn't it amazing how quick the body can add

weight? Sounds like you have your arms around the hypogonadism but the other

hormone deficiencies are starting to be the dominant factors in your life. Have

you considered going back to the routine you were doing when you felt so good

and lost weight? I know you think that the current protocal you are on makes you

feel the best in certain departments but globally it may not be what is best for

you. What has stopped you from getting back in the exercise program?

Arkansas

philip georgian <pmgamer18@...> wrote:

The otherday I helped my wife clean house the temp in the house was 62

and I was soaking wet from sweat. I can't take the heat like I use to now if I

get into the car I keep the door open and turn on the air then get out and let

the car cool down or I can't breathe. Working out side this summer is very hard

for me this yr. The heat tears me down. Your posting on your Sodium my last time

it was tested it was 141 range 132-149mmol/L and Potassium was 5.2 range

3.5-5.5mmol/L. You know I can't help but think that as I age my pituitary is

getting worse and this is why I am having these problems with low Cortisol,

DHEA, IGF-1, Thyroid and Glucose. I am beck up to the weight I was the first of

last yr. so I have gained 65 lbs. back. I can't exercise and watching what I eat

is not doing it. I have no use for any Endo's both my wife and myself have had

it with them they are useless. I have just looked at a test results that is

screaming Pituitary Problems for the last Endo

I seen. This Dr. had me off T meds for 90 days and I was going through hell he

gets the tests back and tells me I am primary. Dam near everything he tested was

low normal now that I know what I know about this and it's not much I can see a

problem with the Pituitary. So to me anyone seeing an Endo is wasting there time

and money. I read sites I have found everyday and all of them say the same dam

thing Endo's are not good Dr.'s. I know that has to be some that or up on this

but 90% of them are not.

Phil

wetrey72 <wetrey72@...> wrote:

I know this article predates my run in with doctors in August 2005,

however, this spells out the smug and sactimonious attitude of the

medical community towards a man who needs TRT. Because I test above

300 ng/dl and below 400 ng/dl. I have all the symptoms of

hypogonadism, yet according to their rules I am not to be treated.

Pmgamer18, I am the guy love_en on the mesomorphosis forum. I am the

one who is forced to treat myself. I am getting my health back no

thanks to doctors. I am the one who is doing damn good. The next

thing I need to deal with is my adrenal insufficiency. At one time,

I though all was well, then I realized that an ACTH stim did not

double my baseline number. It only brought me up from 26 to 38.

Every year, my dumb doctor draws an electrolyte panel on me. My

sodium is always low and my potassium is always high. I crave salt

and indulge that craving. I even ate a bag of pretzels the day

before one of my blood draws to see if my sodium would come up.

Nothing, sodium still came back low. Just when I think I am ok, fall

in Hawaii humbles me. For those of you who do not know, the months

of August through December can be extremely hot and humid.

The so-called experts that have actively doubted, dismissed, and set

up for failure any TRT regime, also failed to include two more

factors why TRT produces equivocal results. Hypothyroidism and

adrenal insufficiency are two conditions that can make the management

of testosterone levels difficult, as well as not produce the results

expected. It is a fact that hypothyroidism and adrenal insufficiency

affects libido, as well as ED negatively. Their policy on diagnosing

and treating these conditions is as flawed as their policy about

hypogonadism. Which is dreadfully incompetent, as well as dangerous

to the health of the many patients who appear with symptoms, yet are

turned away with " your levels are within reference range, your

problem is psychiatric, here is some Prozac. Next please! " I am not

making this up either. The supposedly top endocrinologist in

Honolulu could not do any better than offer me Cialis and Prozac.

That is after I told him my main complaints were fatigue, weakness

and bone pain. That is why I never fail to rip endos a new one every

time they are mentioned.

>

> Dorset, England 1st September 2006

>

> The PNA have contacted me to ask me to read the article listed

below on current " good

> practice " on TRT. Perhaps members gere could read and respond

either here or duect to

> the authors?

> http://media.pituitary.org/newsletter/aug2006/articles.htm

>

>

>

> Extract below:

> FEATURED NEWS AND ARTICLES

> FOR AUGUST

>

> Endocrine News June 2006 Article:

>

> TESTOSTERONE THERAPY

> FOR ANDROGEN DEFICIENT MEN

> New Clinical Guideline from the Endocrine Society

> By Kristiansen, Editor

>

> Prescribing testosterone therapy for male patients can be a

controversial issue that

> leaves many physicians unclear if they are indeed giving optimal

treatment and

> whether they are treating the right patients. To help clarify best

practices in this field

> and provide guidance for the evaluation and treatment of male

androgen deficiency,

> The Endocrine Society has developed a guideline, Testosterone

Therapy in Adult Men

> with Androgen Deficiency Syndromes, which was recently published in

The Journal of

> Clinical Endocrinology & Metabolism.

>

>

> " The document represents a conservative, well-thoughtout, evidence-

based approach that practitioners will

> find useful, " says Shalender Bhasin, M.D., chair of the androgen

guideline task force. " The guideline may

> invite debate, yes. And that is quite reasonable, given that the

field is so controversial. "

>

> Controversial Issue

> Controversy arises because the available data are not sufficient to

answer many key questions. " Because

> there is so much debate, one can infer that the data are not very

good-and that is the case, " Dr. Bhasin

> says. " What is striking is that most studies have been off-label

trials, and they have not been randomized,

> clinical trials, because it´s a relatively new field

>

>

>

> Have a good weekend,

>

>

>

>

>

> _________________________________________

> Randle

>

>

>

[Guest guest]

I don't feel I ever got over the dam bronchitis my Immune system is very low. I

have a hard time breathing but it's getting better I am told Hypopituitary

Problems cause this and now treating things like Cortisol and Thyroid will make

this better but I just started on treatment.

Phil

Dan Meatheany <dmeatheany@...> wrote:

Hey Phil - sorry to hear the news. Isn't it amazing how quick the body can add

weight? Sounds like you have your arms around the hypogonadism but the other

hormone deficiencies are starting to be the dominant factors in your life. Have

you considered going back to the routine you were doing when you felt so good

and lost weight? I know you think that the current protocal you are on makes you

feel the best in certain departments but globally it may not be what is best for

you. What has stopped you from getting back in the exercise program?

Arkansas

philip georgian

wrote:

The otherday I helped my wife clean house the temp in the house was 62 and I was

soaking wet from sweat. I can't take the heat like I use to now if I get into

the car I keep the door open and turn on the air then get out and let the car

cool down or I can't breathe. Working out side this summer is very hard for me

this yr. The heat tears me down. Your posting on your Sodium my last time it was

tested it was 141 range 132-149mmol/L and Potassium was 5.2 range 3.5-5.5mmol/L.

You know I can't help but think that as I age my pituitary is getting worse and

this is why I am having these problems with low Cortisol, DHEA, IGF-1, Thyroid

and Glucose. I am beck up to the weight I was the first of last yr. so I have

gained 65 lbs. back. I can't exercise and watching what I eat is not doing it. I

have no use for any Endo's both my wife and myself have had it with them they

are useless. I have just looked at a test results that is screaming Pituitary

Problems for the last Endo

I seen. This Dr. had me off T meds for 90 days and I was going through hell he

gets the tests back and tells me I am primary. Dam near everything he tested was

low normal now that I know what I know about this and it's not much I can see a

problem with the Pituitary. So to me anyone seeing an Endo is wasting there time

and money. I read sites I have found everyday and all of them say the same dam

thing Endo's are not good Dr.'s. I know that has to be some that or up on this

but 90% of them are not.

Phil

wetrey72 wrote:

I know this article predates my run in with doctors in August 2005,

however, this spells out the smug and sactimonious attitude of the

medical community towards a man who needs TRT. Because I test above

300 ng/dl and below 400 ng/dl. I have all the symptoms of

hypogonadism, yet according to their rules I am not to be treated.

Pmgamer18, I am the guy love_en on the mesomorphosis forum. I am the

one who is forced to treat myself. I am getting my health back no

thanks to doctors. I am the one who is doing damn good. The next

thing I need to deal with is my adrenal insufficiency. At one time,

I though all was well, then I realized that an ACTH stim did not

double my baseline number. It only brought me up from 26 to 38.

Every year, my dumb doctor draws an electrolyte panel on me. My

sodium is always low and my potassium is always high. I crave salt

and indulge that craving. I even ate a bag of pretzels the day

before one of my blood draws to see if my sodium would come up.

Nothing, sodium still came back low. Just when I think I am ok, fall

in Hawaii humbles me. For those of you who do not know, the months

of August through December can be extremely hot and humid.

The so-called experts that have actively doubted, dismissed, and set

up for failure any TRT regime, also failed to include two more

factors why TRT produces equivocal results. Hypothyroidism and

adrenal insufficiency are two conditions that can make the management

of testosterone levels difficult, as well as not produce the results

expected. It is a fact that hypothyroidism and adrenal insufficiency

affects libido, as well as ED negatively. Their policy on diagnosing

and treating these conditions is as flawed as their policy about

hypogonadism. Which is dreadfully incompetent, as well as dangerous

to the health of the many patients who appear with symptoms, yet are

turned away with " your levels are within reference range, your

problem is psychiatric, here is some Prozac. Next please! " I am not

making this up either. The supposedly top endocrinologist in

Honolulu could not do any better than offer me Cialis and Prozac.

That is after I told him my main complaints were fatigue, weakness

and bone pain. That is why I never fail to rip endos a new one every

time they are mentioned.

>

> Dorset, England 1st September 2006

>

> The PNA have contacted me to ask me to read the article listed

below on current " good

> practice " on TRT. Perhaps members gere could read and respond

either here or duect to

> the authors?

> http://media.pituitary.org/newsletter/aug2006/articles.htm

>

>

>

> Extract below:

> FEATURED NEWS AND ARTICLES

> FOR AUGUST

>

> Endocrine News June 2006 Article:

>

> TESTOSTERONE THERAPY

> FOR ANDROGEN DEFICIENT MEN

> New Clinical Guideline from the Endocrine Society

> By Kristiansen, Editor

>

> Prescribing testosterone therapy for male patients can be a

controversial issue that

> leaves many physicians unclear if they are indeed giving optimal

treatment and

> whether they are treating the right patients. To help clarify best

practices in this field

> and provide guidance for the evaluation and treatment of male

androgen deficiency,

> The Endocrine Society has developed a guideline, Testosterone

Therapy in Adult Men

> with Androgen Deficiency Syndromes, which was recently published in

The Journal of

> Clinical Endocrinology & Metabolism.

>

>

> " The document represents a conservative, well-thoughtout, evidence-

based approach that practitioners will

> find useful, " says Shalender Bhasin, M.D., chair of the androgen

guideline task force. " The guideline may

> invite debate, yes. And that is quite reasonable, given that the

field is so controversial. "

>

> Controversial Issue

> Controversy arises because the available data are not sufficient to

answer many key questions. " Because

> there is so much debate, one can infer that the data are not very

good-and that is the case, " Dr. Bhasin

> says. " What is striking is that most studies have been off-label

trials, and they have not been randomized,

> clinical trials, because it´s a relatively new field

>

>

>

> Have a good weekend,

>

>

>

>

>

> _________________________________________

> Randle

>

>

>

[Guest guest]

I have just looked at a test results that is screaming

Pituitary Problems for the last Endo - Phil

Hi Phil

Thanks for your email. I have long wondered why either Internationally or

Nationally we

cannot have a small team of A1 Top endocrinologists so as to vet blood test

results and

prescribe as in telemedicine which is not used world-wide for many specialisms.

Perhaps

ACCE / Endocrinology Society or the PNA (USA) Pituitary Foundation (UK) could

supervise

or start such a pilot scheme. This would allow GPs to have access to leading

experts who

understand via telemedicine practises.

Sorry to hear of your problems,

Kind regards

On 4 Sep 2006 at 8:05, philip georgian wrote:

> The otherday I helped my wife clean house the temp in the house was 62 and I

was soaking wet from sweat. I can't take the heat like I use to now if I get

into the car I keep the door open and turn on the air then get out and let the

car cool down or I can't breathe. Working out side this summer is very hard for

me this yr. The heat tears me down. Your posting on your Sodium my last time

it was tested it was 141 range 132-149mmol/L and Potassium was 5.2 range

3.5-5.5mmol/L. You know I can't help but think that as I age my pituitary is

getting worse and this is why I am having these problems with low Cortisol,

DHEA, IGF-1, Thyroid and Glucose. I am beck up to the weight I was the first of

last yr. so I have gained 65 lbs. back. I can't exercise and watching what I

eat is not doing it. I have no use for any Endo's both my wife and myself have

had it with them they are useless. I have just looked at a test results that is

screaming Pituitary Problems for the last Endo

> I seen. This Dr. had me off T meds for 90 days and I was going through hell

he gets the tests back and tells me I am primary. Dam near everything he tested

was low normal now that I know what I know about this and it's not much I can

see a problem with the Pituitary. So to me anyone seeing an Endo is wasting

there time and money. I read sites I have found everyday and all of them say

the same dam thing Endo's are not good Dr.'s. I know that has to be some that

or up on this but 90% of them are not.

> Phil

>

> wetrey72 <wetrey72@...> wrote:

> I know this article predates my run in with doctors in August 2005,

> however, this spells out the smug and sactimonious attitude of the

> medical community towards a man who needs TRT. Because I test above

> 300 ng/dl and below 400 ng/dl. I have all the symptoms of

> hypogonadism, yet according to their rules I am not to be treated.

>

> Pmgamer18, I am the guy love_en on the mesomorphosis forum. I am the

> one who is forced to treat myself. I am getting my health back no

> thanks to doctors. I am the one who is doing damn good. The next

> thing I need to deal with is my adrenal insufficiency. At one time,

> I though all was well, then I realized that an ACTH stim did not

> double my baseline number. It only brought me up from 26 to 38.

> Every year, my dumb doctor draws an electrolyte panel on me. My

> sodium is always low and my potassium is always high. I crave salt

> and indulge that craving. I even ate a bag of pretzels the day

> before one of my blood draws to see if my sodium would come up.

> Nothing, sodium still came back low. Just when I think I am ok, fall

> in Hawaii humbles me. For those of you who do not know, the months

> of August through December can be extremely hot and humid.

>

> The so-called experts that have actively doubted, dismissed, and set

> up for failure any TRT regime, also failed to include two more

> factors why TRT produces equivocal results. Hypothyroidism and

> adrenal insufficiency are two conditions that can make the management

> of testosterone levels difficult, as well as not produce the results

> expected. It is a fact that hypothyroidism and adrenal insufficiency

> affects libido, as well as ED negatively. Their policy on diagnosing

> and treating these conditions is as flawed as their policy about

> hypogonadism. Which is dreadfully incompetent, as well as dangerous

> to the health of the many patients who appear with symptoms, yet are

> turned away with " your levels are within reference range, your

> problem is psychiatric, here is some Prozac. Next please! " I am not

> making this up either. The supposedly top endocrinologist in

> Honolulu could not do any better than offer me Cialis and Prozac.

> That is after I told him my main complaints were fatigue, weakness

> and bone pain. That is why I never fail to rip endos a new one every

> time they are mentioned.

>

> >

> > Dorset, England 1st September 2006

> >

> > The PNA have contacted me to ask me to read the article listed

> below on current " good

> > practice " on TRT. Perhaps members gere could read and respond

> either here or duect to

> > the authors?

> > http://media.pituitary.org/newsletter/aug2006/articles.htm

> >

> >

> >

> > Extract below:

> > FEATURED NEWS AND ARTICLES

> > FOR AUGUST

> >

> > Endocrine News June 2006 Article:

> >

> > TESTOSTERONE THERAPY

> > FOR ANDROGEN DEFICIENT MEN

> > New Clinical Guideline from the Endocrine Society

> > By Kristiansen, Editor

> >

> > Prescribing testosterone therapy for male patients can be a

> controversial issue that

> > leaves many physicians unclear if they are indeed giving optimal

> treatment and

> > whether they are treating the right patients. To help clarify best

> practices in this field

> > and provide guidance for the evaluation and treatment of male

> androgen deficiency,

> > The Endocrine Society has developed a guideline, Testosterone

> Therapy in Adult Men

> > with Androgen Deficiency Syndromes, which was recently published in

> The Journal of

> > Clinical Endocrinology & Metabolism.

> >

[Guest guest]

I guess I posted this worng I am doing much better my breathing is getting much

better. All I am saying is I am were I was this time last yr. I dam hate set

backs.

Phil

Roy <chickenbirdtree@...> wrote:

I don't feel I ever got over the dam bronchitis my Immune system is

very low. I have a hard time breathing but it's getting better I am

told Hypopituitary Problems cause this and now treating things like

Cortisol and Thyroid will make this better but I just started on

treatment.

Phil

Phil I am so sorry to hear you feeling bad again. Like Dan said

why don't you go back to the regimen that you were on along with

the other treatment and see how you feel. I am doing ok yet but

noticed I couldn't get it up so went back on Arimidex again and

this morning I could get it up a little. Still waiting to see the

docor about my eyes. They are doing ok so far without the Cailis

but I am waiting to get my new glasses as they may be the cause,

who knows. I hope you get over that damn bronchitis one of these

days. Your immune system must really be low.

Good luck and beat Regards,

Roy

[Guest guest]

Well I can tell you bring up my cortisol made my T levels go way up so now we

are lowing my T levels they went up why to high.

Phil

wetrey72 <wetrey72@...> wrote:

A critical eye on those sodium and potassium is also telling. At no

time should potassium be that high. I know something is wrong with

me. My sodium is usually 135 reference range 132-145 and the

potassisum is 4.2 reference range 3.0 to 4.5. This is after the bag

of pretzels. If not that, everything I eat is heavily salted with

natural sea salt. I already know to drink a 1/2 teaspon of salt if I

am feeling faint or nauseated. As a kid, I used to like eating ice

cubes sprinkled with salt. I know lots of people warn against

licorice. But at no time did that ever cause water retention or high

blood pressure in me. The highest I go is 120/80 and that is with

lots of salt and licorice.

I hear you on the heat intolerance. You would not like it in

Hawaii. It is never 62 here, more like 82 to 92. My thyroid is not

that great, but I have no intention of touching it unti I am on

adrenal replacement. In fact, I got my dumb doctor to admit I might

be sightly hyperthyroid. I know the score on that one. I seem

hyperthyroid because of inadequate cortisol and aldosterone. I know

i am supposed to try Isocort first, then hydrocortisone, and

prednisolone with Florinef is the last resort. I do not think I have

adrenal fatigue. Scars, and the skin before your fingernails do not

look muddy if it is adrenal fatigue. That usually happens in primary

adrenal insufficiency. I know something is up when I start the

prednisolone with florinef and my hands stop looking muddy. Remember

that I failed a stim test as well. 38 one hour post injection is not

passing. That mean I cannot produce any more than 38. I would like

to know what it is like to be normal. We did talk about how

testosterone drops cortisol, I am hoping this is not the reason why I

am having a rough time. You have got to be kidding if I will give up

my T. I would much rather replace what I do not have.

>

> The otherday I helped my wife clean house the temp in the house was

62 and I was soaking wet from sweat. I can't take the heat like I

use to now if I get into the car I keep the door open and turn on the

air then get out and let the car cool down or I can't breathe.

Working out side this summer is very hard for me this yr. The heat

tears me down. Your posting on your Sodium my last time it was

tested it was 141 range 132-149mmol/L and Potassium was 5.2 range 3.5-

5.5mmol/L. You know I can't help but think that as I age my

pituitary is getting worse and this is why I am having these problems

with low Cortisol, DHEA, IGF-1, Thyroid and Glucose. I am beck up to

the weight I was the first of last yr. so I have gained 65 lbs.

back. I can't exercise and watching what I eat is not doing it. I

have no use for any Endo's both my wife and myself have had it with

them they are useless. I have just looked at a test results that is

screaming Pituitary Problems for the last Endo

> I seen. This Dr. had me off T meds for 90 days and I was going

through hell he gets the tests back and tells me I am primary. Dam

near everything he tested was low normal now that I know what I know

about this and it's not much I can see a problem with the Pituitary.

So to me anyone seeing an Endo is wasting there time and money. I

read sites I have found everyday and all of them say the same dam

thing Endo's are not good Dr.'s. I know that has to be some that or

up on this but 90% of them are not.

> Phil

[Guest guest]

hey phil..sounds like some other stuff is going on that's increasing your T

levels.

did you try any of these things while you were trialing the HCG? is it

possible your T levels doubled for another reason outside of the HCG?

philip georgian <pmgamer18@...> wrote:

Well I can tell you bring up my cortisol made my T levels go way up so

now we are lowing my T levels they went up why to high.

Phil

wetrey72 <wetrey72@...> wrote:

A critical eye on those sodium and potassium is also telling. At no

time should potassium be that high. I know something is wrong with

me. My sodium is usually 135 reference range 132-145 and the

potassisum is 4.2 reference range 3.0 to 4.5. This is after the bag

of pretzels. If not that, everything I eat is heavily salted with

natural sea salt. I already know to drink a 1/2 teaspon of salt if I

am feeling faint or nauseated. As a kid, I used to like eating ice

cubes sprinkled with salt. I know lots of people warn against

licorice. But at no time did that ever cause water retention or high

blood pressure in me. The highest I go is 120/80 and that is with

lots of salt and licorice.

I hear you on the heat intolerance. You would not like it in

Hawaii. It is never 62 here, more like 82 to 92. My thyroid is not

that great, but I have no intention of touching it unti I am on

adrenal replacement. In fact, I got my dumb doctor to admit I might

be sightly hyperthyroid. I know the score on that one. I seem

hyperthyroid because of inadequate cortisol and aldosterone. I know

i am supposed to try Isocort first, then hydrocortisone, and

prednisolone with Florinef is the last resort. I do not think I have

adrenal fatigue. Scars, and the skin before your fingernails do not

look muddy if it is adrenal fatigue. That usually happens in primary

adrenal insufficiency. I know something is up when I start the

prednisolone with florinef and my hands stop looking muddy. Remember

that I failed a stim test as well. 38 one hour post injection is not

passing. That mean I cannot produce any more than 38. I would like

to know what it is like to be normal. We did talk about how

testosterone drops cortisol, I am hoping this is not the reason why I

am having a rough time. You have got to be kidding if I will give up

my T. I would much rather replace what I do not have.

>

> The otherday I helped my wife clean house the temp in the house was

62 and I was soaking wet from sweat. I can't take the heat like I

use to now if I get into the car I keep the door open and turn on the

air then get out and let the car cool down or I can't breathe.

Working out side this summer is very hard for me this yr. The heat

tears me down. Your posting on your Sodium my last time it was

tested it was 141 range 132-149mmol/L and Potassium was 5.2 range 3.5-

5.5mmol/L. You know I can't help but think that as I age my

pituitary is getting worse and this is why I am having these problems

with low Cortisol, DHEA, IGF-1, Thyroid and Glucose. I am beck up to

the weight I was the first of last yr. so I have gained 65 lbs.

back. I can't exercise and watching what I eat is not doing it. I

have no use for any Endo's both my wife and myself have had it with

them they are useless. I have just looked at a test results that is

screaming Pituitary Problems for the last Endo

> I seen. This Dr. had me off T meds for 90 days and I was going

through hell he gets the tests back and tells me I am primary. Dam

near everything he tested was low normal now that I know what I know

about this and it's not much I can see a problem with the Pituitary.

So to me anyone seeing an Endo is wasting there time and money. I

read sites I have found everyday and all of them say the same dam

thing Endo's are not good Dr.'s. I know that has to be some that or

up on this but 90% of them are not.

> Phil

[Guest guest]

No all I did last yr. was add HCG shots it's been over a yr. now and my T levels

doubled. Then it took all this time of me posting all over the place as to why

my T levels went up so high adding HCG if I am Primary. Most got back to me

saying I can't be Primary so my Dr. did an MRI on my pituitary and it was ok.

So next I started reading everything I could find on Pituitary and started see

people with the same problems as mine and test about the same that had a bad

head injury and it damaged there Pituitary so I showed this to my Dr. he read

them and talked to a friend of his and the next time I seen him he told me I am

Hypopituitary do to this head injury I had some 23 yrs ago. And I feel he is

right because I was fine before this Auto Accident. It was after it that I had

a problem with my balance for 2 yrs. and then was told I had inflammation of the

brain and was put on some powerful steroids to get it under control. Yet I

never felt right after that head injury.

My Dr. has all me files for every Dr. I ever saw for the last 23 yrs. and he

sent them to his friend to go over them and now I know what is wrong. Like my

levels are low normal not because my adrenal glands are not working but because

they are not getting the messages from my pituitary to work right. And the same

for my testis and thyroid. Everything is working half as good as they should

be.

Phil

Jack <rockin813@...> wrote:

hey phil..sounds like some other stuff is going on that's increasing your T

levels.

did you try any of these things while you were trialing the HCG? is it possible

your T levels doubled for another reason outside of the HCG?

philip georgian

wrote:

Well I can tell you bring up my cortisol made my T levels go way up so now we

are lowing my T levels they went up why to high.

Phil

wetrey72 wrote:

A critical eye on those sodium and potassium is also telling. At no

time should potassium be that high. I know something is wrong with

me. My sodium is usually 135 reference range 132-145 and the

potassisum is 4.2 reference range 3.0 to 4.5. This is after the bag

of pretzels. If not that, everything I eat is heavily salted with

natural sea salt. I already know to drink a 1/2 teaspon of salt if I

am feeling faint or nauseated. As a kid, I used to like eating ice

cubes sprinkled with salt. I know lots of people warn against

licorice. But at no time did that ever cause water retention or high

blood pressure in me. The highest I go is 120/80 and that is with

lots of salt and licorice.

I hear you on the heat intolerance. You would not like it in

Hawaii. It is never 62 here, more like 82 to 92. My thyroid is not

that great, but I have no intention of touching it unti I am on

adrenal replacement. In fact, I got my dumb doctor to admit I might

be sightly hyperthyroid. I know the score on that one. I seem

hyperthyroid because of inadequate cortisol and aldosterone. I know

i am supposed to try Isocort first, then hydrocortisone, and

prednisolone with Florinef is the last resort. I do not think I have

adrenal fatigue. Scars, and the skin before your fingernails do not

look muddy if it is adrenal fatigue. That usually happens in primary

adrenal insufficiency. I know something is up when I start the

prednisolone with florinef and my hands stop looking muddy. Remember

that I failed a stim test as well. 38 one hour post injection is not

passing. That mean I cannot produce any more than 38. I would like

to know what it is like to be normal. We did talk about how

testosterone drops cortisol, I am hoping this is not the reason why I

am having a rough time. You have got to be kidding if I will give up

my T. I would much rather replace what I do not have.

>

> The otherday I helped my wife clean house the temp in the house was

62 and I was soaking wet from sweat. I can't take the heat like I

use to now if I get into the car I keep the door open and turn on the

air then get out and let the car cool down or I can't breathe.

Working out side this summer is very hard for me this yr. The heat

tears me down. Your posting on your Sodium my last time it was

tested it was 141 range 132-149mmol/L and Potassium was 5.2 range 3.5-

5.5mmol/L. You know I can't help but think that as I age my

pituitary is getting worse and this is why I am having these problems

with low Cortisol, DHEA, IGF-1, Thyroid and Glucose. I am beck up to

the weight I was the first of last yr. so I have gained 65 lbs.

back. I can't exercise and watching what I eat is not doing it. I

have no use for any Endo's both my wife and myself have had it with

them they are useless. I have just looked at a test results that is

screaming Pituitary Problems for the last Endo

> I seen. This Dr. had me off T meds for 90 days and I was going

through hell he gets the tests back and tells me I am primary. Dam

near everything he tested was low normal now that I know what I know

about this and it's not much I can see a problem with the Pituitary.

So to me anyone seeing an Endo is wasting there time and money. I

read sites I have found everyday and all of them say the same dam

thing Endo's are not good Dr.'s. I know that has to be some that or

up on this but 90% of them are not.

> Phil

[Guest guest]

Hi There

Thanks for your interesting email.

I understand and agree with most of what you say but what are your proposals or

conclusion

as to how to change the International problem?

For example in the USA there was a senate committee about AIDS - Should Senators

be contacted and the Whitehouse Medical / Health Team be petitioned by groups

and

individuals? What do you recommend? I remember detailed pressure groups and

lobbies

in regard to prostate cancer, is this not an extension - Or?

On 5 Sep 2006 at 5:54, wetrey72 wrote:

> I would much rather have an A team of osteopaths. Too many of us

> here have been screwed over by stubborn endocrinologists who forgot

> what hormonal deficiencies do to a person and will take the reference

> range as the final word on whether a person has a problem.

> Endocrinologists are also blind to hypothyroid symptoms, in denial of

> the existence of non-acute adrenal insufficiency and take a

> personally convenient path when faced with a hypogonadal man. In the

> rare instance that they have pulled their head out of their ass and

> see there is a problem or the patient has the good fortune of testing

> below the reference range, treatment rendered is often severely

> undeserving of the description expert. In the treatment of

> hypogonadism, they dogmatically cling to a bimonthly injection of

> testosterone, refuse to monitor, then manage estrogen aromatization,

> refuse to employ HCG when it would be beneficial to the patient and

> fail to observe when transdermal testosterone is not working. Their

> standard protocol for the treatment of hypothyroidism fails in a

> similar manner. Prior to pharmaceutical companies synthesizing T4

> pills, there was natural pork thyroid that very closely matched human

> thyroid output. An effective treatment was abandoned for a

> synthesized product which only benefited the pharmaceutical

> companies. They then monitor and manage treatment based on the TSH,

> which is like monitoring testosterone replacement via LH/FSH. T4

> pills are good at lowering TSH numbers, but are often lacking at

> relieving hypothyroid symptoms Related to their denial of adrenal

> insufficiency, they cannot be bothered to heed the warning concerning

> the administration of thyroid to a patient with latent adrenal

> insufficiency. Much of the side effects that causes physicians to be

> gun-shy about thyroid treatment are connected to adrenal

> insufficiency. The problem that does not exist, therefore not to be

> treated.

>

> The last type of physician I would want reviewing my labwork and

> directing my treatment is what I have outlined above. Self-serving,

> blind, owned by a financially interested parties, and incapable of

> following the instructions generated at considerable expense to the

> pharmaceutical company, which is then passed on to you. No thank

> you. I would much rather take my chance on my own. For the past

> year, I have followed the protocol of a very good osteopath by the

> name of Dr. Crisler. That has yielded great results at minimal

> cost on my part. I cannot afford to become his patient and the

> medical community here has chosen to be stubborn, cowardly, self-

> serving, and blind. However I have gained some of the benefits of

> the type of doctor I would like to see on that dream team.

>

> >

> > I have just looked at a test results that is screaming

> > Pituitary Problems for the last Endo - Phil

> >

> >

> > Hi Phil

> >

> > Thanks for your email. I have long wondered why either

> Internationally or Nationally we

> > cannot have a small team of A1 Top endocrinologists so as to vet

> blood test results and

> > prescribe as in telemedicine which is not used world-wide for many

> specialisms. Perhaps

> > ACCE / Endocrinology Society or the PNA (USA) Pituitary Foundation

> (UK) could supervise

> > or start such a pilot scheme. This would allow GPs to have access

> to leading experts who

> > understand via telemedicine practises.

> >

> > Sorry to hear of your problems,

> > Kind regards

> >

> >

> >

> >

>

[Guest guest]

”As with eggs, there is no such thing as a poor doctor, doctors are either good

or bad,” declared Fuller Albright, MD

Who just happened to an endo.

L

wetrey72 <wetrey72@...> wrote:

There must be an entire paradigm shift in the practice of

endocrinology. It can no longer be acceptable to refute the presence

of a condition based on a lab result. There must also be honest and

unbiased studies about the endocrine system of truly healthy people.

The reason why lab results have lost their credibilty as a diagnostic

tool is the way reference ranges are derrived. In many cases one

must test lower than the sickest person who took that lab before the

medical community will willingly treat. In short, endocrinologists

and primary care physicians have a chance to make a difference in the

lives of many people. They are squandering it by rigid adherence to

flawed reference ranges. I have no idea on how to reeducate the

medical community. Money and politics have poisoned the practice of

medicine

>

> Hi There

>

> Thanks for your interesting email.

>

> I understand and agree with most of what you say but what are your

proposals or conclusion

> as to how to change the International problem?

>

> For example in the USA there was a senate committee about AIDS -

Should Senators

> be contacted and the Whitehouse Medical / Health Team be petitioned

by groups and

> individuals? What do you recommend? I remember detailed pressure

groups and lobbies

> in regard to prostate cancer, is this not an extension - Or?

>

>