GirlyMan's Hormone Replacement Therapy
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02-01-2012, 07:28 PM (This post was last modified: 02-01-2012 10:05 PM by GirlyMan.)
GirlyMan's Hormone Replacement Therapy
Since I keep bringing this up, and since DeepThought posted some interesting points in Mr. Woof's depression thread in response, I felt like I should start a thread to expound on this. This is by far the longest and probably the most boring post I've ever written. I tried to throw in a few expletives and a couple of uncomfortable situations just to try to keep it interesting.

Bob and the Brown Recluse Spider

Bob was a typical middle-aged American male. Sedentary, obese, ate whatever he wanted whenever he wanted. At 44 yo, 5'10" and 280 lbs, Bob got bit on the foot by a Brown Recluse Spider. Bob hadn't been to a Doctor in over a decade but the spider bite warranted a visit given the pain and the fact that the flesh was necrotizing. Doc said yeah that's a Brown Recluse bite, gave me a script for some salve and then noticed that I hadn't been to a Doctor in a long time so he ordered a complete blood workup. Fasting sugar came back borderline high (115 mg/dL), triglycerides came back borderline high (330 mg/dL), A1C came back borderline high (5.8%). Doc ordered an Oral Glucose Tolerance Test for Bob which came back within 2 mg/dL of a full-blown Diabetes diagnosis. Bob was diagnosed pre-diabetic and treament ensued.

Fuckin' spider probably saved my life.

The Birth of GirlyMan

Bob and Doc took his diagnosis seriously. Started mteformin to control the blood sugar and a statin to control the triglycerides and cholesterol. Bob switched to a high protein, low carb, low fat diet consisting mainly of fish and poultry and started exercising. Bob lost 60 lbs in 9 months and brought his fasting sugars down to 100 mg/dL, his A1C down to 5.5% and his cholesterol down to 100 mg/dL total (HDL - 70, LDL - 15, triglycerides 75). But there were side effects from this regimen. Bob's testosterone went from 375 ng/dL (range 241-850) at the time of diagnosis to 315 3 months later, to 275 3 months later, to 210 ng/dL 3 months after that. Metformin is known to lower testosterone in about 1/3 of the population and Bob is a statin hyper-responder. Cholesterol is the precursor to all the sex hormones, Bob no longer had sufficient cholesterol to make even the normal, but rather pathetic amount he was churning out in the first place pre-diagnosis.

I would note that I didn't feel any subjective difference until the last 3 months when my levels were dropping below 2 standard deviations away from the mean (which is how labs define their ranges). I felt that. Bob reported this to Doc and Doc administered the ADAM questionnaire.

1. Do you have a decrease in libido (sex drive)? What libido?
2. Do you have a lack of energy? More like I just can't seem to bring myself to give a shit.
3. Do you have a decrease in strength and/or endurance? No, strongest I've been in several decades since hitting the weights again.
4. Have you lost height? Uh, I don't think so.
5. Have you noticed a decreased "enjoyment of life?" Well, I can't have sex anymore and don't even feel like masturbating so yeah I'd say it's quite a bit less enjoyable.
6. Are you sad and/or grumpy? No more so than usual. (The wife later disputed this answer when I told her what was going on.)
7. Are your erections less strong? What erections?
8. Have you noticed a recent deterioration in your ability to play sports? No, didn't you already ask that? Isn't that the same as question #3?
9. Are you falling asleep after dinner? No, I'm not falling asleep at all, my insomnia is back.
10. Has there been a recent deterioration in your work performance? Yeah, same answer as question #2.

[If you answered YES to questions 1 or 7 or any 3 other questions, you may be experiencing androgen deficiency (low testosterone level).]

These answers coupled with my lab-verified low testosterone presented me and my Doc with a choice. Try to dick around with different diabetes and cholesterol meds in the hope of restoring my initial, rather pathetic, natural testosterone levels or go on Testosterone Replacement Therapy. It wasn't a long discussion. Doc wrote a script for 5g/day of Androgel (effectively delivering about 5mg of testosterone - 1% concentration with approximately an average 10% absorption rate) and GirlyMan was born.

GirlyMan's Postpartum Depression

I didn't feel anything for 2-3 weeks. Then I started waking up with morning erections. One-eyed monster hadn't woken me up in decades. Then I started having spontaneous diurnal and nocturnal erections. Then I started chasing my wife around the house. Then the dogs started running and hiding under the couch every time I looked at them. This lasted for a few weeks and then bam, nothing again. Went back to the Doc and got my levels retested at the 6 week mark. 210 ng/dL - exactly the level that initiated the treatment. What had happened was that for a short period of time Girly's fellas were still producing testosterone in addition to the exogenous supplementation. After a period of time the testes recognized they were no longer needed and decided to go into hibernation until and unless they were needed again. Doc upped my dose, and I joined a couple of forums where old men whose balls had gone into retirement discussed their TRT with young men who had forced their fellas into early retirement (typically from androgenic anabolic steroid use for performance enhancement). I learned that some men have difficulties with absorption due to thick skin (hell, I've always had that).

Doc upped my dose to 7.5g/day and I started prepping my application areas with a hot shower, a razor, and a metal-tipped bristle brush. Also learned that the scrotum is an excellent application area but will result in higher levels of DHT (more on that later). Girly now very happily lives around 500-600ng/dL total testosterone. My guess is that's as high as I've ever been naturally. (The one time I tested higher (750 ng/dL) I started behaving especially dickish and realized it (yes, yes I realize that may be hard to comprehend).)

Well, that's a lot of background just to get to some of the specific points DeepThought was making.

Lab Values vs. Symptoms - To Test or not to Test

(31-12-2011 07:38 AM)DeepThought Wrote:  It's actually really expensive and difficult to get accurate testing on hormone levels. There are a number of other factors that come into it other than the amount of testosterone like levels of sex hormone binding globulin, 5 alpha reductase, aromatase enzymes.

Most of the men on the forums I was on were anal about testing every fucking thing. It had to be the E2 Ultrasensitive Test, you had to get SHBG plus albumin to calculate your free T (the amount of circulating, unbound testosterone), you need to get bioavailable T tested, you need to get your progesterone and pregnenolone tested in addition to your estrogen, you need to shoot for your T levels to be in the upper quartile, yadda yadda. I ran this by my Doc.

Me: Should we test for estrogen and DHT in addition to testosterone?
Doc: Why? Are your nipples or joints swollen or sore?
Me: No.
Doc: Is your libido still good?
Me: Like I'm a horny teenager.
Doc: Are your erections still strong and do you still wake up with them?
Me: Yes and yes.
Doc: Estrogen levels sound fine.
Me: What about DHT?
Doc: Only thing we're worried about with DHT is a potential deleterious effect on the prostate, although we are starting to think estrogen might be a bigger culprit with prostate problems than DHT. We check your PSA every quarter and it looks good. Now drop your pants and bend over for your DRE.
Me: Okay.
Doc: Prostate feels unremarkable. Do you have any signs of BPH, excessive urge to urinate, don't feel like you can empty your bladder, weak flow?
Me: No, I piss like a race horse and even the dribble I had prior to starting TRT is gone.
Doc: Do you still want me to run all these unnecessary tests to deal with nonexistent symptoms?
Me: I guess not. Blush
Doc: Good, now pull your pants up and go see the vampire so we can get the labs that actually matter.

Girly's Take on Testing

Women have been doing HRT longer than men. And they have to orchestrate a hormonal symphony whereas men just need to worry about keeping a beat. Women use symptoms to decide their labs and use the results to tweak their treatment. Men seem to feel a need to engineer their treatment so their labs reflect some supposed "optimal" levels, symptoms be damned. Girly's with the women here. Symptoms should inform labs and treatment, lab values should not drive treatment.

Girly on Inhibiting Downstream Metabolites

(31-12-2011 07:38 AM)DeepThought Wrote:  People who take steroids know more about this stuff. They need to take oestrogen/aromatase inhibitors too. If you have more testosterone more will get converted to oestrogen via aromatase or DHT via 5-AR.

Hey, I take steroids and know a thing or two about this. Some guys think they need to take a aromatase inhibitor to keep their estrogen in check while on TRT. I'm not one of them. I don't think a man should dick with his estrogen with pharmaceuticals. Too low E2 in men means limp dick, too high E2 levels in men means limp dick. Better to adjust the hormonal flow upstream rather than dick with the downstream metabolites and really fuck up a rather delicate and intricate individualized mechanism. That said, I do take some herbal supplements like resveratrol which seem to behave like an estrogen agonist in some tissue while being an estrogen antagonist in other tissues.

(31-12-2011 07:38 AM)DeepThought Wrote:  Lots of DHT can cause prostate problems (more of a problem in older people) also one of the causes of male pattern baldness.

I've already talked about my prostate being better off than before TRT. There's an ongoing debate about the effect of DHT on prostate problems. Estrogen is starting to look more suspicious than DHT. But there is no debate that excessive DHT can trigger the gene for MPB. Girly's hair is thicker and fuller than it's ever been since starting TRT, but that don't mean you won't go bald from TRT. (Whether or not you actually give a shit about going bald is a different subject.) Dicking with the downstream metabolite DHT is far scarier that dicking with estrogen. DHT makes the man. Taking a 5-ar inhibitor (like finasteride) to suppress DHT is playing with your manhood. Some fellas in the forums who took finasteride to slow down their hairloss wound up with a particularly nasty form of ED extremely resistant to conventional treatments. Finasteride-dick is like the worst ED we know of in terms of effective treatment. It's a small percentage of men but if it happens to you, you won't give a shit about the odds. That said, I do take some herbal supplements like saw palmetto as a prostate prophylactic which have a small 5-ar inhibitory effect.

Whew, that's the longest post I've ever made. Hope it helps some other poor emasculated fuck out there. I've thrown in a couple of extra sections just as placeholders until I get back to them.

To Shoot Up or Rub - Injections vs. Transdermals
Pharmacokinetics
Convenience
Pellets, suppositories, sublinguals, and orals

To Supplement or Stimulate - The Role of hCG in TRT
Fertility on TRT
Elevated LH correlation with Alzheimer's

Side Effects - "Nuthin's for free sonny."
Tiny Balls = my wife's call
Shutdown = Infertility (usually)
Inebriation Tolerance

As it was in the beginning is now and ever shall be, world without end. Amen.
And I will show you something different from either
Your shadow at morning striding behind you
Or your shadow at evening rising to meet you;
I will show you fear in a handful of dust.
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02-01-2012, 08:12 PM
RE: GirlyMan's Hormone Replacement Therapy
Quote:This is by far the longest and probably the most boring post I've ever written.

It's the longest, but you've had more boring. Tongue

It was just a fucking apple man, we're sorry okay? Please stop the madness Laugh out load
~Izel
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02-01-2012, 08:25 PM (This post was last modified: 02-01-2012 08:53 PM by GirlyMan.)
RE: GirlyMan's Hormone Replacement Therapy
(02-01-2012 08:12 PM)Erxomai Wrote:  
Quote:This is by far the longest and probably the most boring post I've ever written.

It's the longest, but you've had more boring. Tongue

It was the dogs running under the couch every time I looked at them that saved it, wasn't it? Wink

As it was in the beginning is now and ever shall be, world without end. Amen.
And I will show you something different from either
Your shadow at morning striding behind you
Or your shadow at evening rising to meet you;
I will show you fear in a handful of dust.
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02-01-2012, 09:28 PM
RE: GirlyMan's Hormone Replacement Therapy
(02-01-2012 08:12 PM)Erxomai Wrote:  
Quote:This is by far the longest and probably the most boring post I've ever written.

It's the longest, but you've had more boring. Tongue

Where's your compassion Erxomai? Libido is a serious things and girley's post seems well researched.

It just goes to show that a lot of bodily interactions are going on that may be missed. Depression may well have a lot of hosts other than unbalanced brain chemicals. If lacked sex drive seems the major cause of the depression than it seems smart to take a look at testosterone.
The good little girl said "its hard to be good" and the bad little girl replied "it has to be hard to be good". Wink
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02-01-2012, 09:37 PM
RE: GirlyMan's Hormone Replacement Therapy
Great post Girly. Super informative and genuinely enjoyable to read. Oh and by the by, I've never read one of your posts and been bored. I'm usually thoroughly entertained, and at the least I am intrigued.

"I think of myself as an intelligent, sensitive human being with the soul of a clown which always forces me to blow it at the most important moments." -Jim Morrison
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03-01-2012, 05:09 AM
RE: GirlyMan's Hormone Replacement Therapy
A good share girly...
Cool of you to be so open on embarrassing matters
At least now we got some insight on your weirdness... Tongue

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Disclaimer: Don’t mix the personal opinion above with the absolute and objective truth. Remember to think for yourself. Thank you.
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03-01-2012, 08:51 AM
RE: GirlyMan's Hormone Replacement Therapy
(02-01-2012 09:28 PM)Mr Woof Wrote:  
(02-01-2012 08:12 PM)Erxomai Wrote:  
Quote:This is by far the longest and probably the most boring post I've ever written.

It's the longest, but you've had more boring. Tongue

Where's your compassion Erxomai? Libido is a serious things and girley's post seems well researched.

It just goes to show that a lot of bodily interactions are going on that may be missed. Depression may well have a lot of hosts other than unbalanced brain chemicals. If lacked sex drive seems the major cause of the depression than it seems smart to take a look at testosterone.
The good little girl said "its hard to be good" and the bad little girl replied "it has to be hard to be good". Wink

GM know I'm a miserable bastard like that.

I think he actually started this thread for me as I've mentioned a few times my lack of libido and being treated for major depression and general anxiety. I'm seeing my doctor this afternoon and looking forward to talking about this information with her. Smile

It was just a fucking apple man, we're sorry okay? Please stop the madness Laugh out load
~Izel
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03-01-2012, 10:23 AM
RE: GirlyMan's Hormone Replacement Therapy
Not to derail but Erx you have a female doctor who'm you intend on discussing your libido with? I think I've watched this "movie" whilst... well I've seen it.

"I think of myself as an intelligent, sensitive human being with the soul of a clown which always forces me to blow it at the most important moments." -Jim Morrison
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03-01-2012, 10:55 AM
RE: GirlyMan's Hormone Replacement Therapy
(03-01-2012 10:23 AM)lucradis Wrote:  Not to derail but Erx you have a female doctor who'm you intend on discussing your libido with? I think I've watched this "movie" whilst... well I've seen it.

Yeah... red hair... big boobs...

And GM ... damn dude.. c'mer sit down before ya fall down and have a drink with me. I've got me a jar of blue lightnin' which I only pull out for special situations. Look... your hands are shaking from typing so much.. this nerve juice will settle yer shit out.

Those who can make you believe absurdities can make you commit atrocities. -- Voltaire
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03-01-2012, 01:02 PM
RE: GirlyMan's Hormone Replacement Therapy
Thanks for sharing all this, GM. Looking forward to the next installment.

Religious disputes are like arguments in a madhouse over which inmate really is Napoleon.
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