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tazechip
tazechip, Board Certified Physician
Category: Endocrinology
Satisfied Customers: 28668
Experience:  Board certified in general practice with years of experience treating diabetics with multiple other medical conditions
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My question covers the main hormons. I am 65, diabetic type

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My question covers the main hormons. I am 65, diabetic type 1 since age 40. 2 years ago a routine blood test gace PSA of 14. A biopsy was done, clear for cancer. Within 6 months my health deteriorated rapidly such that after walking 90 minutes each night, I run out of steam now after 10 minutes. Hormone blood tests give Progesterone at 3 times the upper limit for a male, morning Cortisol, at the upper limit, afternoon at the median. On the other side DHEA way too low, Free T is way to low but Total T is off the upper scale, same as an 18 years old. FSH returned at 4 with T3 and T4 just above the lower level. Thyroxine commenced but no change.
Submitted: 1 year ago.
Category: Endocrinology
Expert:  tazechip replied 1 year ago.
Hi. Can you tell me more about this running out of steam problem?
Customer: replied 1 year ago.
Imagine a charged battery. It goes well an dthen it begin sto die and eventually does. Before the biopsy I was fit enough. I walked 45 mins every night, took a short rest and returned home. Now i can manage 10 mins and i'm tired. Not out of breath and not exhausted. I dont recover till the next day.Prior to the biopsy, i could sustain an erection and have normal intercourse. I would seldom ejaculate. Week by week, the erections failed. Even with Viagra, Cialis etc, I can get an erection but it cannot be maintained for more than a few minutes. Intercourse is now unsatisfactory. Ejectulation is rare. Feeling is rare. I started checking the hormones because of this and determined the Total and Free T. At the last test 3 month back, Total T was 27.5nmol/L and Free was a lowly 0.28nmol/L. After 2 months on DHEA the Free rose to 0.33, but i felt no different, generally continuing to decline
Expert:  tazechip replied 1 year ago.
OK. Just to be clear here you had the testosterone prescribe by a physician?
Customer: replied 1 year ago.
Yes. Testosterone Undecanoate NEBIDC, 1,000mg/4ml. One shot in the hip. Over the years I have had a number of T results as follows, Jan '11 - 7.26ng/Ml, March '11 - 8.04 (I had a circumcision done at this time), Jan '12 - 6.32, Oct '13 - 9.5 (same time as the Biopsy). [I have kept a full record of results]. I live in Kuwait, the profession concentrate son traditional issues. Hormones are not part of that and hence no one takes an interest. My Urologist had never heard of DHEA.
Expert:  tazechip replied 1 year ago.
And how many injections did you have? And were your testerone levels checked after that?
Customer: replied 1 year ago.
One only. The date was June '15. Free T was taken just before the injection (0.28 on 7th June). 6 weeks later a second result gave (0.29). The Urologist guessed that my Kidneys were dumping the T and did not want to proceed. My Kidneys are not perfect. Creatinine 126, CGT 87%, measured just 2 weeks back
Expert:  tazechip replied 1 year ago.
OK Sorry for all the questions but at this point can I ask exactly what your question is about this?
Customer: replied 1 year ago.
Im only too happy for the discussion. Please ask more. I want to know this
1. Why is Total T at top of the range and Free T below the bottom?
2. Why is Progesterone 2.5 times the top of the scale (10.9nmol/L) when it should be between 0.6 and 4.5?
3. Why is Estradiol 146 pmol/L when it should be around 30?
4. Why have i no stamina?
5. Why can I not sustain an erection?
6. I could think of more.
Expert:  tazechip replied 1 year ago.
Sorry--one more question--
Did you have your sex hormone binding globulin SHBG level checked?
Customer: replied 1 year ago.
Never
Customer: replied 1 year ago.
Dr. I am willing to answer any question. We have a good Lab here and getting tests done is straightforward with a 3 day turnaround. All tests are blood, no saliva
Customer: replied 1 year ago.
Actually, I see I had SHGB done in 2012. Result 65.4 (range 13-71). I dont know the units
Customer: replied 1 year ago.
Here is my results file. It is not fully uptodate, missing the recent Progesterone, Estradiol and Morning Cortisol only.
Expert:  tazechip replied 1 year ago.
OK
The progesterone and the estradiol being elevated are driving down your free T level which is causing you the problems.
The basic treatment is testosterone injections but I would use depoTestosterone instead of the type of injectable testosterone you were given and it may take several months of monthly injections to bring your level up
Let me know if you need more information please
Customer: replied 1 year ago.
Do you believe my Urologist was being too cautious?
What impact do you believe the depo would have on my kidneys? My Urologist will need some convincing that he is not taking a risk in prescribing the depo
Would you expect Total T to change?
Expert:  tazechip replied 1 year ago.
Yes I do think he didn't fully understand your problem.
The total T might rise a bit but certainly the free T will
The depo shouldn't have any effect on your kidneys
Customer: replied 1 year ago.
Dr Chip. Apologies, it was bed time here (Kuwait).Thank you very much for your opinion on this, a new one by the way that leads me back from the adrenals where I had been looking.Thank you
Customer: replied 1 year ago.
I forgot. What is the monthly dose of depo?
Expert:  tazechip replied 1 year ago.
Sorry--I was off.
The dosage is 400 mg each month
Please remember to rate my service to you
Customer: replied 1 year ago.
Can I hold the rating till tomorrow? I have made an appointment with my Urologist for tomorrow evening (3:30pm GMT). He will have to agree to, prescribe and administer the dose. He may have a comment or a question. Whilst I agree that our discussion has been focused, I just want closure at this time. Is that acceptable?I am surprised and note, that you made no reference to the adrenals, the DHEA involvement etc.
Expert:  tazechip replied 1 year ago.
That's fine
For now there's nothing really to say about your adrenals and the DHEA--this is all a free T problem
Customer: replied 1 year ago.
That is really interesting. It was the huge Progesterone result that led me to Pegnenolone and the adrenal function. So that's a whole "red herring"? Certainly makes life a lot easier
Expert:  tazechip replied 1 year ago.
Yes--basically it is a red herring
Customer: replied 1 year ago.
Many thanks. We are done for now - until tomorrow.
Expert:  tazechip replied 1 year ago.
Talk to you then
Customer: replied 1 year ago.
Good evening Dr. Chip
My U
Customer: replied 1 year ago.
Good evening Dr Chip
My Urologist has accepted your recomendation - BUT - neither Depo, Cypionate or Enanthate, or for that matter, any other T is available in Kuwait.
Seems we only have Undecanote.
If you recall, we did one injection in June and after 6 weeks took free T. No change whatsoever. At no time during the 6 weeks, did I feel anything at all.
It is 1000mg/4ml vial and readily and always available
Is there a dosing protocol that might be suitable?
Expert:  tazechip replied 1 year ago.
Hi. Yes--I would give you 1000mg to start with and another injection in two weeks and then check your T levels in one month. Depending on the result I would then give you 750 mg per month
tazechip, Board Certified Physician
Category: Endocrinology
Satisfied Customers: 28668
Experience: Board certified in general practice with years of experience treating diabetics with multiple other medical conditions
tazechip and other Endocrinology Specialists are ready to help you
Customer: replied 1 year ago.
That is the sort of response I was looking for. I have been reading this http://www.ncbi.nlm.nih.gov/pubmed/15531493, where they recommend 1,000, x 3 times at 6 weeks intervals following thereafter at 9 week.
Your is more extreme, but I agree, It needs a big loading dose
Many thanks
Customer: replied 1 year ago.
May I continue this question please?
Now one month after the 1,000mg Undecanote injection and prior to taking the 1st 250mg Sustanon injection, I took blood tests. Total T has risen to an all time high of 35.36nmol/L (range 9.7 - 27.8), a number that a young man should be happy with. Free T has also risen to the highest I have seen it, at 0.462 nmol/L (range 0.31 - 1.04). Thats a 50% increase on all earlier readings.
Problem is - I feel no different whatsoever.
The Question then. Do I proceed with the Sustanone injection, on Wednesday and thereafter at 2 week intervals?
Expert:  tazechip replied 1 year ago.
Hi--what exactly do you mean by not feeling any different?
Customer: replied 1 year ago.
My feeling of general lethargy is unchanged. If you read again my earlier complaints of lethargy, erectile dysfunction etc, they are no different now than one month back (Free T = 0.3) and one year back
Expert:  tazechip replied 1 year ago.
OK
Have you had your thyroid function checked?
Customer: replied 1 year ago.
Yes. 29th September '15. TSH was 4.27, Free T4 was 15.42pmol/L, waking body temperature 36.2deg C. Dr started me on 25ug of Levo. After 6 weeks, no change. Dose increased to 50ug about 2 weeks back. No change. Waking temperature unchanged.During this past month/6 weeks, my general condition remains no different.
Expert:  tazechip replied 1 year ago.
Has your TSH been rechecked?
Customer: replied 1 year ago.
No. But I can do. Its easy here. As a matter of record, my only ever T3 was taken in September '13 at 3.82. On that date TSH was just 2.25 and T4 was 13.79. At that time I was fighting fit. The general health decline commenced soon after
Customer: replied 1 year ago.
??????
Customer: replied 1 year ago.
Hello Doctor
Is there a reason as to why I have not had a response in almost 24 hours?
Expert:  Shantal-Mod replied 1 year ago.
Hello John,
Sorry for the delay. I have sent messages to some of our other medical experts to see whether they will be able to assist you.
Thank you for your patience,
Shantal
Expert:  DrRussMD replied 1 year ago.
HelloThe problem here is that your TSH is too high.Most patients are optimal at a TSH of about .8You are not treating what is essentially mild hypothyrodism.This is a different expert of course, and you have already rated previously on this post.If you would like to continue with me [I am ranked at the 100th percentile in endocrinology on our medical boards], please find Dr. Thomas in the medical category by request .
Customer: replied 1 year ago.
Dr. I am getting emails that you have responded, but there is no response as "the server cannot be found". Has something changed?
Expert:  DrRussMD replied 1 year ago.
Here is my last responseHelloThe problem here is that your TSH is too high.Most patients are optimal at a TSH of about .8You are not treating what is essentially mild hypothyrodism.This is a different expert of course, and you have already rated previously on this post.If you would like to continue with me [I am ranked at the 100th percentile in endocrinology on our medical boards], please find Dr. Thomas in the medical category by request .

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