Treatment options for Hypogonadism

How you doing?

I took my second shot of Nebido, known as the booster shot, yesterday. 5 weeks after the first shot.

My pharmacy is out of HCG, so I`m experimenting with low dose clomiphene (25 mg 3X weekly first week, then 12,5 mg) as a substitute. I also take Cialis 5 mg prior to bed, but will now go down to 2,5 mg per day due to a tight budget.

I`ve been feeling a little better the last couple of days and usually wake up with wood. Decent libido. Felt like shit last weekend though. It seems like for some reason, I do not respond very well to HCG, even at low doses. E2 spikes maybe. Regardless of not feeling very good the last weeks (save the last days), I`m stronger in the gym despite being careful with the calories, so something is happening I think.

Reading more about Nebido, a lot of guys did not feel on top until after their 3-4 shot, so I`m definitely going to stick with it.

How about yourself?

I don`t think beard growth necessarily is related to low testosterone if I`m correct. I certainly don`t notice any differences there myself. :)

Had another blood draw today. More wait-and-see for me.

Renholder: I think you mentioned having an elevated cortisol level. How high was it? Have you had other high cortisol values?

My cortisol levels have not been measured, but if the current lab work proves to be a dead end, maybe I should have it checked. Elevated cortisol seems like something that could be plausible for me, and it might contribute to my bad sleep patterns

I do alright I guess, besides the sleeping problems and tiredness during the day. Will wait a little while before going to my Doc and getting some blood tests done to know what my levels are.

My libido has been quite furious lately after starting pumping, been jacking of with my one testicle 1- 2 times a day for the last couple of weeks. Regarding the beard growth I know from experience that testosterone gives me more, if I had not taken those two steroid cycles (about 2- 3 years since the last one) I most likely would not have had any beard growth at all. Both my father and my youngest brothers have more than me. I guess its a ‘man’ thing, and would like to grow a beard before I hit the grave one day. I blends right in with some of the inferiority problems stemming from my early years of hitting puberty late.

Thanks for keeping us updated, and from what you write it seems like it is surely, but slowly, starting to take effect.

Vikingwhore: I’m curious about what your disrupted sleep pattern is like. I saw some references to being tired despite a good night’s sleep and some references to getting sleep but not at normal times, but I’m not clear what’s going on.

I wonder if there could be a connection to your workout schedule. I saw you do double split workouts and at least sometimes have pre-workout green tea. I wonder if some combination of post-workout cortisol levels and pre-workout stimulants might be affecting your sleep, especially if your p.m. workout is fairly late in the day. If you do have a blood check, it might be worth trying to include cortisol, since high levels can affect sleep.

I have done double split workouts 5 days/week for years, and I’m beginning to wonder if it might be contributing to my sleep issues. I frequently have high volume, longer duration workout that violate the “maintain high intensity and get done quick” rule - even though I believe the rule to be sound. I don’t do green tea (tried the extract once and it was the ONLY supplement I ever found too nasty to swallow). However, I do consume large quantities of coffee all day. (I’ve self-medicated with coffee for decades, and except for an occasional acid stomach issue, that has never messed with my sleep.)

I have no problem getting to sleep (possibly because I engage in minor sleep deprivation during the work week). However, most nights I wake up after a couple of hours - not “wired,” just wide awake. After a half hour or an hour, I usually get back to sleep, but it prevents a prolonged period of deep sleep.

Anyway, I know a few guys who don’t like p.m. workouts because they feel too amped to sleep for quite a while afterwards. If double split workouts are driving up your cortisol levels, or if you are just particularly sensitive to cortisol, maybe that could be the issue?
Alternately, it sounds like you have been through a lot in the last year and maybe your neurotransmitters are still trying to get re-set.

meatbuilder,
I have the same sleep pattern as you. I have very low cortisol output throughout the day and night. You may want to have your cortisol tested if you haven’t done so already. There is an AM cortisol blood test that does not show your natural cortisol curve throughout the day.

Here’s a test you can order on your own. It’s accurate:

http://www.cana ryclub.org/inde … .php?Itemid=167

Only but the best HRT doctors are up to speed on 24 hour cortisol test. Here’s a quick link if you don’t know much about low cortisol. The above test would rule high or low cortisol out.

http://www.adre nalfatigue.org/ … leep-disruption

Just my thoughts. Take care.

Cortisol should absolutely be tested and I believe you are right that it can contribute to bad sleep patterns. I`ve heard that it is possible to have the cortisol rhythm out of balance, such that you have high output when you ideally should have low (in the night). You should possibly consider using melatonin in order to force yourself into a regular sleep rhythm and see if it can help you sleep throughout the night.

I believe a saliva test taken multiple times during the day to measure variation in cortisol output is the preferred one. I`ve heard cortisol in blood can be less reliable. I now see that the test I`m speaking of is the one bowie knife linked to.

My measurement is done only through blood in the morning, so I don`t read to much into it yet, especially since it have been lower in the past and almost bottom range the first time I went to the doctor three years ago, but I will try to get a 4X saliva test myself.

On my last test cortisol is 841 nmol/L in the morning on a 250-750 reference range.

What you write about your workouts being high volume and of long duration makes me a little worried considering your low testosterone issues. Are you sure you are not training too hard and too much? Training in the evening disrupts my sleep as well. Not the entire night, but I have trouble getting too sleep early.

In terms of continous sleep, I actually read an article recently (backed by science) that dispelled the myth of needing continued sleep throughout the night. Apparently, waking up was very normal and did not affect sleep quality. I can see if I find it if you`re interesed. I`m sure it`s annoying, but perhaps it`s not affecting you as bad as you may think (and worry about). Just thought I should mention it.

Sounds good about the libido!

I understand the need for a beard though. :)

Thanks, Bowie Knife!

A very interesting thought. Your post reminded me of a discussion I read recently about an apparently paradoxical approach to addressing low T levels in elite athletes who happened to have low cortisol levels. I need to do a lot more reading, but I checked a couple of links after seeing your post, and saw the suggestion - presented as accepted knowledge - that chronic “over training” leads to low cortisol levels (after an initial period with a big spike levels). I’m not sure how/why that occurs. Maybe the adrenal gland gets too bored to respond to physical stressors.

I think I should read more about low cortisol. Its harder to see why that affects sleep, unless maybe the body depends on fluctuating levels to know when to sleep.

Thanks for the ideas, Renholder. I think I’ll look in to melatonin. I’m not that distressed by the sleep disruption itself - although there is some relationship between low T and sleep.
The overtraining possibility has occurred to me - although I never experienced signs that many folks equate with overtraining. This would be a tough one for me to address, and if I don’t want to wind up in a padded room changes would have to come in baby steps.

If I am able to confirm that I have a cortisol issue, I’ll have to force myself to move toward higher intensity but shorter workouts. (Although it’s the right thing to do anyway, it does not a very appealing prospect at my age!)

At some point, I will have some forced time off from the gym to correct a hernia, and eventually an even longer hiatus if I break down and fix a shoulder issue. Not looking forward to either “vacation,” but maybe it will be part of a reset process.

Cortisol should be lowest at night, but not too low. If it’s too low, the body produces adrenaline to compensate. Adrenaline secretion is definitely not conducive to a good nights sleep.

Interesting. Maybe low cortisol results from a deficiency in some enzyme/ingredient needed for cortisol but not for adrenaline.

meatbuilder,
There are stages of adrenal fatigue. When a person has suboptimal cortisol output, there adrenal functions are in the later stages of collapse. Now, I’m not saying this is your problem but the 4x saliva test would be of benefit.

How has your blood pressure been? Is it to the low side by any chance. Try taking your temperature (under the armpit is best), is it low? How well do you handle stress? These are all signs of compromised adrenal function.

Here’s a link to the stages of adrenal failure, again, I’m not saying that this is your problem.

What You Need to Know About the Four Stages of Adrenal Fatigue

Don’t let this article scare you or make you become a hypochondriac.

Thanks for the link. I’ll check it out.

It wad a worse-than-average night last night. Up since 2:00 a.m. Thank goodness for middle of the night Olympic trial broadcasts. It feels like its going to be a bit of a zombie day, so I apologize in advance if I eat anyone’s face off!

I have a fairly good info re: vital signs thanks to monthly platelet donations. I’ve never had a problem with low BP. Generally it has been good, though lately I’ve had ocasional blips with somewhat elevated BP. I used to have a downward trending temperature - in the low 97’s and occasionally into the upper 96’s. At one point I was beginning to wonder if there was a thyroid issue but it seemed to sort itself out. My last measurement was in the mid 97’s I think, but the last few before that were well in the 98’s. I might be a little quick with reactions these days, which could be consistent with adrenaline, I suppose.

I might try supplementing with licorice root extract as an experiment. According to Charles Poliquin, it extends the half life of cortisol. If I have low cortisol, by boosting a.m. levels might help to
establish more normal rhythms and better sleep. I’ll also look into testing.

GY

Holy Mother of God that is a lot of information! I’m up to p. 5, and if I didn’t have brain fog before I started, I do now. I’ll have to come back to this when I’m feeling a little less shaky.