thanks for the update but I wonder why your post is in this thread?It is scary how simple Vasectomy made you impotent. I am surprised how Science is still far from understanding human body.
on more question MrMojo
how you were diagnosed primary hypoganadism? were your LH and FSH out of range high? I am interested in knowing how primary diagnosis was made?
My testosterone was very low, estradiol high and I had all the classic symptoms to the nth degree. I was quite disabled physically and mentally at that point.
My initial doctors botched the blood tests; by the time I was properly tested for LH and FSH I was already on TRT. Naturally at that point LH and FSH were almost nonexistent.
My first test was 290 total T, estradiol was not tested and Free T wasn’t specified. (My primary care physician ordered the tests and he didn’t know squat about what to order and how to properly interpret the results.) A second test less than two weeks later had Total T at 379, Free T at 89 and estradiol at 139. FSH was 16.4 which is in the normal range, but not optimal; LH was not tested. With my Free T/estradiol ratio I was running on empty.
I agree with Eugene Shippen and other doctors who think that testing for LH and FSH and properly interpreting the results is dicey at best. If you want to determine whether it is primary or secondary hypogonadism simply prescribe chorionic gonadotropin to the patient. If he responds favorably to the treatment then it is secondary hypogonadism. If not, it is primary.
I think FSH 16 is too high maybe out of renge. do you have range? I saw a true primary hypogonadism. his FSH and LH were too high. I think like 25 and 37 and his father wrote to me every dr is telling LH and FSH are too high but on the same time his testicles were too small since his childhood.
I wish you had clear diagnosis. So you are telling after applying TRT your estrogen rose too high? if yes, how did you bring it down? and why did you use Fin? since with very high Estrogen you should not bee loosing hair.
Please clarify these.
how did you check your FSH if you were on TRT?did you stop TRT and then check FSH? And also did it happen before using Fin/SP? or after using Fin/SP?
when did you have high Estrogen? I mean before starting TRT (when you first diagnosed hypogonadal after vasectomy) or after starting TRT? or after starting Fin/SP?
I am very curious to know exactly when your Estrogen rose. Was it vasectomy which caused damage to your testes and they produced nothing but Estrogen or was it your TRT or was it Fin/SP use?
My first FSH test was done before I began TRT. 16 is within the range but it is at the high end of the range. It would have to be much higher if I had secondary hypgonadism. Subsequent FSH and LH tests were done after I began. Since I was taking relatively high doses of testosterone both FSH and LH were <.5, which is to be expected when doing TRT.
My estradiol level of 139 was measured before I began TRT. It was the second blood draw done before TRT; the first test did not measure estradiol, FSH or LH because my primary care physician does not know how to properly test hormone levels.
After I began TRT my estradiol remained high because I convert testosterone to estradiol. Some men convert and some men do not, or do not convert very much.
I take generic Arimidex to mitigate the aromatization process. I take .25 or .5 mg daily. (I use a razor blade to divide the tiny pills.)
When I switched to injecting testosterone cypionate in late August I tried going without the Arimidex to see if the different supplementation method would alter the aromatization. The physician who is monitoring my current treatment is also using testosterone cypionate and he does not convert. We did a blood test and sure enough, my estradiol was 111. When I resumed taking Arimidex it went down to 28; the ideal range is between 20-30.
I took Finasteride and later combined it with Saw Palmetto because of concerns about my high DHT level caused by the TRT. Ironically, my hair was thinning prior to my hypogonadism diagnosis. An Ayurevedic physician told me that my high “pita” was due to my diet, high coffee consumption and lifestyle factors and that I was “burning the hair right off of my head.” I quit coffee for 1.5 years and made other significant lifestyle changes. (When I resumed drinking coffee I consumed only a fraction of what I did previously.) My hair loss stopped and it has remained the same for over six years. There has even been regrowth of hair. (I didn’t see the Ayurvedic doc about my hair; the subject came up during our initial consultation. I was having other health issues that concerned me.)
One other thing: I have been on high doses of testosterone for over six years. As I mentioned my DHT has been high the entire time. But my prostate is physically “perfect” according to my PCP. It was confirmed by an abdominal ultrasound done when I developed liver dysfunction caused by five rounds of the antibiotic Augmentin prescribed for a stubborn sinus infection. My PSA has consistently been < 1 except for an anomalous result caused by having sex immediately prior to the blood draw. The most recent PSA test done on 8/31/12 was 0.74.
So much for the need to lower DHT to prevent prostate problems…
I think it is typo you mean a high FSH indicates primary (testicular failure) not secondary.In case of secondary (Pitutary problem) LH/FSH go too low. Usually after vasectomy there are anti bodies which attack testicles and thus cause high FSH/LH. brain tries to awaken testicles to produce more sperms/Testosterone. The weird thing is your Estradiol was high too during that period before starting TRT. I don’t know why? Did your Dr had any explaination for high Estradiol? what is your own opinion?
how long did you stay on TRT before starting Fin/SP? Do you think TRT fixed all of your issues 100%?.
could you describe your main issues before and after starting TRT
brain fog before TRT (0 - 10) how much improved after TRT (0 - 10)
fatigue before TRT(0 - 10) how much improved after TRT (0 - 10)
appetite before TRT( 0 - 10) how much improved after TRT (0 - 10)
impotanenc before TRT (0 - 10) how much improved after TRT (0 - 10)
dry eyes before TRT(0 - 10) how much improved after TRT (0 - 10)
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Yes, that is a typo. Thanks for catching it.
None of my doctors have even mentioned it much less offered a possible reason for it. I don’t have any idea why it was so high.
Unfortunately, I didn’t start keeping detailed records until February 2007. Without doing a lot of digging in my files, I began TRT around September 2006. Here is the Finasteride/Saw Palmetto info;
FINASTERIDE/SAW PALMETTO TIME-LINE 1/29/07-8/28/20
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1/29/07 Began taking Finasteride 1.25mg/day.
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6/2/08 Increased to 2.5mg/day.
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2/19/10 Increased to 5mg/day.
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4/13/10 Stopped all oral supplements due to liver dysfunction. Continued topical Testosterone and oral DHEA.
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4/22/10 Resumed some oral supplements and Finasteride 5mg/day.
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5/5/10 Began taking Saw Palmetto 320mg/day.
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6/26/10 Blood test.
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7/25/10 Stopped Finasteride.
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9/1/10 Blood test.
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8/28/10 Stopped Saw Palmetto.
If you are referring to the hypogonadism, the answer is an unqualified yes.
I had most, if not all of the usual symptoms of hypogonadism and I had them bad. In addition, over the course of 1-2 years I would present with excruciating intractable pain in different parts of my body that could not be diagnosed via imaging. In a couple of instances even strong injected narcotics did not adequately address the pain. The pain would eventually resolve on its own. When my low-back pain was the worst I was essentially bed-ridden and I needed a walker to make my way to the bathroom. The brain fog was so bad my wife began accompanying me to appointments because I could not follow a conversation. Writing a simple one paragraph e-mail message would take a half-hour to accomplish.
10/0
10/0
I don’t recall this being an issue… I did gain a fair amount of weight even though I eat a very healthy diet. After I began TRT I did the Sonoma Diet for 14 months and lost over 50 pounds and 10 inches of my waist. Prior to TRT no diet that I tried worked for me. I stopped the diet over three years ago and I have maintained a healthy weight. I currently wear the same size pants that I did in high school: 32 waist. (Due to extreme muscle-wasting I regained some weight after the diet because I did core-strengthening and other exercises to improve my muscle tone. My wife tells me that I looked like a starved concentration camp survivor at the end of my diet.)
10/0. Libido was non-existent for a couple of months before I began treatment.
I don’t remember this being a problem.
It took about a year for all my symptoms to be resolved. The overly-conservative treatment in the beginning and the aromatization issue delayed resolution of some symptoms, while others take some time to resolve once the hormones are balanced. My DHEA and Vitamin D were also very low; I noticed significant improvement when those were increased to optimum levels. In fact, the TRT didn’t have very much effect until my DHEA level was around 450. The compounding pharmacist who at the time was helping to direct my treatment told me that DHEA helps facilitate the utilization of testosterone.
The longest-lasting symptom is low-back pain caused by instability of my sacroiliac joint. The instability is caused by low testosterone which softens the ligaments, preventing them from providing adequate support. The back pain did not resolve until I had four prolotherapy treatments between 9/9/08 and 5/26/09. The symptoms returned after I began experiencing PFS and transdermal testosterone was no longer effective, probably due to the fact that the androgen receptors in my skin were exhausted.
Since 8/31/12 I have had two Platelet Rich Plasma prolotherapy treatments, a much more powerful version of the prolotherapy. I wouldn’t be surprised if I have another 2-3 prolo treatments this year. Based on what I experienced previously the resolution of the ligament problem requires an adequate testosterone level for up to a year combined with the prolo. The only option to prolo is an SI fusion, which is really no option at all. The SI joint is designed to move; fusing one side (my left side has resolved while my right side is still affected…) simply sets you up for more serious problems sooner or later… probably sooner.
I have also needed regular treatment by an osteopath since my SI joint goes out on an almost daily basis. Fortunately, my wife is a health care professional with training in muscle energy and other manipulation techniques. My osteopath has trained her so she can now do the adjustments at home when I need it. If it wasn’t for my wife I would literally be in a world of hurt. Her knowledge and medical connections have been instrumental in my being able to obtain good treatment. And even then I had to work my way through a half-dozen incompetent and semi-incompetent health care providers to get the help I needed. I shudder to think what an average patient must face who does not have our knowledge, training, connections and financial resources.
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MrMojo
you put mostly 10/0 you mean 0 before TRT and 10 after TRT?
could you provide range for your Estradiol? I don’t see unit or range.
Also what about thyroid? usually low thyroid and hypoganadism go hand in hand.
I am surprised about your Testosterone therapy though. Most primary hypogonadism are fixed by simple Testosterone replacement. I have talked to many doctors here in Ottawa and they all told my they give simply T injection, nothing else and all patients are doing well.
TRT stands for Testosterone Replacement Therapy, I assume? Is that something you do forever?
you put mostly 10/0 you mean 0 before TRT and 10 after TRT?
I interpreted 10 as indicating “a lot” and 0 " as “none.” So 10 is fully impotent and 0 is no impotence.
could you provide range for your Estradiol? I don’t see unit or range.
Estradiol is measured as pg/mL at the lab I use. As far as I am concerned the ranges listed by labs are meaningless. All they show is the range of test results of its patients, nothing more. What is optimal for one man may not be optimal for another. Unfortunately, far too many doctors “treat to the test” instead of treating the symptoms. I have heard of doctors refusing to treat patients who have all the classic symptoms of hypogonadism but who fall within the “normal range.”
One fellow I was in contact with had this experience with an andrologist in New York City. (An andrologist is an endocrinologist who has had additional training in diagnosing and treating male hormonal dysfunction.) He wouldn’t treat him because his total testosterone was something like 304, which is just four points above the usual cut-off point for the normal range. (And total testosterone is a relatively meaningless number anyway. The more important values are free or bio-available testosterone and estradiol.) In my case my symptoms are not relieved until my total testosterone is around 1300, free T is in the 50-60 range and estradiol is around 25. Those testosterone values are considered to be “hyper-therapeutic” by many doctors and most wouldn’t allow patients to attain such levels.
Fortunately, my doctor understands that testosterone values above the “normal range” is within the normal range for some men. If we tested the hormones for all men at say 20 years years old it would be a big help in treating those men when they develop hypogonadism later and life because there would be a record of a patient’s unique hormonal values at their peak.
Also what about thyroid? usually low thyroid and hypoganadism go hand in hand.
I don’t think that hypothyroidism and hypogonadism are necessarily related. From what I have read it could be merely coincidental since there is a relatively high prevalence of hypothyroidism. At any rate, I was treated for Wilson’s Temperature Syndrome, which is similar to but different than classic hypothyroidism. Some of the symptoms are different and the treatment protocol is not the same. Info about Wilson’s is available on the Internet.
I am surprised about your Testosterone therapy though. Most primary hypogonadism are fixed by simple Testosterone replacement. I have talked to many doctors here in Ottawa and they all told my they give simply T injection, nothing else and all patients are doing well.
TRT can be relatively easy to treat or it can be more complex depending on the individual. Hormone replacement therapy does not lend it self to the typical “one size fits most” way of practicing medicine. It’s part science, part art. I have seen estimates that as many as 15 million American males have hypogonadism and less than 5% are receiving adequate treatment. If it was relatively easy to diagnose and treat I would expect to see much better statistics.
To answer Cap’s question: TRT is the abbreviation for Testosterone Replacement Therapy. And yes, it is typically something that must be done for the rest of a patient’s life.
thanks MrMojo
so what is your conclusion about hypogonadism caused by vasectomy and caused by Fin/SP? Do you think both cases can be fixed the same way by simply adjusting different hormones? OR you think vasectomy induced hypogonadim is easy to fix but Fin/SP induced hypogonadism is not simply matter of fixing the hormones?
what is your current protocol?
so what is your conclusion about hypogonadism caused by vasectomy and caused by Fin/SP?
I first read about a possible connection between hypogonadism and vasectomy in “Testosterone Revolution” by Malcolm Carruthers, M.D. He devotes an entire chapter to the subject. Carruthers became interested in the possibility of there being a connection after treating a relatively large number of hypogonadic men who had a vasectomy around 10-15 years prior to their diagnosis.
He cites some studies but at the time he wrote the book the studies he refers to had been done 10-20 years previously and were generally of short duration. (There are two editions of his book published in 1996 and 2001.) He also noted that those studies were done before vital factors such as sex hormone binding globulin (SHBG) and prostate specific antigen (PSA) were included in research studies.
What is interesting in relation to PFS is that testosterone and dihydrotestosterone (DHT) are reduced by one third by vasectomy. The dramatic drop in these hormones usually did not occur in the first five years after the procedure and some studies showed an increase in DHT and follicle stimulating hormone (FSH). He suggests that the pituitary gland is trying to compensate for impaired testosterone production by stimulating the testes to produce more hormones. He also notes that several studies have shown an increase in testicular cancer within the first four years after vasectomy. Some studies have noted a link between vasectomy and prostate cancer.
I have read many of the books written for laypeople on hypogonadism and I cannot recall ever reading about a connection between hypogonadism and vasectomy in any of them other than “Testosterone Revolution.”. And it hasn’t come up in any of the over 2700 studies that I have read and have in my database. But I also haven’t done a thorough search of the literature focusing on the subject. I am planning on writing a paper on the subject, so at some point I will be delving into the vasectomy/hypogonadism connection, hopefully by the end of this year.
I’d like to relate something about my own experience with vasectomy. When I underwent the procedure the surgery on my right vas deferens was painless (I wish it had remained that way…the next day I would describe the pain as being the equivalent of having my balls run over by a semi-trailer). But when the doctor snipped the left vas deferens I felt a sharp pain. It subsided rather quickly and I didn’t thing anything much about it except it seemed rather strange since the local anesthetic had certainly numbed my scrotum.
But shortly after the surgery I developed a persistent, nagging pain near my left testicle. The pain remained a constant companion for at least eight years, at times being so uncomfortable that it interfered with sexual activity. (That’s one way to prevent conception, but it wasn’t what I had in mind when I consented to the vasectomy…)
My doctor never mentioned that I might suffer from residual pain; in fact, my doctor did not discuss any possible post-surgical complications with me. (It just goes to show how much the procedure has been minimized by health care practitioners…) I later discovered that persistent post-vasectomy pain is a disturbingly common complication. And there is no cure as such that allopathic medicine can offer to alleviate it.
It was only when I happened to mention it to my acupuncturist during a visit for another complaint that he said to me “Oh, I think that I may be able to help with that.” It turned out that my acupuncturist had experienced testicular problems of his own and he had spent some time studying various treatment options offered by traditional Chinese medicine.
If I remember correctly it took no more than two treatments (I actually recall only one treatment…) but almost immediately my pain was significant reduced. It continued to get better over a period of a few weeks until I was essentially pain-free for the first time in years. That was over seven years ago and while I have occasional twinges and I don’t like being touched very hard at one small spot I have remained pain-free.
Do you think both cases can be fixed the same way by simply adjusting different hormones? OR you think vasectomy induced hypogonadism is easy to fix but Fin/SP induced hypogonadism is not simply matter of fixing the hormones? what is your current protocol?
Well, from what I have read on this forum it doesn’t seem likely that simply adjusting hormones is the magic fix people are hoping for PFS. If a man develops hypogonadism after a vasectomy hormone replacement therapy offers the best chance for a full recovery. But PFS is a more complex syndrome; if it was only a matter of not having sufficient DHT or other hormones one would expect that with all the experimentation going on someone would have stumbled upon a solution. And even if someone does appear to have come up with a protocol that seems to work, I would not be surprised if it didn’t do the trick for other men. (Factor-in the reported spontaneous recoveries and the research waters are considerably muddied.) When it comes to the male endocrine system we are all rugged individualists, for better or worse. It’s more likely that for a treatment to be successful it will have to be tailored to the individual.
Before I go on, I should state that I haven’t perused much of the forum recently and I don’t plan on doing so. (I simply do not have the time; I have had to make some decisions about where to focus my research and I am involved in some demanding projects. I doubt that my input would add much to the discussion anyway since there appears to be plenty of people already looking into the matter.) So please forgive my ignorance as I am not up on all the current theories, etc.
But what has come to mind recently is that PFS may be the result of “gene switching” a relatively new theory in genetics that postulates that certain substances, radiation and environmental factors can cause a gene to switch on or off, which can cause undesirable physical changes. The amount of exposure necessary to trigger the condition apparently varies greatly among people. This would explain why some men get PFS and others do not; you would need to possess a particular gene and then be exposed to Finasteride for it to be switched “on.”
I am also aware of the theory that Finasteride may be able to permanently alter “gene expression.” Bisphenol A (BPA) has been shown to do this in pregnant mice. Tobacco smoke is also suspected of permanently affecting airway epithelial gene expression. There are other examples in the literature. It is an intriguing and disturbing idea and it would explain why the side-effects persist after the drug is no longer present in the body.
I am hopeful that treatments can be developed for PFS. If a gene can be switched on it can be switched off. A change in gene expression may be reversible. But I differ from many who seem to rely on all the answers coming from allopathic-oriented research. I think that there are some non-traditional therapies that show some promise; they might be useful as stand-alone treatments or as an adjunct to traditional modalities. For example, it is extremely shortsighted to dismiss alternatives such as acupuncture and Chinese herbal medicine. They were successfully treating hormonal problems over a thousand years ago… and they didn’t even know that hormones existed. (At the same time the cutting-edge treatment for many maladies in western medicine was bleeding.) Chinese medicine has an incredibly nuanced view of the endocrine system; I think that they have much to teach us, if we will only shut up and listen.
You will have to be more specific regarding your question about my current “protocol.” What exactly are you referring to?
Simply what are you taking/doing after Fin/SP side effects because I don’t think after using Fin/SP your TRT+Arimidex is working any more.
can you turn on your “pm” and “email” if in future you don’t intend to visit this forum?
I agree when he talks about the accupunture therapy…I´ve been doing for almost a month now…and I gotta say its pretty good!!
The TRT and Arimidex are working fine; I previously posted my greatly improved test results after I switched to injecting testosterone cypionate. Transdermal TRT stopped working because the skin receptors simply became exhausted after years of applying testosterone. I was careful to rotate the application sites but in the end they just seemed to peter out…
Other than that, I take a number of supplements including oral DHEA, I eat a diet that does not include processed foods and I strive to maintain a positive attitude. Don’t get me wrong: I do not live a life without pleasure. I like my whisky and I often have a beer with a meal. But I have always tended to do these things in moderation; some of my friends laugh at my 6oz. beer glasses… But I figure that if I don’t over-do things I will be able to enjoy them until the day I die.
I check-in with the forum periodically but I mainly read the threads regarding research and similar matters. When I first came here I read literally hundreds of posts. It was very helpful in helping me decide not to use Clomid to address the PFS symptoms. One post in particular convinced me to ignore the medical advice I had received to use the drug. But now I think that my time is better spent on things that benefit as many men as possible. There are only so many hours in a day and as I have gotten older I am more aware that my time is limited, so I want to make the most of it. I have always tried to maintain a balance between work and my personal life. I think that the lack of stress in my life because I refuse to take on too much is one reason why I was able to recover and my health has generally been excellent for the past fifty years.
I disabled my e-mail and PM because I was getting too many messages that required a considerable amount of time to answer. I have also encountered some hostility to my posts about how I went about treating my symptoms. I am not interested in debating these things. It is not my intention nor desire to try and convince people that my way is the only way. As I see it, we are all here seeking answers. I make it a point to have an open mind because valuable information can come from unexpected sources. I encourage others to try and do the same. We are all in this together; we’ll get better results if we support each other in our efforts.
I am willing to reenable my PM and e-mail settings to receive messages. I only ask that forum members contact me when it isn’t appropriate to use the forum for some reason. Drawing my attention to a discussion where I may be able to contribute something is fine with me. I cannot take the time to answer long e-mails asking me to go over blood tests and discuss individual treatment protocols. I prefer to provide information on the forum so that it reaches the largest number of people.
Ok I am confused again. you were having the same protocol before taking Fin/SP. What have you added in your protocol to mitigate the sides from Fin/SP use? Or you have not changed any thing?
If this is the case then the whole story is redundant.
It’s probably confusing since I was already doing TRT before experiencing the side effects. And I was already living a healthy lifestyle and using supplements such as CoQ10, etc.
I had acupuncture that was focused on the endocrine system. (I posted the exact treatment earlier.) The things that I changed regarding the TRT was an increase in transdermal testosterone, Arimidex and high doses of DHEA. That was all I did to address the side effects of using Finasteride and Saw Palmetto. I have since switched to 100mg IM testosterone cypionate every five days (I was using 300mg testosterone transdermal/day) and I have reduced the oral DHEA to 100mg/daily compared to 325mg/day.
I forgot to note that if thyroid function is compromised for some reason hormone replacement therapy efficacy will be negatively affected. So it is important to deal with thyroid issues if you want a good outcome from TRT and other hormone treatments. Attaining an optimum Vitamin D3 level is also very important.