I do not think it likely that this has anything to do with your current predicament. If you are concerned then put the question to Dr Crisler, I think he will have a similar response to myself.
The cause of you troubles could simply be finasteride, it could be the head trauma you previously mentioned, it could be a predisposition to hypogonadism pushed over the edge by the finasteride etc etc.
In the end it may just carry the label of idiopathic and of unknown origin.
The key is considering the causes in a sensible timely fashion (as opposed to trying to cover any and all possible causes no matter how unlikely) with Dr Crilser and treatment. If a form of treatment works and you regain your health, you may become less concerned with the root cause of the problem and as long as there is no danger to your health that might be how matters end up.
At the end of the day it is about being well, I hope that a form of treatment works for you and that you regain your health- that would be the best outcome.
Your reticence is perfectly natural and understandable even if being conservative is less than helpful.
Try to keep copies of all pathology and relevant tests that you have so that you may consider them at any point in the future at your leisure and also so that you can provide them to any future doctor that may help forward matters for you or avoid covering old ground. Just get hold of them and file them away in a safe place.
Well it means that the test was legitimate and the result boarderline and worth of the consideration that has been applied to it.
My case is exceptionally complicated. I have had cancer twice, at 17 I had liver cancer where I was the only person in the UK in my teens to have the cancer that year and the first person at the specialist cancer centre my age to have the cancer I did for 35 years. I had around a 11 hour operation that removed two thirds of my liver and several tumors, one the size of a mellon and I had follow up highly toxic combination chemotherapy. I then had primary bladder cancer at 25 and had that burnt out. Four years later I was found to have osteoporosis of the spine and low testosterone post puberty thanks to low GnRH which means the cause is hypothalamic/pituitary in origin. The exact date of the onset of the hypogonadism is unknown apart from that it was after I was 17. I have subsequently been found to have carrier genes for Hemochromatosis and elevated total iron and iron saturation but low ferritin and alpha 1 antitrypsin deficiency.
The geneticist, endocrinologists etc all think that there is probably a genetic cause for the cancers. As for the hypogonadism it could be multifactoral or have been caused by any number of potential problems. It could have been caused by the chemotherapy alone, the chemotherapy in conjunction with reduced liver function, iron overload, a genetic link and the effects of the chemo etc etc, it may even be caused by additional factors as yet undiscovered or by one singular cause that has yet to be found.
I myself am awaiting results on synacthen test to look again at my adrenals, I have another Insulin Tolerance test this week to consider growth hormone and I am awaiting a review of my iron studies by a biochemist and I have had another GnRH test to see the current state of the hypothalamic/pituitary axis…
On top of this I am going into hospital for monthly bisphosphonate infusions for the osteoporosis.
That is where I am at present……heyho.
It will be interesting to see what your estradiol level was on your last bloods. I might have an idea of what you might expect from the tamoxifen via this result.
What dosage have you been prescribed and what is the schedule?
I do not think it likely that this has anything to do with your current predicament. If you are concerned then put the question to Dr Crisler, I think he will have a similar response to myself.
The cause of you troubles could simply be finasteride, it could be the head trauma you previously mentioned, it could be a predisposition to hypogonadism pushed over the edge by the finasteride etc etc.
In the end it may just carry the label of idiopathic and of unknown origin.
The key is considering the causes in a sensible timely fashion (as opposed to trying to cover any and all possible causes no matter how unlikely) with Dr Crilser and treatment. If a form of treatment works and you regain your health, you may become less concerned with the root cause of the problem and as long as there is no danger to your health that might be how matters end up.
At the end of the day it is about being well, I hope that a form of treatment works for you and that you regain your health- that would be the best outcome.
[/quote]
Very sorry to hear about all that you’ve been through…makes many of our own issues seem rather trivial by comparison. It is an asset to have someone like yourself nevertheless putting forth the effort that you have been in order help guide us through our own pathologies. Hopefully you’ll be able to straighten this all out for yourself before too long…good health, it seems, shouldn’t be taken for granted.
So, starting today, 9/16:
20 mg 2x/day for 3 weeks
30 mg 1x/day for 2 weeks
20 mg 1x/day for 1 week
10 mg 1x/day for 1 week
Bodybuilding sites should not be trusted or viewed in relation to this subject matter. But just googling away also has its drawbacks as you have no experience of the matters at hand and no context for the effects of given medications.
A) Galapogos might have ED to start with.
B) Where ED does occur, it could be due to; E2 effects being lowered too much by too high a dose of Tamoxifen
C) Where ED does occur, it could be due to; E2 being too high and not lowered enough by too low a dose of Tamoxifen
D) Where ED does occur, it could be due to; free testosterone not being increased enough by Tamoxifen via hpta feedback
E) Where ED does occur, it could be due to; dihydrotestosterone not being increased enough via hpta feedback
F) Where ED does occur, it could be due to; ED being caused by another factor not being treated.
Etc
The side effect of Tamoxifen causing ED is specifically where the effects of estradiol are lowered too much.
There is a window effect of estradiol that is healthy in the male body. If there is too much estradiol working in the body or too little the effect is the same on the libido and on ED. So Tamoxifen can relieve or cause ED.
It depends upon the endocrinology of the individual and the dose and reaction to the Tamoxifen which itself is also based on the HPTA and too a lesser extent genetics.
Also just to clear something else up.
Although Tamoxifen has estrogenic properties acting as a weak estrogen it actually overall greatly lowers the effect of estrogen in the male body. The synthetic estrogen in tamoxifen is MUCH weaker than the VERY potent estrogen estradiol. The synthetic estrogen blocks estradiol at the estrogen receptor sites…that is how tamoxifen works.
So you categorically do NOT have increased estrogen effects on Tamoxifen quite the opposite which is why it has been used quite successfully to reduce gynecmastia in men.
P.S
If estrogen or more particularly estradiol levels are low or normal to start with, it is sometimes possible to lower the effects of estradiol too much.
If that happens you can end up with lowered libido and ED even if you did not have to start with. But the most obvious and notable side effects in such circumstances are usually bone pain and or sweats/hot flushes. A pain in the throat can also occur.
These are side effects to be aware of and watch out for……this is why I asked the question about Galapogos’s blood levels of estradiol.
Bare in mind on Tamoxifen blood tests for estradiol are of no use at all because estradiol is not lowered in the blood but blocked at the receptor sites. On Tamoxifen the blood level of estradiol will not reflect the true level of acting estradiol in the body and blood tests for estradiol will only become usefull after a period of time after the discontinuation of the medication. Because of this fact, symptoms are key and symptoms constitute a hypogondal checklist or similar.
So, ferritin is low…probably has nothing to do with hemochromatosis.
Estrone is low…and estrogens seem sort of low…I suppose this puts me a little more at risk for tamoxifen sides then?
Metabolites (DHEA, Androsterone) are high…wonder what this means…DHEA is a precursor to testosterone, but is not being converted or something? DHEA was actually pretty low in my first labs, so odd to see it fluctuate like this. Not sure what the significance of high androsterone might be exactly…
Alkaline Phosphatase is also low…whatever that means.
Haha, that’s funny…I forgot I had moderator powers now…
I just went to click ‘quote’ but accidentally hit ‘edit’…In case you’re wondering what happened to your blurb about hemochromatosis.
You’re right, I think hemochromatosis is pretty much ruled out. And it’s my error for not giving Dr. Crisler the benefit of the doubt.
As far as the tamoxifen goes, I feel pretty fine so far, can’t really say much either way.
The knees seem just a little bit achy sometimes. And I don’t feel like I sleep quite as well. Nothing really major though. I’ve had moments where I’ve sort of felt libido improve, and so forth, but this is too subjective at this point to really tell. All in all, I can’t really say I’ve noticed anything all that significant.
Anyways, any true “canaries in the coal mine” so to speak, that I should be worried about, as far as side effects go?
Sorry Hypo…once again I managed to inadvertently abuse my moderator powers.
Got what you said about the side effects, and will consult with Dr. Crisler is I experience any of them.
I believe you listed: hot flashed, bone pain, sore throat, weak erections, and a couple more. Basically, if something bad happens, call the doctor. Makes sense.
Not at all. I know it may seem sort of difficult to convey meaning sometimes in the form of the printed word, and I am rarely put aback, really. Just really glad to hear what you have to say.
I’ve been thinking about this anomaly in my urine panel, that has me at high levels of DHEA and Androsterone, but low levels of testosterone and estrone.
Could there be something metabolic going on here after all?
Do DHEA and Androsterone exert any kind of negative feedback effect on the hypothalamus that could be leading to the low testosterone?
I’ve read that DHEA is converted to androgens in the prostate - the same loci that was affected by finasteride. Could this in fact be indicative of a prostate problem blocking the DHEA -> T pathway?
Dr. John: “You just aren’t going to find low testosterone and high DHEA, outside of a patient undergoing a burst of DHEA production due to stressful situation.”
I really don’t think I was all that stressed out the day I took the test. Hmm.
I see no point in speculating on adrenal function.
If you have serious concerns over adrenal function then you would want to have a dynamic synachten and Insulin Tolerance Test. They are the gold standard evaluations.
So you either have those tests or you do not- that is where answers are found be it positive or negative.
The above said you have to understand that you will always get anomalies in results that are pure red herrings, either bizarre results that have little importance or errors due to methodology and limitations of testing.
If you test everyone to the degree that you are being tested, everyone would be found to supposedly have any number of conditions.
So the key is tests in conjunction with symptoms.
If you have symptoms of adrenal problems then you may want more detailed testing outlined at the start of this post. If the symptoms are thought to be testosterone related only then you may wish to treat this and see where this puts you.
Certainly you do factually know that testosterone is an issue due to symptoms, what finasteride is known to do and your multiple tests, on which note the methodology for blood testing testosterone is quite reliable.
You can treat one thing at a time or you can if you believe that adrenal problems exist go and have the more complex gold standard testing.
There is the bottom line then…
I guarantee that if you ask people about these matters a lot of people will come up with a million and one bits of…well crap quite frankly. You can get your head filled with people talking complete rubbish in speculating as to this that or the other….no need for any of such twaddle. You have the bottom line and you know what your choices are.
P.S
I am trying be be very direct and to the point in my posts and somehow when I read them back they seem a little tough, maybe as though the tone it like some pain in the arse school teacher…not quite sure why I feel that or why it seems like it does as I am certainly not trying to convey sucha stuffy mood…odd.
So I’m at day 11, approximately, of SERM treatment.
My libido seemed to have been improving, and actually felt like 100% yesterday morning (I hadn’t felt that good libido-wise for a long time). After that, though, it seems to have dropped off once again. I tried to muster an erection last night but could get half-way it seems. Woke up this morning with an erection but had trouble sustaining it.
My only real concern is about what the negative consequences might be if estrogen does in fact go too low. Can low estrogen result in permanent effects like fibrosis or even impotence?
Wondering what the timeline is supposed to be for people who have success with this. At what point should sensitization be reached and T restoration really become noticeable?
I guarentee that if you are thinking night and day about erections that it will be difficult.
The morning erections and symptoms such as general well-being are better to judge matters.
Estrogen going too low absolutely will NOT cause any long term problem. The only way it could do that would be if it was low for months/ years and reduced bone density or adversely affected lipid profile etc
Do not over anal-ize…er analyze matters…just go about your general day as best as possible and in time judge matters of symptoms and go back to Dr Crisler explain how you have felt and come to an agreement on where to go from there.
I don’t have any of the Cys282Tyr alleles…however, I am homozygous for the His63Asp mutation, whatever that means.
Still doubt this has any bearing on my situation, especially as the SERM seems to be having an effect (increased shedding, testicles like watermelons, somewhat increased libido, etc) which would seem to imply that the pituitary is capable of functioning under the proper stimulation.
Just to take the paranoia about my condition one step further:
I would ask, what about the thyroid?
My TSH is 2.1, which from what I’ve heard should qualify as being “suspect”…Dr. John nevertheless did not issue tests for T3/T4.
The mercury amalgam removal, which somewhat correlated with onset of my condition, could have caused mercury accumulation in my thyroid gland thus precipitating hypothyroidism/hypogonadism. This, apparently, has been known to actually happen.
The tamoxifen regimen is going pretty well. I have noticed somewhat stronger libido on some occasions, but nothing to write home about. Other observations include more watery semen and a slight increase in body/facial hair.
At this point I’ve been on it for 6 weeks, with one more week to go. After that I wait for a month and then Dr. Crisler will have me retested to see where my testosterone stands.
As a sidenote, I’ve also noticed that my body temperature is significantly lower than it should be…I’d say the range is anywhere from high 95’s to low 97’s, depending, but usually 96’s…and never ever been at or above what’s said to the minimum 97.8…I’ve taken my body temperature many many times but I’ve never seen it be where it should…
So this suggests thyroid. However, I just had thyroid checked (though on tamoxifen) and these are my results:
Free T4: 1.24 (0.61-1.76)
Free T3: 3.7 (2.3-4.2)
Everything appears normal, albeit while on tamoxifen, which may mess with thyroid from what I’ve read.
pmgamer in the other forum suggests that the low body temp may indicate thyroid not entering and pooling in the blood, which may indicate some kind of cortisol issue…however, this is doubtful as my 24-hour urine cortisol was measured to be normal.
Well, here are my labs taken one month post-tamoxifen treatment (they aren’t quite complete as I got these numbers over the phone from Dr. Crisler).
Testosterone 506 (250-1100)
Free testosterone 96
Bioavailable testosterone 203 (upper limit: 575)
Estradiol 23 (upper limit: 29)
LH/FSH bottom third of range
So it looks to be an improvement. Besides the jumpstart attempt other changes in lifestyle that I’ve made have been (1) eating more of a low-carb diet, (2) lifting weights/exercising more, (3) all but eliminating masturbation.
Dr. Crisler also mentioned that he tends to see a “bounce” post-tamoxifen, meaning the numbers keep going up. So I’m fairly satisfied with these results.
We’re going to wait another 3 months or so, and recheck levels.
