Newbie needs help with HPTA restart (+ my story)

Member Stories
#1

Hi everybody,

first of all sorry for my English, i’m from germany. I almost got tears in my eyes when i found this forum yesterday because this could be the key to all my problems. I was on propecia for 10 years (from age 26 to 36) and during that time my mucles, energy and libido became more and more weak along with thousand other symptoms such as sleeping problems, brain fog, diarrhea etc. But after quitting propecia two years ago the symptoms even worsened. Due to muscle weakness i almost couldn’t walk anymore and my sexual desire was zero. Meanwhile i consulted a large number of (incompetent) doctors who did uncountable examitations with me and at last only declared me to have “somatoform disorders”. At least a thyroid specialist diagnosed me being hypothyroid (suspicion for Hashimoto’s) and prescribed L-Thyroxin (T4 mono preparate) resp. Armour Thyroid. I raised it up to 190µg L-Thyroxin plus 30mg Armour per day which indeed helped me in some way but didn’t eliminate my main symptoms.

After doing some further research i finally found a good anti-aging doctor who discovered serveral further hormone deficits (testosterone, cortisole, aldosterone). So since four weeks i’m taking 50mg testosterone (Testogel), 1/4 Arimidex, 2mg methylprednisolone (corresponding to 10mg hydrocortisone) and 100µG fludrocortisone per day. That brought me further improvements but wasn’t a breakthrough so far.

So that’s my story. Now, after reading in this forum i have the impression to be a typicial post-finateride sufferer and especially the initiated TRT was the second step before a possible first (HPTA restart trial). My LH and FSH were measured a few times and they were very low in normal range as well as my active testosterone metabolite “androstanediol gluc.”. So i think it could be promising for me to try a HPTA restart. Cave: My doctor is very cooperative and tries to restore all hormone deficits but I’m afraid he doesn’t know any restart programs for “post-propecia sufferers”.

So my question to you: With your experience, what seems to be the most promising restart trial for HPTA in terms of effectiveness and (less) side effects? I have already something about preparates as HCG, Tamoxifen, Clomid or Nolvadex but for the moment it’s just too much for me to put things together. So it would be very kind if you could give me some recommendations for a HPTA restart which i could propose to my doctor.

Thank you very much and best regards,
Oliver

p.s. If necessary i could post a lot of recently done blood and 24h-urine tests.

#2

Hi Oliver,

Welcome to the forum. I’m glad you’ve finally found the actual cause to all your problems… it really is a God-awful drug. As for the right HPTA protocol, although some users here may have some ideas, none of us are medical specialists and your best bet is probably to talk to one. In particular, I think most would recommend Dr. John Crisler in the USA… you’ll find more detailed information about him all over this forum. In short, Dr. Crisler is one of the world’s leading male hormone specialists, and (just as importantly) he’s treated hundreds of post-fin cases and recognizes our problem. If you’re looking to go down this route, I don’t think there is anyone more qualified in the world to help you along. If you can’t make it to the USA in person, I’m pretty sure he offers to consult with you and your doctor to develop a treatment protocol. You should look into the information on this forum as well as on his website… I wish you the best of luck.

#3

Hi sghcnt,

thanks for the reply. I already read about Dr. Crisler and i think it’s a good idea to consult him together with my doctor.

May i ask you another question? Is there a way to stimulate 5AR activity? Due to my last blood tests my total and free testosterone were high in normal range but my androstanediol gluc. was still very low in range. So my problem seems to be the conversion to dht which hasn’t recovered after quitting propecia.

Best,
Oliver

#4

Hi Oliver and welcome to this site. Lost of us are still suffering the same problems as yours…
I took the pill 7 years and after 3 since quit I am still screw up.
I would like to ask you if you have measured DHT. I have low total T and Free T but normal DHT (0.42 between a 0,25-1 range)

Bye

#5

Hi Insomnia,

yes my DHT was measured twice. Once in summer 2007 (two month after quitting Propecia and before taking thyroid hormones). There it was low in normal range (343 ng/l in a 250-1000 range). And the second time one month ago, there it was above normal range (57 ng/dl with an obviously tighter 9.4 to 47.6 range). But at the same time my androstenadiol-gluc was very low in normal range (5.5 ng/ml with range 3.4-22). As i’ve read here this value might show the intracellular activity of 5AR-II more reliable. At least for me that seems to be true.

Best,
Oliver

#6

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#7

Hi Solonjk,

i have done many blood tests during Propecia intake. Which ones are you interested in? What I find remarkable is that my TSH was constantly above the narrower normal range of 2.5 since 2003. Then in 2007 a doctor diagnosed me with Hashimoto’s. So I’m asking me if Propecia triggered Hashi (due to less male hormones) or if I tolerated Propecia so bad because I already had Hashi (could be a model why only some fin users get such heavy side effects).

Furthermore, my serum cortisol was two or three times high in normal range (with ACTH above range) during Propecia, then high again in a saliva test shortly after quitting propecia and then - in two further saliva tests in the next two years - it declined to low normal values. I think that might indicate an arising adrenal fatique.

Presently I’m under treatment by the Belgian Dr. Hertoghe who seems to be an experienced anti-aging doctor. As i wrote, he prescribed me testo as well as cortison (methylprednisolone) and aldosterone (in form of fludrocortisone). But at the moment I’m struggling to raise to the recommended dosages because it means a huge adaption for your body.

Best,
Oliver

#8

Hello Oliver
I have heard Dr Herthoge’s name mentioned before, can you post his contact details on the forum for the rest of us to see please.
I am in England and have experienced continuous muscle wasting as you have and other problems. But I have given up on any doctors in this country so a trip to Belgium would be interesting.

Good luck,
Robin

#9

Hi Robin,

Dr. Hertoghe has an own website:

hertoghe.eu/

Best,
Oliver

#10

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#11

Hello Oliver, welcome to the forum and thanks for your story.

When did you get measured for LH and FSH? If you measured them while on TRT, of course they would be low, as TRT surpresses pituitary release of LH and FSH.

Sounds like you have a great doctor working with you. Please read the STICKIES in the “Drug Therapy” section – propeciahelp.com/forum/viewforum.php?f=5

There are studies on Clomid and hCG being used to jumpstart T production, as well as hCG use to maintain fertility while on TRT. Print those and bring with you the doc.

You might want to consider putting your doc in touch with Dr Crisler, who prefers Tamoxifen vs. Clomid to restart, or Dr. Shippen, who prefers Clomid, to discuss potential treatment options.

Yes, if you could post all your bloodwork with date, time, and ranges in the HORMONES & BLOODTESTS section, it would be much appreciated.

I have to say, congratulations – you are the first and only person on this forum (so far) to have gotten Androstanediol glucuronide (3alpha-diol G, the final metabolite of DHT) measured.

Besides getting a genital skin fibroblast culture done to check for 5AR2 activity/metabolism post-Finasteride, we have hypothesized that blood testing for 3a-diol G would likely provide insights into 5AR2 activity, based on the following thread (read whole thing, and screenshots): propeciahelp.com/forum/viewtopic.php?t=761

Other details, from bio-medicine.org/medicine-pr … t-18544-1/

"Androstanediol glucuronide (3alpha-diol G) is the glucuronide conjugate of 3alpha-androstanediol, a major metabolite of dihydrotestosterone (DHT) [1,2]. 3alpha-diol G has strong androgenic activity estimated at 75% of the bioactivity of testosterone [2]. Serum 3alpha-diol G is the product of intracellular reduction of DHT, and in addition, a significant proportion of serum 3alpha-diol G is derived from DHEA-Sulfate and androstenedione. "

For others reading this thread, ARUP LABS can do this blood test:
aruplab.com/guides/ug/tests/ … ronide.jsp

aruplab.com/guides/ug/tests/0078001.jsp

Thus, it seems clear that while you may have adequate serum DHT levels (which could come from 5AR1), for some reason your 5AR2 reduction and further glucuronidation of DHT to it’s final metabolite seems to be impaired, or operating at a very low level.

This could provide clues as to what has gone wrong, as a potential area of investigation (impaired glucuronidation, which usually takes place in the liver, via the enzyme 3a-hydroxysteroid dehydrogenase (3aHSD)).

What did Dr. Hertoghe say about your 3a-diol G result?

The following studies provides more detail on 3a-diol G, importance of liver in 5AR metabolism and 3a glucuronidation, and how it works as a molecular switch and regulates DHT occupancy of the androgen receptor… please print and provide these to Dr Hertoghe.

  1. jcem.endojournals.org/cgi/conten … t/76/4/977

  2. propeciahelp.com/forum/viewtopic.php?t=2700

  3. propeciahelp.com/forum/viewtopic.php?p=14859

  4. propeciahelp.com/forum/viewtopic.php?p=14862

  5. propeciahelp.com/forum/viewtopic.php?p=12575

Of particular interest is the abstract conclusion from #3, above:

"However, a number of studies suggest
that blood DHT or 3a diol are not reliable indicators of peripheral
DHT formation. This is particularly suggested by discrepancies
in the specific activity of DHT in blood and urine following
infusion of labeled DHT, suggesting that total body DHT formation
is not reflected by blood levels. Thus, DHT should be
thought of as a paracrine hormone formed and acting primarily
in target tissues. 3a androstanediol glucuronide (3a diol G) is a
major metabolite of DHT. An important site of its formation is the
skin. Levels in blood and urine are increased in hirsutism and
acne, and blood levels closely parallel pubertal development. 3a-
diol G levels are especially increased in adrenal disorders of
androgenicity such as andrenogenital syndrome; it is also a
good marker of response to therapy. Levels are reduced in various
forms of male pseudohermaphroditism. 3a androstanediol
glucuronide appears to be the best marker available of DHT
formation in target tissues such as skin."

In essence, we know that while taking Finasteride, our hormonal profile is transformed to match that of a 5AR2 deficient pseudohermaphrodite:

propeciahelp.com/forum/viewtopic.php?t=658

Perhaps in our cases such alterations have resulted in a fixed “5AR2 deficient pseudohermaphrodite” state where the body no longer metabolises DHT and 3a-diol G correctly. Considering your low levels of 3a-diol G and the materials above, you should discuss this further with Dr. Hertoghe.

As well, considering the enzyme 3a-hydroxysteroid dehydrogenase (3aHSD) is responsible for converting DHT to it’s final metabolite 3a-diol G, the 3a-hydroxysteroid dehydrogenase pathway should also be investigated. We’ve done some initial theorizing on this already:

propeciahelp.com/forum/viewtopic.php?t=1400

#12

Hello Mew,

thanks very much for your comments and links! And thanks for the very competent research you do for this forum!

My LH and FSH were measured before TRT. So they were surpressed although I didn’t supplement any T. Maybe because of my too high estradiol which was twice above normal range after quitting fin. I guess that this may have shut down my pituitary.

Thanks for the hints. I already wrote Dr. [CENSORED] (Hertoghes competent assistant who is treating me) an email regarding Dr. Crisler and HTPA restart. She answered me that they only use HCG so far to prevent fertility problems on TRT. So I will try to convince her to consult Dr. Crisler on my next appointment in Brussels on September, 23rd.

BTW: I haven’t read all your links and stickies so far but could you tell me typical doses of a restart protocol as Dr. Crisler would use (HCG and Tamoxifen).

OK, I will scan it in the next days and post it there.

Yes, my case might be an evidence for your theory about 3a-diol G and its significance for fin sufferers.

BTW, do you know any supplements or nutritions which could stimulate 5AR resp. 3A-HSD? I mean, the deiodases especially need selenium, so from my laical point of view there have to be minerals or amino acids which could stimulate these T enzymes. Or am I totally wrong?

Dr. [CENSORED] was very concerned about my low 3a-diol G and thinks that this is the main reason for my muscle weakness and sexual problems. She told me that this value is more meaningful than DHT itself. Interestingly, she prescribed me (besides cortisone and fludrocortisone) supraphysiolocial doses of T (200 mg per day). So, although she seemed not exactly to know the problems of finasteride, she may have given me one of the few promising treatments for us.

After slowly raising doses I’m now on 200 mg T since one week and I’m noticing my mucles getting significantly stronger and my stamina getting better (but still not “normal”). And I’m getting morining erections which I havn’t had for years. So I hope I’m on the right way. But I’ve learned that the body needs a lot of time to adapt to hormonal changes, so I’ll give it some time.

Yes I will. I already mentioned to her that fin may have damaged my male enzyme system durably. Interestingly she replied that they only would prescribe fin together with T to prevent side effects. Well, as I’ve read here that isn’t totally safe at all.

Best,
Oliver

#13

Oliver isnt quite the first person here to have had Adiol-G measured. If you follow this link you can read the thread of another guy who did, back in May 2008: propeciahelp.com/forum/viewt … ht=diol%2A.

His Adiol-G measurement is in a spreadsheet attached to the post dated 22 May 2008, and - like Oliver’s - it comes out low: something like 7 range 3 to 22.

Oliver: it’s extremely interesting that you are seeing improvement via supraphysiological doses of T.

You say you’re taking 200mg of T a day. Am I right in thinking that you’re applying 20grams of Testogel a day? As you know, standard dose of Testogel is between 5grams and 10grams. Remember, though, that only about 10% of the testosterone in Testogel is absorbed into the bloodstream, so a daily dose of 20grams means you’ll absorb 20mg of T. That’s 140mg of T every week, which is fairly high but not outrageously so. Steroid abusers use doses of 500mg per week and above.

Can you post bloodwork, to show what your T and free T was before you started Androgel, and what it is now?

I have a few questions for you, if that’s OK:

You say on your last blood test T and DHT were high-normal. Was that before starting Androgel, or after?

Are you feeling any estrogenic effects from Androgel: bloating, gynecomastia, etc? Have you been increasing Arimidex dose as you increased the T dose?

How long have you been on TRT? Commonly in post-finasteride men we see an initial positive response to TRT that fades after a few days/weeks, leaving only the estrogenic effects of TRT, and no anabolic or androgenic effects. But that doesn’t seem to be happening in your case.

Did your doctor prescribe the high T dose in an attempt to overcome poor use of DHT in target tissues, which is indicated by the low Adiol-G score?

Do you know if Hertoghe is treating any other post-finasteride cases? Has he had any success in the past with high dose TRT?

Please do keep us updated on your progress.

#14

Just FYI – I censored your doc’s assistant’s name for privacy reasons.

Before deciding to commence TRT, did you bring your E2 (estradiol) levels down (ie, low dose Arimidex)? If not, why not? Perhaps this would have made a major difference in your situation without having to resort to TRT.

Well, you can provide her the actual studies on clomid (and hCG) to help educate, such as:

download.journals.elsevierhealth … 045508.pdf

pubmedcentral.nih.gov/picren … obtype=pdf

nature.com/ijir/journal/v15/ … 00981a.pdf

propeciahelp.com/forum/viewtopic.php?t=971

jcem.endojournals.org/cgi/conten … 80/12/3546

www3.interscience.wiley.com/jour … 1&SRETRY=0

I do not know. Best to speak with Crisler, or visit his forum at musclechatroom.com and ask him there, or read his sticky posts there.

The user “Kermangd” (who took Saw Palmetto) tried Choline based on his own research regarding 5AR2 activity, which you can read about here:

propeciahelp.com/forum/viewt … ht=choline

Other drugs which could potentially have an affect on 5AR include Morphine:
propeciahelp.com/forum/viewtopic.php?t=984

… and Minocycline (antibiotic):
propeciahelp.com/forum/viewtopic.php?t=1271

Now, the thing is… none of this may have to do with 5AR2 – the problem could be with the enzyme 3a-hydroxysteroid dehydrogenase (3aHSD), which is responsible for converting 5AR2 reduced DHT (from Testosterone) to the final metabolite 3a-diol G.

So if 3aHSD is messed up, that’s a different problem considering it acts as a molecular switch for androgen action.

That seems somewhat high. On the other hand – has she considered DHT gel, and then re-measuring your 3a-diol G levels to assess 3aHSD enzyme function? If not, it may be an idea to consider.

Interestingly, Dr. Crisler has also mentioned it has taken supraphyisological doses of Testosterone in order to get a positive response in some post-Fin sufferers as noted here: propeciahelp.com/forum/viewtopic.php?p=14127

Again, if you are on TRT I hope they are monitoring more than just your T levels… ie, E2, TSH, SHBG, Prolactin etc.

#15

Oliver, if you are seeing results via TRT, I’d be extremely cautious about jumping ship and trying a re-start protocol instead.

As you appreciate, whatever this post-Propecia syndrome is, it is very hard to treat. This forum is full of guys who have tried Tamoxifen or Clomid restarts and seen no symptomatic improvement. I used Tamoxifen to boost my T from around 12nmol to 28 nmol (right at the top of the normal range) and felt no different. Typical dosage on a Tamox restart protocol might be: 20mg a week for four weeks, then cut to 20mg for two weeks, then 10mg for two weeks, then 5mg for two weeks, then stop. That’s pretty much what I did.

Now, given that you are using supraphysiological doses of T, you might try using Clomid or Tamoxifen to boost T to a supraphysiological level. But even then there is certainly no guarantee that this will produce the symptomatic improvement that you are experiencing now on TRT. Indeed, Dr Crisler often mentions how, in his experience, achieving a certain serum level of T via Tamox or Clomid simply does not produce the same symptomatic improvement as when that same serum level of T is achieved via TRT. He says that he doesn’t know why this is, but he’s seen it many times.

Hertoghe is an excellent TRT doctor, I’m sure he knows what he’s doing when it comes to monitoring hormonal changes that may result from TRT.

As you well know, this condition is debilitating, and can last for many years. We have guys here who have seen no symptomatic improvement across almost a decade. There’s good reason, then, to suspect that this condition is essentially life-long. You are now seeing improvement on TRT: do you really want to mess with that?

If I were you, I’d talk to Hertoghe about using low dose HCG to maintain fertility and testicular size, and stick with the TRT. See how you’re doing in another three months. You may well get your life back. A daily three minute application of Androgel for the rest of your life is surely a small price to pay for that.

#16

Hi!

I’m using 2 grams a day of a 10% liposomal T gel. Ironically, it seems to be less intensive than 1 % T gel on ethanol basis which I used up before (resulting in 75mg T a day). Thanks for the hint on the absorption. That might explain why I havn’t any significant side effects. Another explanation might be that we just need much more T if the converting enzymes are damaged.

Here is the first (and so far only) bloodwork and 24h urine of Herthoge (from May 2009, two years after quitting fin). By far the most comprehensive tests ever done:

img125.yfrog.com/img125/1385/hertogheblut1.jpg
img35.imageshack.us/img35/2848/hertogheblut2.jpg
img369.imageshack.us/img369/9724 … eblut3.jpg

img371.imageshack.us/img371/2050 … 4hurin.jpg

That was before TRT. To me it seems as if my testicles were producing enough T but the conversion to 3a-diol G doesn’t work. That might, as you considered, reduce the chances of success of a HPTA restart.

So far not. It’s the opposite: I lose fat around the waist and breast. I have not much side effects from the regimen so far, only slight permanent headache since I’m on full T and cortisone dosage. End of September I have my first blood control after TRT start. Then I maybe have to adjust Arimidex or hormones. I’m not happy about Arimidex since an enzyme inhibitor ruined some years of my life. But I have no choice but testing it.

I’m on TRT for around six weeks, but on the full dose of 200mg a day since two weeks. We’ll see if the positive effects fade away. Maybe we need such high (or even higher) doses to keep the effects. I guess we need to supplement more T than the body can reduce its own production.

Yes, indeed. He said that A-diol G is a better measure than DHT itself and my value shows a poor activity of androgens in tissue.

I don’t think so. Hertoghe prescribes (and uses!) Propecia himself, but only together with T. So I think he doesn’t know the awful bad experiences we have made. He told me that he knows from side effects if you don’t combine fin with T. Thats not totally logical, as we know. So it may be helpful if some other fin sufferers would consult him. He seems to be one of the few doctors in Europe who at least have the capability to understand our problems.

Of course I will. Great forum here …

@ScaredMale and Mew. I will answer your further questions later.

#17

Hi Oliver

Thanks for that info. What you are reporting is extremely interesting.

You’re the first person here to have acted on a finding of low Adiol-G.

Before TRT, your T tested mid-range, and free T and DHT both high. Nevertheless, Hertoghe put you on TRT in response to the fact the Adiol-G was very low. We’ve never seen this before.

Although you’re now on a custom made gel, I think I’m right in saying that your T dose amounts to 20mg of T a day? Two grams of the gel contains 200mg of T. Around 10% of that will get into your bloodstream = 20mg. The 10% absorption thing pretty much applies to any transdermal cream/gel, and is all part of the plan. There’s no way Hertoghe would have you on 200mg of T a day: that’s an insanely high dose. Injectable TRT is usually around 100mg of T a week.

Typically, we see good effects of TRT fade away in post-Propecia cases after a couple of weeks. You’ve already sustained improvement for six weeks, which is extremely encouraging.

It will be extremely interesting to see what T, free T, DHT, estrogen, and - crucially - Adiol-G look like at your next test.

If you keep feeling better, and Adiol-G is raised, then we have a pretty clear indication that poor production of DHT in target tissue is at least part of the post-fin problem. And we’ll also have an indication that this problem can be helped by high dose TRT.

It’s still a mystery, though, why most post-Propecia guys can’t tolerate TRT, and you are doing well on it. Usually these men start to feel strong
estrogenic effects from TRT, even when their estrogen is kept well within range: it is as though they are insensitive to the rise in androgens caused by TRT, and are left with only the rise in estrogens.

It may be, as Mew mentions above, that in fact you are not suffering from the full-blown post-Propecia syndrome, and that your only problem was high estrogen: it was almost three times over range just before you started TRT.

It may be that simply by now taking Arimidex, you have lowered E to a healthy level and are getting all your symptomatic improvement from that. The T you are now adding to your body may only be doing the job that your own T cd have done just as well, if you had lowered estrogen.

But who knows? Let’s see how you do, and see what the next round of blood tests reveals.

How is your libido?

#18

Hi Mew,

thanks for the further infos and links.

No, Hertoghe (I use his name instead of his assistant) prescribed me T and Arimidex (1/4 mg 5 times a week) together. I agree with you that an isolated treatment with Arimidex could have been worth trying. But I have to mention that I took Arimidex since the first day on (lower doses) T whereas significant results came later with the high doses of T. I think the combination amplifies resp. accelerates the treatment.

In general they seem to prescribe DHT cream because it is mentioned on their patients guide about T application. I asked me this question too, and have no reasonable answer. Maybe because T has a longer half life or - as a prohormone - can be stored better? I’ll ask them next time.

Yes, of course. I already have my new order form for the Belgian lab. And all these values will be measured plus FSH, DHEA, progesterone, oestrone, ft3, ft4, insuline and lipid values.

I want to tell you another observation which I noticed since many years: I’m responding very good to alcohol. When I drink 2-3 beers in the pub, my muscles and libido get significantly stronger, almost “normal”. And that is not the normal “exciting” effect of alcohol. The effect on libido even remains good until the next evening. I guess it has to do with hormones, neurohormones or receptor sensivity. Do you have an idea or do yo remember another user reporting such a phenomenon?

Best,
Oliver

#19

Hi Scared,

thanks for the hints on HPTA restart.

I tend to agree with you.

Yes, taking into acount the 10% absorption, you should be right. But I mean to have read that Dr. Crisler normally prescribes only 50mg T per day in form of gel. Would that mean that only 5mg per day get into the bloodstream? Or does he prescribe injections?

My libido is not perfect but much better than before TRT + Arimidex. My sexual desire was very low for years. But now I’m at least interested in beautiful girls and want a new relationship. That’s a major step forward for me. I hope it lasts …

Best,
Oliver

#20

Hi Oliver

Great news that your libido is improving.

Crisler says that he prefers T gel in the first instance when he tries TRT. He prescribes the standard dose, which is one 5gram sachet of Androgel per day, delivering - as you said - 5mg of T into the bloodstream per day. That doesn’t seem much, but apparently it is enough to take some people into the upper range for total T. Others work up to a 7.5gram or 10gram application per day. Your cream dose, delivering 20mg a day, is high: but perhaps that what we post-finasteride cases need.

Are you seeing other androgenic effects now that you’re on TRT? Oilier skin? More beard growth or body hair? Even a deeper voice?

How is your physical energy? Were you fatigued before? How is your memory and concentration?

I think you stopped finasteride two years ago? When you stopped, did you experience a brief (say two week) recovery period shortly after, and then come crashing back down again? That’s common for many of us.

Thanks.