Re: Heading to the docs (UK) this week and could use some advice please...

[Guest guest]

Hi Mark and Welcome,

I get so upset when I read a story like yours when I first got sick after an

Auto Accident after some testing they told me I am suffering from Major

Depression and because I was off work on sick leave I had to go along with

this.  I was put in every dam AD drug on the market never felt any better.

It's a dam long said story you can read it at this link.

http://forums.realthyroidhelp.com/viewtopic.php?f=5 & t=9239

After reading your labs I feel it's criminal that your Dr.'s in the UK did not

treat you.  You look to me to be Secondary meaning your Pituitary is not telling

your Testis to make Testosterone.  You need to have this checked out for a tumor

here in the USA they do an MRI.  This is range to be cancer and I have this

problem but it's from a head injury.

We have a few men here from the UK hope one will chime in here and help.  Most

men in the UK need to see a Privet Dr. to get help.  One you might have luck

with in finding a good one is this Dr. call him and ask him for a Dr. that can

test and treat you.

http://featherstone.bravehost.com/thyroid/peatfieldadrenal.html

If you go to the links and files section you will find a ton of info about

testing and treating this problem.  It's on the left side of the screen at the

home page.

Go to Dr. 's site and read TRT: A Recipe for Success in this are labs you

need and why.

www.allthingsmale.com

Here are a few links about this problem to get you started.

http://answers.google.com/answers/threadview?id=450553

http://www.griffinmedical.com/male_hormone_modulation_therapy.html

Most of the problems we feel like brain fog and anxiety low of libido are high

levels of Estradiol you need this tested you should be at about 74 pmol/L for

the best level.

http://www.lef.org/magazine/mag2008/nov2008_Dangers-of-Excess-Estrogen-in-the-Ag\

ing-Male_01.htm

You just don't get Hypogonadism from depression and anxiety your levels can go

down a little but not as low as you are. It's the low Testosterone and make us

feel depression and anxiety.

Here is a link to a forum in the UK that might be of some help.

http://www.andropause.org.uk/newforum/forum_frameset.htm

Co-Moderator

Phil

> From: blackers1100 <blackers1100@...>

> Subject: Heading to the docs (UK) this week and could use some

advice please...

>

> Date: Tuesday, September 21, 2010, 8:48 AM

> Hi all,

>

> I would appreciate some help and advice please as I plan on

> going back to my GP with a list of symptoms and as much

> information as possible to get new tests done and try to get

> a referral to an endo.

>

> I suspected I might have low test problems based on near

> non-existant libido, fat retention and an inability to gain

> muscle for most of my post teen years (I'm 36). Also I've

> had anxiety problems for 10 years now. I should also mention

> that I've been on ADs (Prozac or Effexor) for 8 years. 6

> months ago I stopped taking them.

>

> I had some tests done 2 years ago:

> 12/6/08:-

> Serum Test 6.5nmol/L (8-27)

> Serum TSH 1.6mu/L (0.3-5.5)

>

> 30/6/08:-

> Serum cholesterol 4.2mmol/L (this was 5.9 a few years

> prior)

> Serum cortisol 461nmol/L (140-690)

> Serum LH 1.0u/L (1.5-18.1)

> Serum FSH 3.5u/L (1.4-18.1)

>

> 22/7/08:-

> Serum LH 1.3u/L (1.5-18.1)

> Serum Test 8.1nmol/L (8-27)

> Serum FSH 4.2u/L (1.4-18.1)

>

> From this I was told 'There was nothing there that could be

> causing or contributing to my anxiety. The low readings were

> probably caused by my anxiety/depression. The

> anxiety/depression should be treated as primary.

>

> My symptoms are (Not in any particular order):

> Anxiety - my flight or fight response seems to be on a hair

> trigger. Things that used to only make me nervous/alert now

> seem to cause a cascade of adrenaline resulting in

> heightened anxiety/shaking etc (Not panic tho). I can't seem

> to rationalise my fear. It is disproportionate to the

> situation.

> Emotional - I seem extremely over sensative, I fill up

> watching TV programs for eg.

> Irritable/arguementative - minor irritations often cause an

> excessive amount of anger/frustration and usually an

> outburst.

> Brain fog - Most days I can't hold a conversation. By the

> time I've thought of something to say the moment has passed.

> I also go into 'standby' during meetings/presentations etc.

> Poor focus/concentration - I'm always drifting.

> Very slow mental & physical reaction times and

> clumsyness.

> Fat retention - in spite of 8hrs of exercise per week I

> can't shift fat but lose muscle.

> I have alot of body hair though!?

> Poor libido - no interest in sex. I don't have ED although

> it is not as firm as it used to be.

>

> There may be more symptoms but can't think due to brain

> fog!

>

> What tests should I ask for?

> Is Serum test the same as total test?

> Are there any sources which give age specific reference

> ranges?

>

> Thanks in advance for your help.

> Mark.

>

>

>

> ------------------------------------

>

>

[Guest guest]

" blackers1100 " <blackers1100@...> wrote:

My guesses as to what's happening below:

> Anxiety - my flight or fight response seems to be on a hair trigger. Things

that used to only make me nervous/alert now seem to cause a cascade of

adrenaline resulting in heightened anxiety/shaking etc (Not panic tho). I can't

seem to rationalise my fear. It is disproportionate to the situation.

Low cortisol; adrenaline is secreted when cortisol isn't available

> Emotional - I seem extremely over sensative, I fill up watching TV programs

for eg.

Either high estrogen or low cortisol

> Irritable/arguementative - minor irritations often cause an excessive amount

of anger/frustration and usually an outburst.

Low thyroid/low cortisol

> Brain fog - Most days I can't hold a conversation. By the time I've thought of

something to say the moment has passed. I also go into 'standby' during

meetings/presentations etc.

Low thyroid

]

> Poor focus/concentration - I'm always drifting.

Low thyroid

> Very slow mental & physical reaction times and clumsyness.

Low thyroid

> Fat retention - in spite of 8hrs of exercise per week I can't shift fat but

lose muscle.

Low thyroid, low testosterone, possibly high rT3

> I have alot of body hair though!?

I thought this was high testosterone, but that doesn't make sense, unless it's

genetic

> Poor libido - no interest in sex. I don't have ED although it is not as firm

as it used to be.

Low dopamine, possibly caused by the high adrenaline

> What tests should I ask for?

Thyroid: Free T3, Free T4, Total T4, TSH, reverse T3,

Hormones: total testosterone, estradiol, morning cortisol

Other: full iron panel, ferritin, B12, Vit D

Barb

[Guest guest]

Hi Barb,

Good response - I always learn from your posts!

Two comments:

.. Body hair - some body hair growth is genetic, but most of it is

caused by testosterone. Testosterone causes hair to start growing, but

doesn't necessarily have to be present in large amounts for hair to keep

growing. This is why old guys who have low testosterone can still grow a

beard. This is also why women have to be careful where they put

testosterone creams. Also, insulin resistance can cause hair growth

(hirsutism) in women, so I would assume this could be the same in men (but I

don't know for sure). High Estradiols (E2) would cause insulin resistance,

bigger stomach, poor libido, depression, anxiety, etc.

.. Poor libido - I would add that high E2 can cause this, too. High

E2 can also cause erections to be not as firm.

From: [mailto: ]

On Behalf Of Barb

Sent: Tuesday, September 21, 2010 10:48 AM

Subject: Re: Heading to the docs (UK) this week and could use

some advice please...

> I have alot of body hair though!?

I thought this was high testosterone, but that doesn't make sense, unless

it's genetic

> Poor libido - no interest in sex. I don't have ED although it is not as

firm as it used to be.

Low dopamine, possibly caused by the high adrenaline

[Guest guest]

Good additions !

The excess body hair doesn't make sense if it's high testosterone, because I

thought he tested low in that. PCOS in women is also caused by high

testosterone.

And yes, his estrogen may be affecting his libido, but he described multiple

symptoms of too much adrenaline. A direct quote from Dr. no says it all:

" if a freight train was coming at you, you would hardly have libido nor an

erection "

Barb

>

> Hi Barb,

>

>

>

> Good response - I always learn from your posts!

>

>

>

> Two comments:

>

>

>

> . Body hair - some body hair growth is genetic, but most of it is

> caused by testosterone. Testosterone causes hair to start growing, but

> doesn't necessarily have to be present in large amounts for hair to keep

> growing. This is why old guys who have low testosterone can still grow a

> beard. This is also why women have to be careful where they put

> testosterone creams. Also, insulin resistance can cause hair growth

> (hirsutism) in women, so I would assume this could be the same in men (but I

> don't know for sure). High Estradiols (E2) would cause insulin resistance,

> bigger stomach, poor libido, depression, anxiety, etc.

>

> . Poor libido - I would add that high E2 can cause this, too. High

> E2 can also cause erections to be not as firm.

>

>

>

>

>

>

>

> From: [mailto: ]

> On Behalf Of Barb

> Sent: Tuesday, September 21, 2010 10:48 AM

>

> Subject: Re: Heading to the docs (UK) this week and could use

> some advice please...

>

> > I have alot of body hair though!?

>

> I thought this was high testosterone, but that doesn't make sense, unless

> it's genetic

>

> > Poor libido - no interest in sex. I don't have ED although it is not as

> firm as it used to be.

>

> Low dopamine, possibly caused by the high adrenaline

>

>

>

>

>

>

>

[Guest guest]

Sorry! I realized that I wasn't really clear right after I sent the last

message. What I meant to say is that it only takes high testosterone at one

time in the past. Maybe during puberty, his testosterone was high and that

caused most of the hair to start growing. Now, even with low T, the hair

will continue to grow.

I hadn't seen that quote, but I like it! J

I am not very familiar with adrenaline issues. Just wondering, how does

low/high adrenaline affect estradiols? I remember Phil talking about taking

some additional Cortisol at night to prevent excess estrogen production, but

how does it work?

From: [mailto: ]

On Behalf Of Barb

Sent: Tuesday, September 21, 2010 11:40 AM

Subject: Re: Heading to the docs (UK) this week and could use

some advice please...

Good additions !

The excess body hair doesn't make sense if it's high testosterone, because I

thought he tested low in that. PCOS in women is also caused by high

testosterone.

And yes, his estrogen may be affecting his libido, but he described multiple

symptoms of too much adrenaline. A direct quote from Dr. no says it

all: " if a freight train was coming at you, you would hardly have libido nor

an erection "

Barb

>

> Hi Barb,

>

>

>

> Good response - I always learn from your posts!

>

>

>

> Two comments:

>

>

>

> . Body hair - some body hair growth is genetic, but most of it is

> caused by testosterone. Testosterone causes hair to start growing, but

> doesn't necessarily have to be present in large amounts for hair to keep

> growing. This is why old guys who have low testosterone can still grow a

> beard. This is also why women have to be careful where they put

> testosterone creams. Also, insulin resistance can cause hair growth

> (hirsutism) in women, so I would assume this could be the same in men (but

I

> don't know for sure). High Estradiols (E2) would cause insulin resistance,

> bigger stomach, poor libido, depression, anxiety, etc.

>

> . Poor libido - I would add that high E2 can cause this, too. High

> E2 can also cause erections to be not as firm.

>

>

>

>

>

>

>

> From:

<mailto: %40>

[mailto:

<mailto: %40> ]

> On Behalf Of Barb

> Sent: Tuesday, September 21, 2010 10:48 AM

> <mailto: %40>

> Subject: Re: Heading to the docs (UK) this week and could

use

> some advice please...

>

> > I have alot of body hair though!?

>

> I thought this was high testosterone, but that doesn't make sense, unless

> it's genetic

>

> > Poor libido - no interest in sex. I don't have ED although it is not as

> firm as it used to be.

>

> Low dopamine, possibly caused by the high adrenaline

>

>

>

>

>

>

>

[Guest guest]

Here is a copy of a reply to a post I made at Dr. 's forum the mod there

chilln has the same problems I have he told me this.

From this link.

http://www.musclechatroom.com/forum/showthread.php?t=14851

====================================================

Re: Estradiol how much do you need a week.

--------------------------------------------------------------------------------

Quote:

Originally Posted by pmgamer18

For me Estradiol is becoming a big problem last Nov. my dose of Arimidex to keep

my Estradiol levels down was .25 mgs every 2 to 3 days.

Now I need .5 to .75mgs everyday at the time we added in HGH but from what I

know about it it does not cause high Estraidol problems.

We have lowered my dose of HCG from 400 IU's the 2 days each in between my Test

C shots every 3 days to just 250 IU's the day before my next Test C shot.

And about 4 months ago we lower my Test C shot from 80mgs every 3 days to 70

mgs. My last set of labs my levels fell from the upper 800's down to the low

500's. So six weeks ago I was told to go back up to 80 mgs of Test C every 3

days.

Now I have problems still needing a lot Arimidex to keep Estradiol levels down

and feeling bad from low T levels.

I see my Dr. next week Tue and hope my labs look better if not I am thinking

about stopping HCG to see if this is why my Estadiol is so high.

If I don't take this higher dose I get Panic feelings that rune my day.

So how much do you need to keep your Estradiol in check.

---------------------------------------------------

chilln says this.

==================================================

I finally understand why this is so.

Your body is dumping T into E2 because your cortisol metabolism is still too

low, both by day, and overnight while you're sleeping.

What should be happening is that your cortisol metabolism should be higher, and

then it would be downregulating your T metabolism (as is always the case with

higher cortisol levels).

This would then allow your body to tolerate higher levels of serum total T,

without trying to dump the excess T into E2.

Sorry I overlooked this connection earlier. It was because I've been

concentrating on responding to newby posts, thinking that the more established

members were already stable and just generally chatting about stuff other than

hormones.

..

__________________

Warning:

A) Slow excreters have pooly functioning livers. They must monitor hormone

levels very carefully, to ensure their dosages are low enough to prevent

accumulation of hormones to the point where levels become excessive, or even

toxic, after several days or weeks of supplementation.

Fast excreters have excessive liver enzyme activity. These people require

relatively high and frequent doses of hormones, and the cost of hormone

supplementation, for these people, is relatively high.

----------------------------------------------------

and later this.

====================================================

When you need this much arimidex, you're generating a lot of E2, in which case

some of that is being generated at night, and needs suppression.

Ie: if you're injecting T, then that T is leeching from your muscle at night.

That T needs suppression too. Cortisol is needed to suppress that. If your

pituitary isn't triggering enough ACTH at night, then your night time T will

convert into E2 if your body detects your T metabolism is too high.

I'm not guaranteeing that you need HC at night, but I am saying that it's a

highly likely possibility, based on your symptoms.

Co-Moderator

Phil

> From: <hostmaster@...>

> Subject: RE: Re: Heading to the docs (UK) this week and could

use some advice please...

>

> Date: Tuesday, September 21, 2010, 1:07 PM

> Sorry!  I realized that I wasn't

> really clear right after I sent the last

> message.  What I meant to say is that it only takes

> high testosterone at one

> time in the past.  Maybe during puberty, his

> testosterone was high and that

> caused most of the hair to start growing.  Now, even

> with low T, the hair

> will continue to grow.

>

>

>

> I hadn't seen that quote, but I like it!  J

>

>

>

> I am not very familiar with adrenaline issues.  Just

> wondering, how does

> low/high adrenaline affect estradiols?  I remember

> Phil talking about taking

> some additional Cortisol at night to prevent excess

> estrogen production, but

> how does it work?

>

>

>

>

>

>

>

> From:

> [mailto: ]

> On Behalf Of Barb

> Sent: Tuesday, September 21, 2010 11:40 AM

>

> Subject: Re: Heading to the docs (UK) this

> week and could use

> some advice please...

>

>

>

>  

>

> Good additions !

>

> The excess body hair doesn't make sense if it's high

> testosterone, because I

> thought he tested low in that. PCOS in women is also caused

> by high

> testosterone.

>

> And yes, his estrogen may be affecting his libido, but he

> described multiple

> symptoms of too much adrenaline. A direct quote from Dr.

> no says it

> all: " if a freight train was coming at you, you would

> hardly have libido nor

> an erection "

>

> Barb

>

>

> >

> > Hi Barb,

> >

> >

> >

> > Good response - I always learn from your posts!

> >

> >

> >

> > Two comments:

> >

> >

> >

> > . Body hair - some body hair growth is genetic, but

> most of it is

> > caused by testosterone. Testosterone causes hair to

> start growing, but

> > doesn't necessarily have to be present in large

> amounts for hair to keep

> > growing. This is why old guys who have low

> testosterone can still grow a

> > beard. This is also why women have to be careful where

> they put

> > testosterone creams. Also, insulin resistance can

> cause hair growth

> > (hirsutism) in women, so I would assume this could be

> the same in men (but

> I

> > don't know for sure). High Estradiols (E2) would cause

> insulin resistance,

> > bigger stomach, poor libido, depression, anxiety,

> etc.

> >

> > . Poor libido - I would add that high E2 can cause

> this, too. High

> > E2 can also cause erections to be not as firm.

> >

> >

> >

> >

> >

> >

> >

> > From:

> <mailto: %40>

> [mailto:

> <mailto: %40> ]

> > On Behalf Of Barb

> > Sent: Tuesday, September 21, 2010 10:48 AM

> >

> <mailto: %40>

>

> > Subject: Re: Heading to the docs (UK)

> this week and could

> use

> > some advice please...

> >

> > > I have alot of body hair though!?

> >

> > I thought this was high testosterone, but that doesn't

> make sense, unless

> > it's genetic

> >

> > > Poor libido - no interest in sex. I don't have ED

> although it is not as

> > firm as it used to be.

> >

> > Low dopamine, possibly caused by the high adrenaline

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

With hormones, there are multiple pathways.

Low thyroid can lead to low cortisol.

Low cortisol causes high estrogen.

Low cortisol causes high adrenaline.

So you can have high estrogen and high adrenaline for the same reason, low

cortisol.

Barb

" " <hostmaster@...> wrote:

> I am not very familiar with adrenaline issues. Just wondering, how does

> low/high adrenaline affect estradiols? I remember Phil talking about taking

> some additional Cortisol at night to prevent excess estrogen production, but

> how does it work?

[Guest guest]

Thanks so much Phil for taking the time out to reply, really appreciate it.

Already I feel like I am right to pursue this in spite of what the doctors say.

I just have to build my own case and educate myself enough to stand my ground.

I have a very simpathetic GP who has helped alot in the past before I found out

about my hormone levels. Unfortunately hormones aren't her 'special interest'

(mental health is). She took advice from another GP there who supposedly 'knows'

about hormones.

So basically I face an uphill struggle. Hopefully my GP will agree to all the

tests I ask for as a starting point.

>

> > From: blackers1100 <blackers1100@...>

> > Subject: Heading to the docs (UK) this week and could use

some advice please...

> >

> > Date: Tuesday, September 21, 2010, 8:48 AM

> > Hi all,

> >

> > I would appreciate some help and advice please as I plan on

> > going back to my GP with a list of symptoms and as much

> > information as possible to get new tests done and try to get

> > a referral to an endo.

> >

> > I suspected I might have low test problems based on near

> > non-existant libido, fat retention and an inability to gain

> > muscle for most of my post teen years (I'm 36). Also I've

> > had anxiety problems for 10 years now. I should also mention

> > that I've been on ADs (Prozac or Effexor) for 8 years. 6

> > months ago I stopped taking them.

> >

> > I had some tests done 2 years ago:

> > 12/6/08:-

> > Serum Test 6.5nmol/L (8-27)

> > Serum TSH 1.6mu/L (0.3-5.5)

> >

> > 30/6/08:-

> > Serum cholesterol 4.2mmol/L (this was 5.9 a few years

> > prior)

> > Serum cortisol 461nmol/L (140-690)

> > Serum LH 1.0u/L (1.5-18.1)

> > Serum FSH 3.5u/L (1.4-18.1)

> >

> > 22/7/08:-

> > Serum LH 1.3u/L (1.5-18.1)

> > Serum Test 8.1nmol/L (8-27)

> > Serum FSH 4.2u/L (1.4-18.1)

> >

> > From this I was told 'There was nothing there that could be

> > causing or contributing to my anxiety. The low readings were

> > probably caused by my anxiety/depression. The

> > anxiety/depression should be treated as primary.

> >

> > My symptoms are (Not in any particular order):

> > Anxiety - my flight or fight response seems to be on a hair

> > trigger. Things that used to only make me nervous/alert now

> > seem to cause a cascade of adrenaline resulting in

> > heightened anxiety/shaking etc (Not panic tho). I can't seem

> > to rationalise my fear. It is disproportionate to the

> > situation.

> > Emotional - I seem extremely over sensative, I fill up

> > watching TV programs for eg.

> > Irritable/arguementative - minor irritations often cause an

> > excessive amount of anger/frustration and usually an

> > outburst.

> > Brain fog - Most days I can't hold a conversation. By the

> > time I've thought of something to say the moment has passed.

> > I also go into 'standby' during meetings/presentations etc.

> > Poor focus/concentration - I'm always drifting.

> > Very slow mental & physical reaction times and

> > clumsyness.

> > Fat retention - in spite of 8hrs of exercise per week I

> > can't shift fat but lose muscle.

> > I have alot of body hair though!?

> > Poor libido - no interest in sex. I don't have ED although

> > it is not as firm as it used to be.

> >

> > There may be more symptoms but can't think due to brain

> > fog!

> >

> > What tests should I ask for?

> > Is Serum test the same as total test?

> > Are there any sources which give age specific reference

> > ranges?

> >

> > Thanks in advance for your help.

> > Mark.

> >

> >

> >

> > ------------------------------------

> >

> >

[Guest guest]

There is a Dr. here in the USA Dr. if your GP is willing he will order

tests and work with her to treat you over the phone. He is one of the best male

hormone Dr.'s there is.

www.allthingsmale.com

and this is a link to his forum.

http://www.musclechatroom.com/forum/forumdisplay.php?f=2

Co-Moderator

Phil

> From: blackers1100 <blackers1100@...>

> Subject: Re: Heading to the docs (UK) this week and could use

some advice please...

>

> Date: Tuesday, September 21, 2010, 4:07 PM

> Thanks so much Phil for taking the

> time out to reply, really appreciate it. Already I feel like

> I am right to pursue this in spite of what the doctors say.

> I just have to build my own case and educate myself enough

> to stand my ground.

>

> I have a very simpathetic GP who has helped alot in the

> past before I found out about my hormone levels.

> Unfortunately hormones aren't her 'special interest' (mental

> health is). She took advice from another GP there who

> supposedly 'knows' about hormones.

>

> So basically I face an uphill struggle. Hopefully my GP

> will agree to all the tests I ask for as a starting point.

>

>

>

>

> >

> > > From: blackers1100 <blackers1100@...>

> > > Subject: Heading to the docs (UK)

> this week and could use some advice please...

> > >

> > > Date: Tuesday, September 21, 2010, 8:48 AM

> > > Hi all,

> > >

> > > I would appreciate some help and advice please as

> I plan on

> > > going back to my GP with a list of symptoms and

> as much

> > > information as possible to get new tests done and

> try to get

> > > a referral to an endo.

> > >

> > > I suspected I might have low test problems based

> on near

> > > non-existant libido, fat retention and an

> inability to gain

> > > muscle for most of my post teen years (I'm 36).

> Also I've

> > > had anxiety problems for 10 years now. I should

> also mention

> > > that I've been on ADs (Prozac or Effexor) for 8

> years. 6

> > > months ago I stopped taking them.

> > >

> > > I had some tests done 2 years ago:

> > > 12/6/08:-

> > > Serum Test 6.5nmol/L (8-27)

> > > Serum TSH 1.6mu/L (0.3-5.5)

> > >

> > > 30/6/08:-

> > > Serum cholesterol 4.2mmol/L (this was 5.9 a few

> years

> > > prior)

> > > Serum cortisol 461nmol/L (140-690)

> > > Serum LH 1.0u/L (1.5-18.1)

> > > Serum FSH 3.5u/L (1.4-18.1)

> > >

> > > 22/7/08:-

> > > Serum LH 1.3u/L (1.5-18.1)

> > > Serum Test 8.1nmol/L (8-27)

> > > Serum FSH 4.2u/L (1.4-18.1)

> > >

> > > From this I was told 'There was nothing there

> that could be

> > > causing or contributing to my anxiety. The low

> readings were

> > > probably caused by my anxiety/depression. The

> > > anxiety/depression should be treated as primary.

> > >

> > > My symptoms are (Not in any particular order):

> > > Anxiety - my flight or fight response seems to be

> on a hair

> > > trigger. Things that used to only make me

> nervous/alert now

> > > seem to cause a cascade of adrenaline resulting

> in

> > > heightened anxiety/shaking etc (Not panic tho). I

> can't seem

> > > to rationalise my fear. It is disproportionate to

> the

> > > situation.

> > > Emotional - I seem extremely over sensative, I

> fill up

> > > watching TV programs for eg.

> > > Irritable/arguementative - minor irritations

> often cause an

> > > excessive amount of anger/frustration and usually

> an

> > > outburst.

> > > Brain fog - Most days I can't hold a

> conversation. By the

> > > time I've thought of something to say the moment

> has passed.

> > > I also go into 'standby' during

> meetings/presentations etc.

> > > Poor focus/concentration - I'm always drifting.

> > > Very slow mental & physical reaction times

> and

> > > clumsyness.

> > > Fat retention - in spite of 8hrs of exercise per

> week I

> > > can't shift fat but lose muscle.

> > > I have alot of body hair though!?

> > > Poor libido - no interest in sex. I don't have ED

> although

> > > it is not as firm as it used to be.

> > >

> > > There may be more symptoms but can't think due to

> brain

> > > fog!

> > >

> > > What tests should I ask for?

> > > Is Serum test the same as total test?

> > > Are there any sources which give age specific

> reference

> > > ranges?

> > >

> > > Thanks in advance for your help.

> > > Mark.

> > >

> > >

> > >

> > > ------------------------------------

> > >

> > >

[Guest guest]

Thanks everyone for your replys.

It all seems so complicated. I can see it's going to take a long time to sort

all this out, especially with the NHS. I have an 8mth old baby so going private

is not an option for me, not if it's going to be a lifetime of medication and

test fees.

It's hard not to get down about it. One step at a time though, first do some

reading and get some fresh tests done.

>

> > I am not very familiar with adrenaline issues. Just wondering, how does

> > low/high adrenaline affect estradiols? I remember Phil talking about taking

> > some additional Cortisol at night to prevent excess estrogen production, but

> > how does it work?

>

[Guest guest]

Thanks to both Phil and Barb for their responses!

From: [mailto: ]

On Behalf Of philip georgian

Sent: Tuesday, September 21, 2010 12:29 PM

Subject: RE: Re: Heading to the docs (UK) this week and could

use some advice please...

Here is a copy of a reply to a post I made at Dr. 's forum the mod there

chilln has the same problems I have he told me this.

From this link.

http://www.musclechatroom.com/forum/showthread.php?t=14851

====================================================

Re: Estradiol how much do you need a week.

----------------------------------------------------------

Quote:

Originally Posted by pmgamer18

For me Estradiol is becoming a big problem last Nov. my dose of Arimidex to

keep my Estradiol levels down was .25 mgs every 2 to 3 days.

Now I need .5 to .75mgs everyday at the time we added in HGH but from what I

know about it it does not cause high Estraidol problems.

We have lowered my dose of HCG from 400 IU's the 2 days each in between my

Test C shots every 3 days to just 250 IU's the day before my next Test C

shot.

And about 4 months ago we lower my Test C shot from 80mgs every 3 days to 70

mgs. My last set of labs my levels fell from the upper 800's down to the low

500's. So six weeks ago I was told to go back up to 80 mgs of Test C every 3

days.

Now I have problems still needing a lot Arimidex to keep Estradiol levels

down and feeling bad from low T levels.

I see my Dr. next week Tue and hope my labs look better if not I am thinking

about stopping HCG to see if this is why my Estadiol is so high.

If I don't take this higher dose I get Panic feelings that rune my day.

So how much do you need to keep your Estradiol in check.

---------------------------------------------------

chilln says this.

==================================================

I finally understand why this is so.

Your body is dumping T into E2 because your cortisol metabolism is still too

low, both by day, and overnight while you're sleeping.

What should be happening is that your cortisol metabolism should be higher,

and then it would be downregulating your T metabolism (as is always the case

with higher cortisol levels).

This would then allow your body to tolerate higher levels of serum total T,

without trying to dump the excess T into E2.

Sorry I overlooked this connection earlier. It was because I've been

concentrating on responding to newby posts, thinking that the more

established members were already stable and just generally chatting about

stuff other than hormones.

..

__________________

Warning:

A) Slow excreters have pooly functioning livers. They must monitor hormone

levels very carefully, to ensure their dosages are low enough to prevent

accumulation of hormones to the point where levels become excessive, or even

toxic, after several days or weeks of supplementation.

Fast excreters have excessive liver enzyme activity. These people require

relatively high and frequent doses of hormones, and the cost of hormone

supplementation, for these people, is relatively high.

----------------------------------------------------

and later this.

====================================================

When you need this much arimidex, you're generating a lot of E2, in which

case some of that is being generated at night, and needs suppression.

Ie: if you're injecting T, then that T is leeching from your muscle at

night. That T needs suppression too. Cortisol is needed to suppress that. If

your pituitary isn't triggering enough ACTH at night, then your night time T

will convert into E2 if your body detects your T metabolism is too high.

I'm not guaranteeing that you need HC at night, but I am saying that it's a

highly likely possibility, based on your symptoms.

Co-Moderator

Phil

> From: <hostmaster@... <mailto:hostmaster%40jancik.com> >

> Subject: RE: Re: Heading to the docs (UK) this week and

could use some advice please...

> <mailto: %40>

> Date: Tuesday, September 21, 2010, 1:07 PM

> Sorry! I realized that I wasn't

> really clear right after I sent the last

> message. What I meant to say is that it only takes

> high testosterone at one

> time in the past. Maybe during puberty, his

> testosterone was high and that

> caused most of the hair to start growing. Now, even

> with low T, the hair

> will continue to grow.

>

>

>

> I hadn't seen that quote, but I like it! J

>

>

>

> I am not very familiar with adrenaline issues. Just

> wondering, how does

> low/high adrenaline affect estradiols? I remember

> Phil talking about taking

> some additional Cortisol at night to prevent excess

> estrogen production, but

> how does it work?

>

>

>

>

>

>

>

> From:

<mailto: %40>

> [mailto:

<mailto: %40> ]

> On Behalf Of Barb

> Sent: Tuesday, September 21, 2010 11:40 AM

> <mailto: %40>

> Subject: Re: Heading to the docs (UK) this

> week and could use

> some advice please...

>

>

>

>

>

> Good additions !

>

> The excess body hair doesn't make sense if it's high

> testosterone, because I

> thought he tested low in that. PCOS in women is also caused

> by high

> testosterone.

>

> And yes, his estrogen may be affecting his libido, but he

> described multiple

> symptoms of too much adrenaline. A direct quote from Dr.

> no says it

> all: " if a freight train was coming at you, you would

> hardly have libido nor

> an erection "

>

> Barb

>

>

> >

> > Hi Barb,

> >

> >

> >

> > Good response - I always learn from your posts!

> >

> >

> >

> > Two comments:

> >

> >

> >

> > . Body hair - some body hair growth is genetic, but

> most of it is

> > caused by testosterone. Testosterone causes hair to

> start growing, but

> > doesn't necessarily have to be present in large

> amounts for hair to keep

> > growing. This is why old guys who have low

> testosterone can still grow a

> > beard. This is also why women have to be careful where

> they put

> > testosterone creams. Also, insulin resistance can

> cause hair growth

> > (hirsutism) in women, so I would assume this could be

> the same in men (but

> I

> > don't know for sure). High Estradiols (E2) would cause

> insulin resistance,

> > bigger stomach, poor libido, depression, anxiety,

> etc.

> >

> > . Poor libido - I would add that high E2 can cause

> this, too. High

> > E2 can also cause erections to be not as firm.

> >

> >

> >

> >

> >

> >

> >

> > From:

<mailto: %40>

> <mailto: %40>

> [mailto:

<mailto: %40>

> <mailto: %40> ]

> > On Behalf Of Barb

> > Sent: Tuesday, September 21, 2010 10:48 AM

> >

<mailto: %40>

> <mailto: %40>

>

> > Subject: Re: Heading to the docs (UK)

> this week and could

> use

> > some advice please...

> >

> > > I have alot of body hair though!?

> >

> > I thought this was high testosterone, but that doesn't

> make sense, unless

> > it's genetic

> >

> > > Poor libido - no interest in sex. I don't have ED

> although it is not as

> > firm as it used to be.

> >

> > Low dopamine, possibly caused by the high adrenaline

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

There is a guy in the UK Nick O'Hara if you need help with this he is at

this web site.

http://www.androids.org.uk/

Co-Moderator

Phil

> From: blackers1100 <blackers1100@...>

> Subject: Re: Heading to the docs (UK) this week and could use

some advice please...

>

> Date: Wednesday, September 22, 2010, 2:00 AM

> Thanks everyone for your replys.

>

> It all seems so complicated. I can see it's going to take a

> long time to sort all this out, especially with the NHS. I

> have an 8mth old baby so going private is not an option for

> me, not if it's going to be a lifetime of medication and

> test fees.

>

> It's hard not to get down about it. One step at a time

> though, first do some reading and get some fresh tests

> done.

>

>

> >

> > > I am not very familiar with adrenaline

> issues.  Just wondering, how does

> > > low/high adrenaline affect estradiols?  I

> remember Phil talking about taking

> > > some additional Cortisol at night to prevent

> excess estrogen production, but

> > > how does it work?

> >

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

I've just come back from an appointment with my GP. Mixed results really. I

showed her a list of my symptoms (It was easier to spend some time writing it

out properly beforehand rather than risk missing something or describing

something badly while `under the spotlight'), the AMS questionnaire filled in

and also referred her to my previous test results she had up on the monitor.

Her initial reaction was `these are all symptoms of depression'. I did well to

remain calm as I know I'm not depressed but every time I see her she tries to

convince me it's depression! I agreed that there was an overlap of symptoms but

I was sure that I wasn't depressed. Reading between the lines I think she thinks

I'm depressed and that I'm desperately trying to find something that it could be

other than depression, if that makes sense.

She said `your testosterone was normal in that test'. I could have talked about

`normal' test results but simply said One result of 6.5 and one of 8.1 is not

normal.

After agreeing to the tests listed below she asked what I wanted to do when the

tests ruled out Hypogonadism! She suggested referring me to the local hospital

which run a psychosexual clinic!

I have to go back on 12th October to have the blood drawn for the following

labs;

Serum Testosterone

SHBG (She didn't think the lab would know about measuring free testosterone)

Estrodiol (I asked her to note on the request that is was for a male but she

wasn't sure they would have a sensitive test for this)

LH

FSH

TSH

Cortisol

Prolactin

In hindsight I could have pushed for her to check what the lab could test for

but over here you only get 10minutes and I was conscious I had already got more

than I expected to get!

I walked out with the lab test request slip to make an appointment at reception

and she had forgotten to write on the slip the appointment had to be early

morning! So I got 11.40am. I know this will work in my favour for testosterone

but not sure about the others.

My task now is to prepare for when I get my results. It will probably take a

couple of weeks after the 12th. I think I need to be prepared to argue my case

for referral if I get low normal testosterone and low normal LH like I had

before. I also need to have documentation of good source to support my referral

request. I mentioned I was a member of this forum to which she replied that the

internet has a broad range of information.

What do I do if I get the same response as last time? `It's psychological'. I

need some documentation to support that my symptoms, plus possibly borderline

test results warrant treatment. Can you guys here help with that please?

[Guest guest]

Being that your in the UK it will be hard Dr.'s will tell men in the bottom of

the normal range they are OK. I feel if your below 450 ng/dl in USA units your

to low. And any good Dr. would go by how you feel. Today most Dr.'s in the USA

will test Sex Hormone levels when some man looks to be depressed first and treat

this first.

Back in the day Dr.'s here did what your Dr. is trying to do treat you for

Depression. The first 5 yrs I was sick this happened to me. I feel like I lost

5 yrs of my life on all them dam AD drugs that if your have low T will only make

you feel worse.

This best thing I could give you that she might listen to is this link to the

AACE Guildelines.

And this is old dated.

http://www.aace.com/pub/pdf/guidelines/hypogonadism.pdf

I attach a file Testosterone levels by age this might help.

Co-Moderator

Phil

> From: blackers1100 <blackers1100@...>

> Subject: Re: Heading to the docs (UK) this week and could use

some advice please...

>

> Date: Monday, October 4, 2010, 1:47 PM

> I've just come back from an

> appointment with my GP. Mixed results really. I showed her a

> list of my symptoms (It was easier to spend some time

> writing it out properly beforehand rather than risk missing

> something or describing something badly while `under the

> spotlight'), the AMS questionnaire filled in and also

> referred her to my previous test results she had up on the

> monitor.

>

> Her initial reaction was `these are all symptoms of

> depression'. I did well to remain calm as I know I'm not

> depressed but every time I see her she tries to convince me

> it's depression! I agreed that there was an overlap of

> symptoms but I was sure that I wasn't depressed. Reading

> between the lines I think she thinks I'm depressed and that

> I'm desperately trying to find something that it could be

> other than depression, if that makes sense.

>

> She said `your testosterone was normal in that test'. I

> could have talked about `normal' test results but simply

> said One result of 6.5 and one of 8.1 is not normal.

>

> After agreeing to the tests listed below she asked what I

> wanted to do when the tests ruled out Hypogonadism! She

> suggested referring me to the local hospital which run a

> psychosexual clinic!

>

> I have to go back on 12th October to have the blood drawn

> for the following labs;

> Serum Testosterone

> SHBG (She didn't think the lab would know about measuring

> free testosterone)

> Estrodiol (I asked her to note on the request that is was

> for a male but she wasn't sure they would have a sensitive

> test for this)

> LH

> FSH

> TSH

> Cortisol

> Prolactin

>

> In hindsight I could have pushed for her to check what the

> lab could test for but over here you only get 10minutes and

> I was conscious I had already got more than I expected to

> get!

>

> I walked out with the lab test request slip to make an

> appointment at reception and she had forgotten to write on

> the slip the appointment had to be early morning! So I got

> 11.40am. I know this will work in my favour for testosterone

> but not sure about the others.

>

> My task now is to prepare for when I get my results. It

> will probably take a couple of weeks after the 12th. I think

> I need to be prepared to argue my case for referral if I get

> low normal testosterone and low normal LH like I had before.

> I also need to have documentation of good source to support

> my referral request. I mentioned I was a member of this

> forum to which she replied that the internet has a broad

> range of information.

>

> What do I do if I get the same response as last time? `It's

> psychological'. I need some documentation to support that my

> symptoms, plus possibly borderline test results warrant

> treatment. Can you guys here help with that please?

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

Just tell her that Hypogonadism is commonly misdiagnosed as depression by

UNINFORMED doctors. That ought to fix her! You can add that " depression "

is a common symptom of low T so any doctor that doesn't first rule that out

hasn't done adequate pre-diagnosis screening. This will in fact do injury

to the patient by treating a problem that doesn't really exist while failing

to treat the true cause. That is just BAD medicine. There are no two ways

about it here. Brett

Re: Heading to the docs (UK) this week and could use

some advice please...

> I've just come back from an appointment with my GP. Mixed results really.

> I showed her a list of my symptoms (It was easier to spend some time

> writing it out properly beforehand rather than risk missing something or

> describing something badly while `under the spotlight'), the AMS

> questionnaire filled in and also referred her to my previous test results

> she had up on the monitor.

>

> Her initial reaction was `these are all symptoms of depression'. I did

> well to remain calm as I know I'm not depressed but every time I see her

> she tries to convince me it's depression! I agreed that there was an

> overlap of symptoms but I was sure that I wasn't depressed. Reading

> between the lines I think she thinks I'm depressed and that I'm

> desperately trying to find something that it could be other than

> depression, if that makes sense.

>

> She said `your testosterone was normal in that test'. I could have talked

> about `normal' test results but simply said One result of 6.5 and one of

> 8.1 is not normal.

>

> After agreeing to the tests listed below she asked what I wanted to do

> when the tests ruled out Hypogonadism! She suggested referring me to the

> local hospital which run a psychosexual clinic!

>

> I have to go back on 12th October to have the blood drawn for the

> following labs;

> Serum Testosterone

> SHBG (She didn't think the lab would know about measuring free

> testosterone)

> Estrodiol (I asked her to note on the request that is was for a male but

> she wasn't sure they would have a sensitive test for this)

> LH

> FSH

> TSH

> Cortisol

> Prolactin

>

> In hindsight I could have pushed for her to check what the lab could test

> for but over here you only get 10minutes and I was conscious I had already

> got more than I expected to get!

>

> I walked out with the lab test request slip to make an appointment at

> reception and she had forgotten to write on the slip the appointment had

> to be early morning! So I got 11.40am. I know this will work in my favour

> for testosterone but not sure about the others.

>

> My task now is to prepare for when I get my results. It will probably take

> a couple of weeks after the 12th. I think I need to be prepared to argue

> my case for referral if I get low normal testosterone and low normal LH

> like I had before. I also need to have documentation of good source to

> support my referral request. I mentioned I was a member of this forum to

> which she replied that the internet has a broad range of information.

>

> What do I do if I get the same response as last time? `It's

> psychological'. I need some documentation to support that my symptoms,

> plus possibly borderline test results warrant treatment. Can you guys here

> help with that please?

[Guest guest]

Yeah,it's a standard thing to be told you are depressed(you might be)but in the

UK we are a bit behind the current thinking on low T.I would ask your GP if a

man was feeling great with a level of T of say 22 then a few years later was

feeling rotten with a level of say 11,what is the OPTIMAL level for that man not

a " normal " level(normal for who?).I wonder if a top marathon runner who usually

takes 2hours 10 minutes to run the 26 miles then starts taking 3 hours50 minutes

would be happy to be told " it's ok,you are in the normal range " .Ask the GP to

refer you to an endo,if she will not then ask her to start you on some T

replacement anyway.If you do see an Endo you may get told different things by

each endo which considering medicine is supposed to be based on evidence is a

joke.Let us all know what happens,keep pushing your GP,it's your life not hers.

Andy

[Guest guest]

Just a mini update as I feel the need to vent!

Just phoned my docs and spoke to a receptionist about my results. She went

through the whole list and said 'tell ok', 'tell ok'.....

Gutted! It would have been so much easier if my levels had been below normal

rather than borderline. Now I know I'm going to struggle to get treatment.

I don't know what my specific numbers are yet. I will collect a print out

tomorrow.

It's so absurd to think that there's a fine line and that if your result falls

one side you must be ok and if it falls the other you have a problem. Between

black and white there are many shades of grey, that makes sense, that is

logical. Not just with testosterone but any blood test result.

I have buried myself in research papers & books for the last 2-3weeks preparing

my arguement. I just hope when it comes to the docs appointment I can articulate

my point. If I get emotional I wont be able to string a sentence together let

alone make an arguement.

I read that testosterone levels vary circannually as well as circadian and that

end summer-end autumn is the peak. Not sure how much they fluctuate though.

I will post my figures tomorrow.

[Guest guest]

My internist told me that 345 was normal.

My reply was that (1) the Cleveland Clinic and other prestigious research

centers recommend TRT at levels of 350 and below. (2) I listed my symptoms,

and asked him what the next step in diagnosis would be, if his opinion was

that it was not my hormones.

He ordered testosterone.

I believe that my previous doctor would not have cooperated. Sometimes you

can work with a doctor, and sometimes not.

[Guest guest]

I feel your pain and pray you get through this read this link.

http://www.intelligencetest.com/stan-deviation.htm

Learn enough of this about labs and the size if the sample use to come up with

ranges remind your Dr. about his math if your at or near the bottom of the range

your not good your in the lower % of all the people in the sample that were dam

sick and old.

Co-Moderator

Phil

> From: blackers1100 <blackers1100@...>

> Subject: Re: Heading to the docs (UK) this week and could use

some advice please...

>

> Date: Thursday, October 21, 2010, 6:41 AM

> Just a mini update as I feel the need

> to vent!

>

> Just phoned my docs and spoke to a receptionist about my

> results. She went through the whole list and said 'tell ok',

> 'tell ok'.....

>

> Gutted! It would have been so much easier if my levels had

> been below normal rather than borderline. Now I know I'm

> going to struggle to get treatment.

>

> I don't know what my specific numbers are yet. I will

> collect a print out tomorrow.

>

> It's so absurd to think that there's a fine line and that

> if your result falls one side you must be ok and if it falls

> the other you have a problem. Between black and white there

> are many shades of grey, that makes sense, that is logical.

> Not just with testosterone but any blood test result.

>

> I have buried myself in research papers & books for the

> last 2-3weeks preparing my arguement. I just hope when it

> comes to the docs appointment I can articulate my point. If

> I get emotional I wont be able to string a sentence together

> let alone make an arguement.

>

> I read that testosterone levels vary circannually as well

> as circadian and that end summer-end autumn is the peak. Not

> sure how much they fluctuate though.

>

> I will post my figures tomorrow.

>

>

>

> ------------------------------------

>

>

[Guest guest]

And ask this dam Dr. how he would like to live with levels of a man over 100 yrs

of age.

Co-Moderator

Phil

> From: Spanky <spankysd@...>

> Subject: Re: Heading to the docs (UK) this week and could use

some advice please...

>

> Date: Thursday, October 21, 2010, 10:26 AM

> My internist told me that 345 was

> normal.

>

> My reply was that (1) the Cleveland Clinic and other

> prestigious research

> centers recommend TRT at levels of 350 and below. (2) I

> listed my symptoms,

> and asked him what the next step in diagnosis would be, if

> his opinion was

> that it was not my hormones.

>

> He ordered testosterone.

>

> I believe that my previous doctor would not have

> cooperated. Sometimes you

> can work with a doctor, and sometimes not.

>

>

>

[Guest guest]

In my case my doc thinks my depression (which I don't have but she thinks I have

because my symptoms fit) is causing my reduced serum test.

What I don't get is that saying I have depression puts a label on it but doesn't

give me a treatment option since I've taken ADs for years & still had the same

symptoms. I spent thousands on therapy because the NHS don't provide it (Except

CBT).

So it leaves me with symptoms and no options. Since studies show that test

improves both anxiety and depression why wouldn't that be a logical option

rather than for me to be expected to live with it!

Blood's boiling again!!!!!

[Guest guest]

What were your numbers?

Maybe you need to explore other options, like getting a different doctor.

On Thu, Oct 21, 2010 at 10:32 AM, blackers1100 <blackers1100@...>wrote:

>

>

> In my case my doc thinks my depression (which I don't have but she thinks I

> have because my symptoms fit) is causing my reduced serum test.

>

> What I don't get is that saying I have depression puts a label on it but

> doesn't give me a treatment option since I've taken ADs for years & still

> had the same symptoms. I spent thousands on therapy because the NHS don't

> provide it (Except CBT).

>

> So it leaves me with symptoms and no options. Since studies show that test

> improves both anxiety and depression why wouldn't that be a logical option

> rather than for me to be expected to live with it!

>

> Blood's boiling again!!!!!

>

>

>

[Guest guest]

Depression is often caused by low T3, a thyroid hormone.

>

> In my case my doc thinks my depression (which I don't have but she thinks I

have because my symptoms fit) is causing my reduced serum test.

>

> What I don't get is that saying I have depression puts a label on it but

doesn't give me a treatment option since I've taken ADs for years & still had

the same symptoms. I spent thousands on therapy because the NHS don't provide it

(Except CBT).

>

> So it leaves me with symptoms and no options. Since studies show that test

improves both anxiety and depression why wouldn't that be a logical option

rather than for me to be expected to live with it!

>

> Blood's boiling again!!!!!

>

[Guest guest]

I have a similar story, in that I have been diagnosed multiple times by

different medical persons with dysthymia, a fancy word for chronic mild

depression. This has gone on for years. I have tried every anti-depressant

known. I was partnered with a psychiatrist for 14 years. He gave me anything

which he thought would help.

Over the past couple years, my libido went away, and I started feeling a

sense of malaise. Where I had been industrious in the past, keeping up my

house and tending to chores, ready to start work in the morning, etc... I

just didn't have the inclination to do anything. I was working from my bed.

Within a day or two I found that I was getting out of bed in the morning

without even thinking about it.

The testosterone injections were the answer for me. Now I am going to tend

to my other hormone levels, and fine tune things.

[Guest guest]

Try getting some help at this forum it's in the UK.

http://www.andropause.org.uk/newforum/forum_frameset.htm

You don't need to put up with this crap post about your problem the men there

will help you out.

Co-Moderator

Phil

> From: blackers1100 <blackers1100@...>

> Subject: Re: Heading to the docs (UK) this week and could use

some advice please...

>

> Date: Thursday, October 21, 2010, 1:32 PM

> In my case my doc thinks my

> depression (which I don't have but she thinks I have because

> my symptoms fit) is causing my reduced serum test.

>

> What I don't get is that saying I have depression puts a

> label on it but doesn't give me a treatment option since

> I've taken ADs for years & still had the same symptoms.

> I spent thousands on therapy because the NHS don't provide

> it (Except CBT).

>

> So it leaves me with symptoms and no options. Since studies

> show that test improves both anxiety and depression why

> wouldn't that be a logical option rather than for me to be

> expected to live with it!

>

> Blood's boiling again!!!!!

>

>

>

> ------------------------------------

>

>