Re: Hi my first message...need help with low testosterone

April 2, 2010

Hi vktalasila and welcome,

The Dr. giving you Clomid is the best one if you want to make a baby. If you

take Testostrone meds this will shut down your testis from making Testosterone

so as long as you don't have bad sides from the Clomid go for it.

Co-Moderator

Phil

> From: vktalasila <no_reply >

> Subject: Hi my first message...need help with low testosterone

>

> Date: Friday, April 2, 2010, 1:18 PM

> I am 34 and I have low testosterone.

> I am married for 41/2 years. We wanted to have a baby, and I

> was havingg ED problem. Then I realised to go to urologist n

> get checkup..Finally the worst happened...My T levels are

> low.. In Nov it was 330, I went to diff urologist in mar

> first week and it was 270 and he did the test a week after

> and it is 404. He gave me clomid. He said I have to go for

> replacement therapy in future..Coz if i do now i wont have

> sperm to get my wife pregnant.Any suggestions about which

> doctor to see?

>

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

>

April 3, 2010

Hi

I changed my id to rickydude35. I have a one more question. I want to know id

taking clomid will bring back my levels or if I have to go for TRT for sure. I

also need some help about TRT. Would i be taking it for a life time? Its just

feels like a big bump in my marriage too. Wife is also feeling very depressed. I

wish I can make things right. NeNeed lot of help.....Any suggestions???

April 3, 2010

From what I understand Clomid is probably a good choice.

Here's some encouragement:

I was talking about this with my doctor and he said that even with low

Testosterone, sterility is not necessarily a problem because we men produce

millions and millions of sperm.

And it only takes 1.

So keep trying!

Good luck!

>

> > From: vktalasila <no_reply >

> > Subject: Hi my first message...need help with low

testosterone

> >

> > Date: Friday, April 2, 2010, 1:18 PM

> > I am 34 and I have low testosterone.

> > I am married for 41/2 years. We wanted to have a baby, and I

> > was havingg ED problem. Then I realised to go to urologist n

> > get checkup..Finally the worst happened...My T levels are

> > low.. In Nov it was 330, I went to diff urologist in mar

> > first week and it was 270 and he did the test a week after

> > and it is 404. He gave me clomid. He said I have to go for

> > replacement therapy in future..Coz if i do now i wont have

> > sperm to get my wife pregnant.Any suggestions about which

> > doctor to see?

> >

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

> >

April 3, 2010

You need to wait and see there are men here on Clomid to keep there Testosterone

levels up and doing fine on it. If it dose not bring up your levels it means

your testis don't work well and you will need TRT and yes it's for life. Here

is a link about this and Clomid from the AACE Guildelines.

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

And here is a cut and paste from Dr. M about how this can happen and what all

can go wrong.

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

#1

Drno

Physician, Psychiatrist

Join Date: Mar 2009

Location: Carmel, California

Posts: 448 HPA Axis Dysregulation Summary

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

This is from the thread: http://www.definitivemind.com/forums...hread.php?t=49

Quote:

Originally Posted by Shaolin

What happens if you treat the adrenals with low dose of testosterone monotherapy

or try some low dose tamoxifen/clomiphene citrate instead of directly treating

with cortisol and other adrenal steroids??

Since you have many times stated that testosterone is a strong norepinephrine

signal reducer couldnt low doses of T over a long long period of time restore

the HPA axis and adrenal responsiveness??

Do you feel that not only adrenal output is impaired but also the sensitivity of

tissues to cortisol effects plays some role too??

When i was at my lowest levels i felt i had way decreased spatial orientation

and understanding of 3d environment plus low levels of taste and smell, but

never really understood if it was due to cortisol on its own or other hormones

played a role in that as well. I supplemented with HC at that time but didnt see

any serious improvement, apart from sleep issues which got slightly better.

To summarize some issues a lot (since the actual mechanisms can be

mind-bogglingly complex):

Chronic or traumatic stress may lead to hypothalamic-pituitary-adrenal axis

dysregulation (the term which I believe is more accurate to use than the term

" adrenal fatigue " ), HPA dysregulation for short.

HPA dysregulation leads to lower production of adrenal cortex signals/hormones.

This includes lower cortisol and/or DHEA, progesterone, pregnenolone,

testosterone, estradiol, or aldosterone.

The primary signal for stress is norepinephrine. Norepinephrine is in a positive

feedback loop with corticotropin releasing hormone. This positive feedback loop

is interrupted by cortisol signaling. To increase norepinephrine, the brain has

to also reduce production of some or all of the control signals that suppress

norepinephrine signaling. These include reductions in serotonin, dopamine, GABA,

etc.

Stress (particularly if it is a perceived threat), may lead to an increase in

pro-inflammatory cytokine signaling from the brain and from the immune system

(which is directly innervated by neurons of the sympathetic nervous system - the

primary norepinephrine-releasing neurons of the nervous system). Stress may also

lead to an increase in histamine signaling from brain mast cells. These changes

lead to an activation of the immune system. These changes in large excesses may

lead to an increase in inflammatory processes. The loss of anti-inflammatory

signaling - which includes cortisol, DHEA, progesterone and testosterone -

exacerbates these pro-inflammatory changes.

Excessive pro-inflammatory cytokine signaling may trigger automatic defensive

programs in the brain. Defensive programs may induce behavioral changes

including depressed mood, loss of interest or motivation in activities, loss of

enjoyment from activities, social isolation, changes in sleep including the

desire to sleep excessively.

There may be a loss of energy from excessive pro-inflammatory cytokine

signaling. The actual mechanisms of the loss of energy are not clear. I

currently speculate that perhaps there may be impaired brain astrocyte

conversion of thyroxine (T4) to triiodothyronine (T3) - which leads to a

hypothyroid central nervous system with a euthyroid body (as in Alzheimer's

disease). Perhaps the increase in pro-inflammatory cytokines is one of the

signaling problems leading to HPA dysregulation, aside from excessive

norepinephrine signaling. However, other regulatory systems may also be involved

- such as the opiate signaling systems (which also involve dopamine signaling).

HPA dysregulation, from whatever cause, leads to a loss of energy. The loss of

energy production, however, under some circumstances. These circumstances

include bipolar disorder and attention deficit/hyperactivity disorder with

hyperactivity. In these cases, norepinephrine production is an effective signal

for energy.

Nutrition plays a large role in the development of HPA dysregulation. Omega 3

vs. Omega 6 balance helps determine the balance between inflammation and

anti-inflammation. Various nutrients (such as the B-vitamins, fat soluble

vitamins, magnesium, etc) are cofactors for many of the processes involving

signal production. Vitamin A and D are generally anti-inflammatory signals.

Vitamin D reduces insulin resistance (which helps the body tolerate low blood

sugar from impaired cortisol signaling), increases serotonin and dopamine

production. Vitamin A helps regulate the sensitivity to various hormones/signals

such as thyroid hormone.

The other endocrine signaling systems such as the reproductive system are in

play. Testosterone helps reduce norepinephrine, increases dopamine production.

It also suppresses adrenocorticotropin releasing hormone and directly inhibits

adrenal cortex activity - this may be significant depending on the sum of

signaling interactions and problems a person has. Estrogen acts similarly to a

monoamine oxidase inhibitor - thus increasing serotonin, norepinephrine and

dopamine (but serotonin primarily). Estrogen in relative excess may be

pro-inflammatory, reduces free thyroid hormone. Thyroid hormone signaling loss

is compensated by an increase in norepinephrine production with simultaneous

activation of adrenal cortex signals. Over time, however, this compensation may

fail as HPA dysregulation occurs. Insulin, glucagon, the incretins, etc. also

have a role. Insulin, itself, is pro-inflammatory. Growth hormone has a calming

effect and is anti-inflammatory. Etc.

etc. etc. etc.

The entry point of all these processes is stress. This is represented primarily

by norepinephrine signaling. However histamine (from brain mast cells) and

pro-inflammatory cytokines (from brain microglia) are also involved in the

process. Stress induces responses that are ostensibly designed to improve

survival. The problem is that in the modern world, these responses may be

dysfunctional instead.

===

Given the complexity of the interactions involved, a single intervention may or

may not work. Which direction an intervention goes depends on the sum of the

changes that occur as a result of that intervention. In psychiatry, the usual

answer to a question is " It depends. "

Stress is the entry point. Environmental and behavioral interventions would

clearly help with few downsides.

Low dose testosterone may help, particularly in women, by helping to reduce

norepinephrine and increasing dopamine signaling, and helping to reduce

pro-inflammatory signaling. Low dose testosterone would not help in men since it

may do nothing or it would suppress endogenous production of testosterone,

leading to lower overall testosterone levels. Men would need replacement doses

of testosterone. Testosterone, however, may also worsen adrenal cortex function

depending on a person's susceptibility to this. In men, exogenous testosterone

treatment also suppresses testicular thyroid releasing hormone production,

leading to a loss of thyroid hormone production, which then leads to an increase

in norepinephrine production. This is why in certain men, even if hypogonadal,

testosterone treatment is intolerable. The rest of the system has to be

optimized before testosterone treatment can be done.

Tamoxifen (I would prefer this to Clomiphene due to the visual changes that can

occur with Clomiphene) is a weak estrogen. This blocks the stronger estrogens

from being sensed by the brain. This then causes the brain to release more

Luteinizing Hormone to stimulate testosterone production, leading to estrogen

production. The increase in testosterone would have the effects listed

previously. The problem is that Tamoxifen also blocks estrogen. This leads to

lower estrogen signaling activity. Estrogen helps control norepinephrine by

increasing serotonin and dopamine production. Estrogen is also needed to improve

sensitivity to testosterone by increasing testosterone receptor production.

Estrogen is also important in generating energy, motivation, drive,

competitiveness, sex drive (libido). Estrogen (particularly in women) is

important for neuron growth and memory. The loss of estrogen signaling,

depending on the balance with testosterone, may lead to

negative effects. If testosterone production is driven high enough, then

perhaps this would improve things overall. This is particularly true in men.

However, in women, this may not occur and destabilization of the system and

dysfunction may occur instead. This is why many women do not like treatment with

Tamoxifen or Arimidex for breast cancer.

Cortisol treatment alone may or may not work. Cortisol treatment in

sub-replacement doses helps because it helps break the norepinephrine-CRH

positive feedback loop. Cortisol also acts in the brain to improve

concentration/focus by allowing the brain to ignore emotionally distracting

memories or information. Cortisol also is the most important anti-inflammatory

signal that reduces immune system activity. Cortisol triggers gluconeogenesis -

helping improve blood sugar production. etc. etc. Thus it can be a useful

component of treatment. However, Cortisol treatment alone also suppresses

adrenal cortex activity. Thus, there is also a loss of pregnenolone,

progesterone, DHEA, testosterone, estradiol, aldosterone, etc. If this loss is

large enough, then the person may be worse off than without treatment. Since the

majority of these other signals are calming, help control norepinephrine, are

anti-inflammatory signals, a significant loss may cause the opposite

intended effect of cortisol treatment. This is where some people become more

tired, get " brain fog " , become more anxious, etc. on cortisol monotherapy.

A systematic treatment has to be considered to address the multiple issues that

invariably occur, contributing to HPA dysregulation. Single modality treatments

may help - particularly in those people who don't have large problems in the

rest of their system. But often, in more severe cases, they don't. A systemic

approach would then be needed. I would count the person who responds to

monotherapy as very fortunate.

__________________

-

Romeo B. no, MD, physician, psychiatrist

Any information provided on www.definitivemind.com is for informational purposes

only, is not medical advice, does not create a doctor/patient relationship or

liability, is not exhaustive, does not cover all conditions or their treatment,

and will change as knowledge progresses. Always seek the advice of your

physician or other qualified health provider before undertaking any diet,

exercise, supplement, medical, or other health program.

Co-Moderator

Phil

> From: rickydude35 <rickydude35@...>

> Subject: Re: Hi my first message...need help with low

testosterone

>

> Date: Saturday, April 3, 2010, 10:34 AM

> Hi

>

> I changed my id to rickydude35. I have a one more question.

> I want to know id taking clomid will bring back my levels or

> if I have to go for TRT for sure. I also need some help

> about TRT. Would i be taking it for a life time? Its just

> feels like a big bump in my marriage too. Wife is also

> feeling very depressed. I wish I can make things right.

> NeNeed lot of help.....Any suggestions???

>

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

>

April 3, 2010

Hi dave

the thing is my wife is worried that with all the frustration of low T and ED

problems,even if we hav a baby, itsgonna be lot worse for the baby too...i want

to fix my low T problem n then have a baby....just keeping fingers crossed to

see if clomid can fix this

________________________________

From: Dave <dcbaden@...>

Sent: Sat, April 3, 2010 12:12:16 PM

Subject: Re: Hi my first message...need help with low

testosterone

Â

From what I understand Clomid is probably a good choice.

Here's some encouragement:

I was talking about this with my doctor and he said that even with low

Testosterone, sterility is not necessarily a problem because we men produce

millions and millions of sperm.

And it only takes 1.

So keep trying!

Good luck!

>

> > From: vktalasila <no_reply@group s.com>