Thursday, August 9, 2012

Depression vs. Low Testosterone, Part 2

Part 1 of this post can be found here.

At the end of the last post, I'd basically been told by my PCP that my testosterone levels were fine.  He told me to keep taking the four different meds I've been taking for depression and anxiety.  An endocrinologist had told me that my testosterone levels were marginal, but in range, and no treatment was warranted.

At this point, I was furious.  The only thing that mattered to the doctors was a number, not the patient and the patient's symptoms.  I turned to the internet.  Basically, I found two categories of information.  First, I found a lot of information about "andropause" and the use of testosterone and HGH (or products known as HGH secretagogues) as a remedy for andropause.  Most of this information came from online "clinics" that seemed to offer easy access to these medications.  Most of them were based in CA or FL.  All of them seemed to make a lot of wild promises about restoring youth and vigor and losing weight and getting smarter, etc.

I spent a lot of time pondering the validity of the claims and wondering about the legality of what they were promising.  Were these places steroid factories for athletes to gain access to HGH and testosterone?  It's actually fairly hard to get HGH these days, because the federal government created a special law just to govern that one medication.  Normally, once a drug has been approved for usage by the FDA, doctors have discretion to prescribe it for any reason they see fit.  HGH is no longer governed that way and providers can get into legal hot water if they prescribe it without very specific diagnoses.

The other type of information I found was mostly on internet forums and bulletin boards.  Some of these were really disheartening.  It seems like doctors everywhere are fast do diagnose depression and prescribe pills.  A few doctors seem willing to try the trans-dermal forms of testosterone, and it seems a lot of men get little benefit from these medications.

For the people who had found a solution, there seemed to be a recurring theme - the American Association for Anti Aging Medicine, also known as A4M.  This organization includes an alliance of doctors who are open to therapies to improve the quality of life for people as they get older.  I'm not necessarily interested in living forever.  I would like to have quality in my years though.  So, I used the directory at A4M to find a clinic.  I still traveled out of state to see a doctor.  The doctor did not take insurance, so everything is out of pocket - office visits, labs, and medications.

In May of this year, I got the most comprehensive set of lab work done that I've ever seen.  This time, my testosterone level was no longer borderline low.  It was officially clinically low - 177 nanograms per deciliter.  The bottom of the reference range for this lab was 280.  I don't think I'd ever been happy to see a "bad" lab result before.

After a follow-up conversation with the provider, I was prescribed injectable testosterone cypionate.  I was also given injectable vitamin B12.  And, two other medications to deal with possible estrogen issues as I added the testosterone back to my body.

Twice a week, I give an injection of testosterone and an injection of B12.  I thought it would be difficult, given my lifelong needle phobia, but it hasn't been that bad.  One of the anti-estrogen medications is a bit tricky.  It seems like it's possible to take too much of it, so the goal is to figure out a personal minimum effective dosage.

Is it helping?  In 11 weeks, I've dropped two of the four medications I've been taking for anxiety and depression and my brain feels fine.  I hope to drop the other two over the next few months, but some tapering is required with those medications.  I'm doing better in the gym.  I'm sleeping better.  I feel more alert and focused at work.  Two other meds I'd been taking are also gone.

In general, I would say that there's been a huge turnaround for me.  I imagine that there are many other men out there, living with a diagnosis of depression or anxiety or adult ADHD, when the real problem is something else entirely.  I'm certainly not a doctor.  What seems to be working for me might not be appropriate for anyone else, although I've participated in enough online forums to know that it seems to be working for others.  At this point in time, I'm injecting something into my body that it should normally make on its own - a bio-identical hormone.  I'd much rather do that than take the plethora of pills the pharmaceutical industry has been pushing and that I've been swallowing for eight years.

I think the biggest lesson I've learned in all of this is that you need to question your doctor.  If your doctor isn't open to being questioned, perhaps you are seeing the wrong person.

This post is also "to be continued", but over a much longer period of time.


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