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@DrMariano 2977 wrote:
Are you saying is that until recently, you have been on a poor diet?
Diabetes occurs most often in those with poor diets.
It is difficult to lose weight when one has insomnia. The underlying causes of insomnia predispose someone to weight gain.
Why did you stop testosterone replacement? Optimizing testosterone is one way of helping reduce insulin resistance and reducing body fat in men.
Generally, when people have problems losing weight, there are problems which are not being addressed.
Nutrition is probably the biggest contributor to obesity since that is what has worsened since the beginning of the 1900s. The general trend is to have less nutrition per calorie eaten. Traditional diets can have up to 10 times more nutrition per calorie than modern diets. The more nutrition per calorie, fewer calories one needs to feel satisfied.
My diet up nutil a few months ago was ok. I would go off track sometimes especially working long days and coming home tired I would eat something probabaly not great for my diet, but this wasn’t every day. For 4 months now I’ve been more strict with my diet so it’s gotten better.
I went on TRT 3 times over a period of 5 years. My libido was completely dead the whole time. Only one time my libido turned on for about 6 days and that was it. The first time I went on TRT I would take arimidex and it would make me very sharp and focused, but that was impossible to sustain. The next 2 times I went on trt, taking arimidex never got me back to that state which tells me something else was wrong. I lost my fiancee of 6 years because we never saw the light at the end of the tunnel with trt. I would of stayed on it if it worked. I felt the same on it as I do off of it and the only time I fell like a million bucks was that one time that my libido kicked in. It was very strong libido surge for 6 days and I felt sharp and focued. My shbg is around 14 so I’d have to get my e2 very low, but staying there is hard because my e2 waas consistantly at 30 and t-levels at 800-850 while on trt.
I’ve had normal levels of testosterone in the past in the 500’s range, but when it dropped into the 300 is when I went on trt. Even when they were normal my libido was very weak, energy was low and was very lazy, socially shy, and brain fog. I knew something was wrong growing up and even during high school. I stopped playing sports freshman year becuase my joint fell weak like they were going to break. It’s been 6 years of treatments and 3 doctors, but no one has been able to figure out or fix what’s wrong with me. It’s really impacted my relationship and my career job.
Another issue is I was losing so much hair on T-cream and then t-shots. I stopped TRT 8 months ago and I’m still losing so much hair and don’t know why.
I knew insomnia was contributing to my weight gain, but everytime I address this with my doc they didn’t know why I was having insomnia unitl I figured it out for my self. now I know and barely have any sugar anymore.
Generally, when problems are occurring in treatment, there are problems which need to be first addressed.
When it comes to obtaining mental health and physical health, there are a hierarchy of areas where problems have to be first addressed:
1. Nutrition
2. Immune system problems
3. Nervous system problems (this includes brain, psychological and social issues)
4. Adrenal signaling regulation
5. Thyroid signaling
6. Testosterone signaling
7. Estrogen signaling
8. Growth HormoneIf problems at one level are addressed prematurely, then the foundation for the treatment may not have been set to either self-correct or minimize adverse effects.
Optimizing nutrition often involves obtaining nutrient testing to see what one is actually obtaining from one’s diet. Modern diets can be seriously deficient despite appearances.
A good starting point for nutrition is the book “Nourishing Traditions” by Sally Fallon. This is based on the work of Weston Price DDS who found that traditional diets are very nutrient dense (up to 10 times more) and that traditional diets leads to greater physical health than modern diets.
Physical health needs to be optimized if one is to achieve mental health. Mental health includes sexual function, emotional function, cognitive function, relationship and social functioning, etc. etc.
@DrMariano 2985 wrote:
Generally, when problems are occurring in treatment, there are problems which need to be first addressed.
When it comes to obtaining mental health and physical health, there are a hierarchy of areas where problems have to be first addressed:
1. Nutrition
2. Immune system problems
3. Nervous system problems (this includes brain, psychological and social issues)
4. Adrenal signaling regulation
5. Thyroid signaling
6. Testosterone signaling
7. Estrogen signaling
8. Growth HormoneIf problems at one level are addressed prematurely, then the foundation for the treatment may not have been set to either self-correct or minimize adverse effects.
Optimizing nutrition often involves obtaining nutrient testing to see what one is actually obtaining from one’s diet. Modern diets can be seriously deficient despite appearances.
A good starting point for nutrition is the book “Nourishing Traditions” by Sally Fallon. This is based on the work of Weston Price DDS who found that traditional diets are very nutrient dense (up to 10 times more) and that traditional diets leads to greater physical health than modern diets.
Physical health needs to be optimized if one is to achieve mental health. Mental health includes sexual function, emotional function, cognitive function, relationship and social functioning, etc. etc.
Dr. M,
Does neurotransmitters play a role in sense of smell? The one thing I’ve noticed in the past when my mood was little better years ago there would be a distinct smell in the air outside especially during the summer. The smell of grass, tree, leaves would stimulate endorphins. Summer would make me happy, but for many years now I can’t smell that. I know this sound strange, but it’s true for me at least and can’t seem to figure it out. I haven’t lost my sense of smell completely, but it’s not the same. I also have been experiencing ringing in my ears for few years now. I though fixing thyroid was supposed to help, but it didn’t and I’m not sure how to fix it.Going back to trt for a sec. I’ve had the most difficult time in controlling estrogen while on trt 3 different times. Not sure why I have no luck, but how does one keep there estrogen in the right “range” for a long time? I would either go too low or not low enough or hit the zone, but would not stay there. I’ve read many horror stories on people who quit trt because libido was always inconsistent which is why I quit.
@loopy107 2998 wrote:
Dr. M,
Does neurotransmitters play a role in sense of smell? The one thing I’ve noticed in the past when my mood was little better years ago there would be a distinct smell in the air outside especially during the summer. The smell of grass, tree, leaves would stimulate endorphins. Summer would make me happy, but for many years now I can’t smell that. I know this sound strange, but it’s true for me at least and can’t seem to figure it out. I haven’t lost my sense of smell completely, but it’s not the same. I also have been experiencing ringing in my ears for few years now. I though fixing thyroid was supposed to help, but it didn’t and I’m not sure how to fix it.Going back to trt for a sec. I’ve had the most difficult time in controlling estrogen while on trt 3 different times. Not sure why I have no luck, but how does one keep there estrogen in the right “range” for a long time? I would either go too low or not low enough or hit the zone, but would not stay there. I’ve read many horror stories on people who quit trt because libido was always inconsistent which is why I quit.
Smell is the earliest of the special senses to develop through evolution. It is developed so early, the odor receptors are directly wired to cortex rather than having to pass through the thalamus. The cortical areas for processing smell are organized in a way that is a model for the rest of the cortex (the outer grey matter of the brain). It is specialized and structured for pattern recognition.
Neurotransmitters are the intercellular signals that go directly between nerve cells and glial cells in the brain to transmit information and to help process the information. Yes, they are necessary for the pattern recognition needed for smell.
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In regard to controlling estrogen, estradiol production tends to worsen when the peaks of testosterone added are higher. Dosing, thus is important in minimizing estrogen production. With testosterone replacement, in order to avoid excessive estrogen, dosing frequency needs to be increased to minimize peak doses of testosterone. And, the overall level needs to be lowered. The goal needs to be changed from trying to achieve the upper end of the range (which is what many practitioners try to attain) to trying to achieve a mid-range blood level.
Trying to control estradiol with Arimidex or another aromatase inhibitor can be tricky and frustrating. For some men, Arimidex, itself, poses problems where they do not feel well on it. With others, the body compensates for lowered estradiol production by producing it through other routes or by increasing other estrogens. With a week half-life, getting a good dose of Arimidex can also take a very long time since it takes 6 weeks to stabilize in dose. One can end up chasing one’s tail with some men.
Since estrogen affects multiple other signals – thyroid, inflammatory signals, adrenal signals, testosterone signaling, norepinephrine, serotonin, dopamine signaling, etc. – rather than attempt to control estrogen, it may be better to address problems in these other signaling systems. Problems there may be the actual cause of libido problems with estrogen. These other signaling systems also have independent effects on libido. So problems there may be inadvertently attributed to estrogen, when it is not.
It is common for a patient to present to me already on testosterone replacement, already with good estrogen levels, but having zero libido.
Libido primarily involves specific brain circuits on which numerous signals control function. Estradiol is often not the primary problem. Most often, it is a minor player. I often prefer examining function in the other signaling systems since it is often a more rewarding endeavor when it comes to improving function.
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