Treatment Why is it one doctor is telling me I need to have my thyroid checked before she will take over my testosterone therapy?

[Juicewrldfan]

There is just a lot of stuff written here. My first reaction is maybe you are kind of hypomanic. But, it sounds like you need to get back to baseline.

I'm mostly confused by giving estrogen pills. I have never heard of that before, honestly. Doesn't seem rational.

I'm also concerned with your username. If you have a history of AAS abuse, this changes things. Androgen receptors tend to get desensitized with abuse. Use of topical creams/gels can often be a superior option because there are more androgen receptors in your skin. From my old days on the meso-rx forum, a lot of the AAS recovery docs there said topical testosterone was superior to injections for patients with a history of AAS abuse.

I also have a history of such abuse, and while it takes a while, you do recover enough that you can function. I'm very anti-drug of everything at this point, and I hope to return to a 100% drug free life. Not trying to push a lifestyle on you, but something to think about.

Thank you for taking the time to clarify what you were thinking. I will do my best to explain it as coherently as possible as it seems I am writing in a confusing manner?

To be very honest, I am starting to question if I do have bipolar disorder...but we can think ourselves into anything. I was DXd at 17, but they only had me there for two weeks. How the hell do you come up with that diagnoses in two weeks with a teenager at that. It makes it much harder to diagnose. They said OCD and Bipolar disorder. They were quacks, but then they had to be because they tricked me into being locked up there. Tricked me like MF...my dad too...tricked me...I guess they thought i wouldn go...i probably wouldnt of. So yeah, I have a deep distrust of pscyhiatrists. The dark side of psychiatry doesnt help with lobotmies and the like in modern times.

BUT, I have been seeing the same therapist for 7 years, every week. She has not ever brought up bipolard disorder and then again she doesnt like to give me diagnoses for whatever reason idk. She will if i push it. I asked her once if she thought i had bipolar disorder. She didnt say i did have it at the time. It was maybe 2 years or so ago i asked her though. But to be honest, I met with her today and I mentioned to her that someone said i sounded manic on here and testosterone I know can trigger mania so will need mood stabilizer if that happens or did happen idk. And it was at the last minute so didnt really dive into it, but she said something along the lines of " no ive seen you manic before and you are not manic at this moment I dont think"

I was perplexed. She is an extremely talented therapist for me. We are just a really good fit and she knows I push back against that diagnoses because i told her about the past and I just dont buy it, but now i wonder. I really wonder. But even so cant you treat it without meds? like TMS idk...I do not want meds if i can avoid it at all IF i have it.

I dont have issues sleeping ever aside from sometimes i get dream issues. I dont like calling them NT. I abbreviated it. Thats how much I hate that word. Sounds like a little baby having a bad dream. But i assure you they are realistic and can be pretty terrifying. One time i thought ghoul was in front of me and i was fighting it. My wife woke me up seeing my hands in the air swinging wildly while standing up sleeping.

I just have never had the "dont need sleep and energetic portion". I mean. Im considered hyper by most people as far as I talk alot and yes I am a very bad listener though I try very hard to be attentive. They attributed that to adhd, but I do not take stims for it anymore. I actually dont take anything at all. And wouldn't mania have been triggered by stimulants? Never once did that happen. Actually was extremely depressed from them, but ever since i started testosterone man, night and day. I have a thirst for life and and driven again. Yeah thinking about everything i wrote it looks like mania, but doesnt mean it is necessarily, right?

I mean drug use for long periods of time. Say I was abusing stims off and on over the past year. It would make sense if my brain was still trying to reach homeostasis and hasnt quite yet so was conditioned to be like a roller coaster from the stim abuse. So maybe it just takes time.

Idk. I really dont know. I am willing to take meds if absolutely necessary and my fear is if it is true that i am manic then I will lose my drive and thirst for life again if i take meds...god damn it this does all sound like classic bipolar. BUt i sleep. I sleep every night for a regular amount of time. So, maybe its just adhd? right? Right?

I am unsure...but am starting to think its true. Maybe not all bipolar disorders need meds. I haven't been on bipolar meds for extremely long time 15 years or so. I tried them again just beause i was desperate and homeless at the time. Didn't help. I hate bipolar meds...damn it....

But i will do whats necessary if necessary...

In regards to the AAS, I have no idea what that is? I am guessing steroids, but no I have never took steroids. I apologize if my story was confusing, but what I was saying in my story is I was tricked and yes I took estrogen like a fool for 5 months and now i have to take T shots well coupled with drug abuse caused this.

Yeah, idk. I like myself so much more if this is mania. I like it. But honestly I just think i feel good about life because I started working out last week too and have been reaching and acheiving alot of goals. Yet, in my interviews I did great, except one. I was kinda all over the place, but I also hadnt taken T yet today and it was due. I got the T stuff sorted out.

well idk how to tell if i have it...I emailed my therapist and asked her to clarify if i have it, because I have my first psych appointment Tuesday. I have been seeing a GP for MAT and I wanted them to take it over. I do NOT trust psychiatrists AT ALL, but I am giving this one a chance. I know him kinda. Well he used to be the clinical director at the inpatient hospital i used to end up at for SI.

I dont get SI anymore. I haven't since I abused stims. Havent had a lick of depression.

K I think im out of meaningful things to add.

 

[Eryximachus]

I was DXd at 17, but they only had me there for two weeks. How the hell do you come up with that diagnoses in two weeks with a teenager at that.

In a hospital setting, bipolar is really easy to diagnose. If you present as manic, and respond to anti-manic agents, then that's your diagnosis. They work fast, definitely faster than 2 weeks.

I just have never had the "dont need sleep and energetic portion".

A minority of patients have this symptom.

So, maybe its just adhd? right? Right?

The presentation that is most common is summarized by psychiatrists as "the 4 A's" - anger, anxiety, aggression and attention problems. Attention problems are very common.

I know him kinda. Well he used to be the clinical director at the inpatient hospital i used to end up at for SI.

If you've had multiple hospitalizations, you really need to stay 100% clean and probably consider being on psych meds for life. Work with this physician of course, but you can't go through life like that.

 

[Juicewrldfan]

In a hospital setting, bipolar is really easy to diagnose. If you present as manic, and respond to anti-manic agents, then that's your diagnosis. They work fast, definitely faster than 2 weeks.

A minority of patients have this symptom.

The presentation that is most common is summarized by psychiatrists as "the 4 A's" - anger, anxiety, aggression and attention problems. Attention problems are very common.

If you've had multiple hospitalizations, you really need to stay 100% clean and probably consider being on psych meds for life. Work with this physician of course, but you can't go through life like that.

Thanks man for taking the time to read my book LOL. I am terrible with being long winded. I need to learn to be more direct and to the point. Im very bad about that. Yeah, I guess i should go back on meds. And yeah, I am working on rooting out all drugs in my life. I have been clean for the past week and a half and before that a month, just slipped because I thought I could take adderral as prescribed for some reason. I stopped that prescription.

That makes sense. I do have attention issues unless I am hyperfocused. Thats the only time I focus well. BUT I also have PTSD and likely bipolar disorder. God i hate saying that part.
BUT if it will make my life and those around me better I will take meds. I see the new psych next week...

If I am manic, its hypomania and I read online that in some cases it can be treated with lifestyle changes and skill learning with a therapist.

 

[snmfmy]

JWF, I apologize, I completely ignored/ missed your question at the beginning of the thread.

The reason that she wants to test your thyroid function is because low functioning thyroid is a proximal cause of low testosterone.

If your thyroid is not functioning properly, she would prefer to fix it, instead of 'tying a bow on a pig' (I mean honestly, why would you put lipstick on a pig? they don't have lips, They have one lip and one snout) by just giving you TEST.

I don't know if you were aware that low thyroid causes low test.

Did they ever do a biopsy of your testes to determine exactly what the damage was? Or did they just rely on free and total testosterone?

I'm guessing they just relied on the values and that's why your female doctor wants to actually test your thyroid function because there's no actual physical damage to your testes.

If she had evidence supporting that there is actually testicular dysfunction caused by (according to you) "drug related damage", she wouldn't be concerned about your thyroid function.

Why did they prescribe you estrogen? Were you trying to transition MTF and then changed your mind?. I mean that's fine. I mean nobody's going to judge you.

But, you haven't made it very clear what the complete picture of your situation is. That makes it difficult for us to understand and give any reasonable advice.

 

[Juicewrldfan]

JWF, I apologize, I completely ignored/ missed your question at the beginning of the thread.

The reason that she wants to test your thyroid function is because low functioning thyroid is a proximal cause of low testosterone.

If your thyroid is not functioning properly, she would prefer to fix it, instead of 'tying a bow on a pig' by just giving you TEST.

I don't know if you were aware that low thyroid causes low test.

Did they ever do a biopsy of your testes to determine exactly what the damage was? Or did they just rely on free and total testosterone?

I'm guessing they just relied on the values and that's why your female doctor wants to actually test your thyroid function because there's no actual physical damage to your testes.

If she had evidence supporting that there is actually testicular dysfunction caused by (according to you) "drug related damage", she wouldn't be concerned about your thyroid function.

Why did they prescribe you estrogen? Were you trying to transition MTF and then changed your mind?. I mean that's fine. I mean nobody's going to judge you.

But, you haven't made it very clear what the complete picture of your situation is. That makes it difficult for us to understand and give any reasonable advice.

No need to apologize. I tried to explain that. I was bamboozled into thinking I was trans and. They said this would fix me so yeah I did for 5 months. And yes there is damage. I have an ascending testicle. Before T I as shooting blanks. I mean nothing would come out ever and it was very difficult to get there. So kinda TMI but yeah I’m confident there is damage to my testes.

My current doctor who prescribed the testosterone did check my thyroid yesterday and said no I do t need to hold the testosterone because I was only on it for one week and hadn’t taken my dose yet for the next week. Everything was in range my T4 as 1.35 I think if I remember right and thyroid tsh 1.7.

Said he will check my blood every theee months and testosterone levels

I will say I think this dose is too high tho. Because when I took my second dose I still feel goood mentally and still had morning wiid which I hadn’t had n years but have been every day since last week but usually was horny all day with the T but now it’s not so much like that. I can perform but I’m not like a teenage boy anymore wanting it all day.

Or maybe I’m adjusting to the testosterone. I don’t know why they want to wait three months. I would think he would check in Two weeks

 

[Juicewrldfan]

In a hospital setting, bipolar is really easy to diagnose. If you present as manic, and respond to anti-manic agents, then that's your diagnosis. They work fast, definitely faster than 2 weeks.

A minority of patients have this symptom.

The presentation that is most common is summarized by psychiatrists as "the 4 A's" - anger, anxiety, aggression and attention problems. Attention problems are very common.

If you've had multiple hospitalizations, you really need to stay 100% clean and probably consider being on psych meds for life. Work with this physician of course, but you can't go through life like that.

So I definitely fit the criteria for the 4 As. But I will never take stimulants again. My primary symptoms I think is impulsivity, I do well on my anger now but sometimes I do get rage but that’s very rare, used to be frequent pre T.

Attention issues are there and were horrible before T. They are still there but not anywhere near as bad to the point I think I need meds though I would consider an SNRI. I just don’t know if that decreases testosterone though because don’t most antagonize 5ht2a?

And yes aggression comes with the rage unfortunately but I exercise now too so I handle cortisol much better than I did before and this is very infrequent now and mostly looks like punching walls when noones around. This does not happen regularly. Not even every month anymore.

Definitely anxiety but only really when it comes to interviews amd that’s normal I think but also I get really anxious around my wife because I never know when she is going to lash out at me so feel like I have to walk on egg shells.

That said, I think that makes sense now that they were able to diagnose me at 17 with the way you explained it. So idk..

Is TMS a treatment option? Or not for bipolar disorder? I’d be open to spravato but iv ketamine felt like I took a placebo so idk…

 

[Eryximachus]

So I definitely fit the criteria for the 4 As. But I will never take stimulants again. My primary symptoms I think is impulsivity, I do well on my anger now but sometimes I do get rage but that’s very rare, used to be frequent pre T.

Attention issues are there and were horrible before T. They are still there but not anywhere near as bad to the point I think I need meds though I would consider an SNRI. I just don’t know if that decreases testosterone though because don’t most antagonize 5ht2a?

And yes aggression comes with the rage unfortunately but I exercise now too so I handle cortisol much better than I did before and this is very infrequent now and mostly looks like punching walls when noones around. This does not happen regularly. Not even every month anymore.

Definitely anxiety but only really when it comes to interviews amd that’s normal I think but also I get really anxious around my wife because I never know when she is going to lash out at me so feel like I have to walk on egg shells.

That said, I think that makes sense now that they were able to diagnose me at 17 with the way you explained it. So idk..

Is TMS a treatment option? Or not for bipolar disorder? I’d be open to spravato but iv ketamine felt like I took a placebo so idk…

You need to start on one of the drugs that works well. Lithium, valproate, quetiapine, olanzapine. You need to get stable. No way you can focus when you're all over the place like this. You can't speculate on experimental treatments, antidepressants, or hormones that we don't fully understand. Fundamentally, bipolar disorder is dysfunction of the hypothalamus-pituitary-adrenal axis, of which cortisol indirectly affects. Your body quite literally doesn't react to adrenaline correctly. Also why meth can fuck you up, but so too can anabolic steroids.

You're not smart enough to understand receptors and their function. I'm not. You just need to get to stable with a doc and your counselor, then slowly rework your life. Keep a daily journal. Use the mood tracking function on the new iOS devices. To me, you don't seem to have insight into how you're just all over the place.

 

[Juicewrldfan]

You need to start on one of the drugs that works well. Lithium, valproate, quetiapine, olanzapine. You need to get stable. No way you can focus when you're all over the place like this. You can't speculate on experimental treatments, antidepressants, or hormones that we don't fully understand. Fundamentally, bipolar disorder is dysfunction of the hypothalamus-pituitary-adrenal axis, of which cortisol indirectly affects. Your body quite literally doesn't react to adrenaline correctly. Also why meth can fuck you up, but so too can anabolic steroids.

You're not smart enough to understand receptors and their function. I'm not. You just need to get to stable with a doc and your counselor, then slowly rework your life. Keep a daily journal. Use the mood tracking function on the new iOS devices. To me, you don't seem to have insight into how you're just all over the place.

Well, that was something I asked about and someone who does know about receptors much more than I do said that things that antagonize 5ht2a can decrease testosterone but I’m on therapy so I guess that’s not really a big issue anymore now that I think about it. And I my level of intelligence has no relationship to being manic. I do understand some receptors to certain degrees and do read up on them sometimes. I guess what I’m saying is with the proper education I’m certain I could understand them thoroughly.

So, I look like I’m all over the place on here? I guess it’s worth exploring more with a the psychiatrist tomorrow. If it’s that apparent to you all on here then maybe I am manic…and maybe I do have bipolar disorder. And I guess based off spending two weeks in the hospital that kind of would seem obvious to most people. Maybe I’ve just been unwilling to see it.

Idk…what about Clonidine for hyperactivity? The issue with Depakote is it’s hard in the liver and I have had hep. And lithium is hard on the kidney. Seraquel doesn’t work well for me. Just makes me tired and I don’t have issue sleeping. Idk what olanzipine is. Trileptal caused severely high liver enzymes.

So it’s like every mood stabilizer has great risk. That’s why I was exploring the other options like TMS and or spravato but I think recent manic episodes disqualify you from spravato.

 

[Juicewrldfan]

You need to start on one of the drugs that works well. Lithium, valproate, quetiapine, olanzapine. You need to get stable. No way you can focus when you're all over the place like this. You can't speculate on experimental treatments, antidepressants, or hormones that we don't fully understand. Fundamentally, bipolar disorder is dysfunction of the hypothalamus-pituitary-adrenal axis, of which cortisol indirectly affects. Your body quite literally doesn't react to adrenaline correctly. Also why meth can fuck you up, but so too can anabolic steroids.

You're not smart enough to understand receptors and their function. I'm not. You just need to get to stable with a doc and your counselor, then slowly rework your life. Keep a daily journal. Use the mood tracking function on the new iOS devices. To me, you don't seem to have insight into how you're just all over the place.

Last thing, so I feel stable though. feel like I’ve been very stable the last week and a half…other than pressured speech but that’s always been a thing. Always thought it was adhd because I was afraid to forget what I was trying to communicate if I didnt get it out.

I really sound that unstable on here? The only reason I ask is because I am still trying to decide if I am going to go on meds tomorrow or not when I meet the doctor and if it’s that apparent to several people then I probably need to get on meds for it as much as I hate it.

 

[Eryximachus]

Last thing, so I feel stable though. feel like I’ve been very stable the last week and a half…other than pressured speech but that’s always been a thing. Always thought it was adhd because I was afraid to forget what I was trying to communicate if I didnt get it out.

I really sound that unstable on here? The only reason I ask is because I am still trying to decide if I am going to go on meds tomorrow or not when I meet the doctor and if it’s that apparent to several people then I probably need to get on meds for it as much as I hate it.

Listen man - I've blown through much of the past 3 years where I thought I was stable, but I really wasn't. It's really hard to tell. You're just sort of grasping at a lot of straws - TRT, thyroid, ketamine, TMS, ADHD meds, SNRIs... it's just too much. You're writing a ton here, and it's hard to follow.

Just go to a doc and say you're manic and you need meds. None of it is controlled. 2400mg of lithium per day for 2 weeks should have a big impact. Same with 2 grams of Depakote. It's not like these drugs at those doses will hurt you for 2 weeks. But if you use big doses, they work fast. Why not just do that first?

 

[Juicewrldfan]

Listen man - I've blown through much of the past 3 years where I thought I was stable, but I really wasn't. It's really hard to tell. You're just sort of grasping at a lot of straws - TRT, thyroid, ketamine, TMS, ADHD meds, SNRIs... it's just too much. You're writing a ton here, and it's hard to follow.

Just go to a doc and say you're manic and you need meds. None of it is controlled. 2400mg of lithium per day for 2 weeks should have a big impact. Same with 2 grams of Depakote. It's not like these drugs at those doses will hurt you for 2 weeks. But if you use big doses, they work fast. Why not just do that first?

It’s not a bad idea to see if I have it but the reason why I don’t want to take Depakote again ( I took it at 17 briefly) because it’s hard on the liver and I have had hep c.

I always have slightly elevated liver enzymes and lithium is supposedly o end the best meds for mania but it is toxic long term. So for a short period I do t have an issue with taking them but long term I do. And I need something long term. Again, I’m not opposed to trialing it but long term concerns me. My wife’s dad died from kidney failure from lithium. He didn’t drink and was only in his 60s.

Thank you for taking the time to discuss this with me btw.

 

[Juicewrldfan]

It’s not a bad idea to see if I have it but the reason why I don’t want to take Depakote again ( I took it at 17 briefly) because it’s hard on the liver and I have had hep c.

I always have slightly elevated liver enzymes and lithium is supposedly o end the best meds for mania but it is toxic long term. So for a short period I do t have an issue with taking them but long term I do. And I need something long term. Again, I’m not opposed to trialing it but long term concerns me. My wife’s dad died from kidney failure from lithium. He didn’t drink and was only in his 60s.

Thank you for taking the time to discuss this with me btw.

Then again I’m terrified of relapsing in drugs…I suppose I’m that case maybe the risks out weigh the benefits…

 

[Eryximachus]

A second line option is carbamazepine. I take it now and it works great for me. It increases liver enzymes that affects other drugs you are taking. But it is very safe so far as side effects. Doctors don’t like to use it because the doses of other drugs you are taking need to be doubled or even tripled. Like depakote, there are a few studies that indicate it reduces drug cravings and the probability of relapse.

No weight gain. No negative impact on liver or kidney function. No impact on blood glucose levels. Doesn’t raise LDL.

It is anticholinergic, but so too are most antipsychotics including Seroquel.

Your issues might be drug related. I think my bipolar issues were caused by drug abuse. My plan is to stay 100% sober for a year while on mood stabilizers and try to eventually go psych drug free combined with major lifestyle changes.

 

[Juicewrldfan]

A second line option is carbamazepine. I take it now and it works great for me. It increases liver enzymes that affects other drugs you are taking. But it is very safe so far as side effects. Doctors don’t like to use it because the doses of other drugs you are taking need to be doubled or even tripled. Like depakote, there are a few studies that indicate it reduces drug cravings and the probability of relapse.

No weight gain. No negative impact on liver or kidney function. No impact on blood glucose levels. Doesn’t raise LDL.

It is anticholinergic, but so too are most antipsychotics including Seroquel.

Your issues might be drug related. I think my bipolar issues were caused by drug abuse. My plan is to stay 100% sober for a year while on mood stabilizers and try to eventually go psych drug free combined with major lifestyle changes.

I would be willing to do that if it is okay on the liver. Ohhh...i think i misunderstood. I thought you meant it increases ALT type enzymes. and ast? Yeah if its not hard on organs I am more than willing to take it. how about hormones and libido?

 

[Eryximachus]

The only long term risk of carbamazepine I can discern is dementia, but I’ve yet to figure out precisely how it is anticholinergic. It doesn’t seem to directly affect musceriaiic

I would be willing to do that if it is okay on the liver. Ohhh...i think i misunderstood. I thought you meant it increases ALT type enzymes. and ast? Yeah if it’s not hard on organs I am more than willing to take it. how about hormones and libido?

I have no problems. I’m tapering off Seroquel, so bloods are still fucked. Libido is ok. I choke the chicken, but fear dating as I have no clue how to meet chicks sober.

 

[pollies]

I chose the hospitals very carefully..