Author Topic: Andrology Department - UCLH  (Read 3146 times)

Brenton

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Andrology Department - UCLH
« on: December 14, 2013, 07:33:02 PM »
Hello

I had a very disappointing visit to the endocrinologist at Addenbrookes Hospital yesterday. She didn't consider T levels of 7.6 and 7.9 to be anything to worry about. She wanted to have more blood tests done and said she'd see me in 3 months time. I chatted to Nick O'Hara Smith about it and he recommended the Andrology department at UCLH in London. Does anyone have any experience of this department? David Ralph heads up the team - is he the best person to see?

 My main problem is that my oestradiol level is very high in ratio to my testosterone and therefore TRT on its own did not work as it simply pushed my oestradiol levels even higher. I'm hoping that the Andrology team at UCLH will consider prescribing me an aromatise inhibitor alongside either Clomid or TRT to help me. I have spent the last six months waiting to see two different NHS endos and both have been useless.

I am starting to feel pretty desperate to get a solution to the horrible symptoms I have been suffering - fatigue, anxiety, depression, poor memory/concentration, night sweats, no libido etc.

Thanks

Brenton
« Last Edit: December 14, 2013, 07:34:35 PM by Brenton »

db570uk

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Re: Andrology Department - UCLH
« Reply #1 on: December 14, 2013, 11:33:16 PM »
Hi Brenton

Sorry to hear about the problems you have been having trying to get treatment, I can relate to your symptoms, though 7.6 is really low. I can recommend UCLH Andrology department to get onto TRT or Clomid. Your best bet is to ask to referal to Dr Ralphs clinic though you are most likely to see any of up to 1-2 Andrologists in the Rosenheim building.

I was told by my GP if I wanted a referal to a specific NHS doctor i.e andrologist I would have apply  private to see a specific NHS doctor. Is this something you wanted to do?  I was referred to Dr Ralphs clinic (i.e referal to the department  hence no need to apply as a  private patient and all the costs that go with that) and have been dealing with the same Andrologist each time and jointly in my last consultation. I have been seeing Dr Raheem. It was luck of the draw on my first visit as I was late for my appointment and got to see Dr Raheem as a result. He promised me he would be the one I will be seeing  on any subsequent visits was glad it was him.  I was told no one else at UCLH would give this Clomid treatment for TRT, only him. Once you attend your clinic appointment you could ask to wait until Dr Raheem is available to see you on the day ( if you are given another Andrologist). I am sure the team can accommodate you on that.

I am not sure what the other Andrologists would give as treatment. I know I am very lucky to be given Clomid as TRT and their protocol for Clomid for TRT seems to be no different to the dosage you give to someone who wants Clomid for Fertility treatment i.e 50mg  for 3 days a week.

I will be pushing for a lower dose Clomid for TRT protocol rather than for fertility type protocol i.e 12.5 or 25 mg every other day. Dr Raheem did say he can adjust the dose. I am just hoping all the hormones are in range and not out of whack and require additional drugs. I have developed a sharp pain under by left rib cage area like muscle cramping which is quite painful on moving and I am hoping it isnt any problem with my liver. I have had the pain now for 3 days and will probably need to see my GP. My libido is good on the Clomid but I am a bit worried about prolactin and E2 as I have been experiencing dizziness and lightheadedness a lot more since being on clomid. On the days I don't take it I feel a lot better. I have occasionally reduced the dose to 25mg. I have read that the half life of clomid is 5 days and that is maybe why levels can buildup/shoot up real high in all the hormones. I have trouble concentrating on my reading/studies since been on Clomid and feels like a little difficult to remember things.
I try and take it after lunch so I can have a good/productive morning at work.

Aiming to try to take the lowest dose possible to build up T levels over time.     

Dr Raheem did say he is prepared to give an aromatase inhibitor when I asked him, but be careful as he does not check E2 and Prolactin as part of the protocol he has me on (sense protocol is no different to the clomid for fertility protocol). Prior to me starting on Clomid he acknowledged none of the guys he treats with Clomid have it for TRT purposes only for fertility and only for 6 months. I will push for these to be checked and have to guide him. Please make sure/insist to get these baselined at UCLH before you start Clomid. 

I have been on Clomid now for 4 weeks of a 6 month trial and took the follow up blood test yesterday (Friday at 8:30am). I see Andrology a week on Monday to discuss the results.

I am glad I don't have to take gel as I don't like the skin irritation I get with it especially when using it on my forearms

Wishing you the best and really hoping you can get your symptoms dealt with as its real frustrating when coming up against  inexperienced doctors.

Kind Regards
Dave
« Last Edit: December 15, 2013, 12:32:14 AM by db570uk »

BigV

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Re: Andrology Department - UCLH
« Reply #2 on: December 15, 2013, 05:05:16 PM »
The guidelines  state a level under 8nmol/L could be treated with TRT.  http://www.androids.org.uk/hypogonadism1.pdf

However, we can see from the members informal 'reference range map' posted here: http://www.androids.org.uk/forum/index.php?topic=260.0  that levels of 7-8nmol/L are often falling within the 'normal range' in many areas, which is probably why the endo didn't seem bothered.

To be honest many of them don't see bothered to treat hypogonadism unless the tests results are ridiculously abnormal. Symptoms don't seem to count for much.  It is the same for 'mildly' hypothyroid patients as well. 

I don't know a huge amount about clomid but I have a few concerns really.....
1) It is normally used for fertility, I can't see many doctors being willing to prescribe it long-term as TRT. 
2) Would it even be safe/effective long term treatment - side effects? 
3) Surely it is only an option if you have secondary hypogonadism.  With primary no amount of clomid/HCG is going to help.
 

Brenton

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Re: Andrology Department - UCLH
« Reply #3 on: December 15, 2013, 06:54:59 PM »
Big V

Thanks for your message. I don't think Clomid is right for me either and as they only seem to give it to people in a relationship or who want to have children, that counts me out too.

I have had an MRI on my pituitary which was clear.  Have also been tested for Klinefelter Syndrome and it was also negative. My main problem is E2. When I tried T gel, most of it converted to E2 - I was 111 which is very high when your T is only raised to 9 on the gel. Do you think they would consider giving me T replacement and an aromatase inhibitor like Arimidex? Am I right in thinking that use of Arimidex in men is not formally approved in the UK? Also, would I be best combining T gel with Arimidex or T injections like Sustanon or Nebido?

Thanks for your advice

Brenton

nick

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Re: Andrology Department - UCLH
« Reply #4 on: December 15, 2013, 07:52:36 PM »
Hi Brenton,

As I said when I met you, UCLH is the place to go to get help.

Ultimately I think a dose of Clomid may be the way to go once you have switched away from SSRI anti-depressants and begun to control the Estrogen.

Arimidex has been prescribed for elevated Estradiol on the NHS by two doctors that I know of. Therefore I see no reason to expect an issue in attempting to firstly give your body the best chance of recovery and secondly, to see whether the T levels will rise as the Estradiol lowers. If they don't then it is a matter of ascertaining whether your system can be kickstarted on its own.

There are a number of reasons to be prescribed these kinds of drugs, one of which includes gender issues, should you have them.

In any event, for me, it makes sense to go down the path I suggested on Friday. It will of course take time, however, in my view it is better to start from a base point where you know your body is free of complicating factors like Estradiol and SSRI anti-depressants.

Having said all that, far be it from me to speculate on the reaction you receive or the decisions to be made by doctors. One step at a time my friend. I know it is very difficult to deal with this and causes a lot of stress, but try to be patient and have some confidence that this forum is right behind you to help.

I hope it helps.

best as always

Nick