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PostPosted: Sun Feb 12, 2017 7:25 pm 
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AFreshStart1 wrote:
I have heard of people skipping days on bupe. I would like to try this.


this is easy to do. bupe has such a long half life that you will still have some in your system even if you skip a day or dose. you could try skipping a pm dose if you take yours twice a day, then take your reg morning dose. there are tons of taper schedules that involve skipping days and even a kicker dose at the end.

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PostPosted: Tue Feb 14, 2017 12:41 pm 
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Just an update peeps. been a mad week.Hope everyones well.

I eventually got on TRT. i start tomorrow on sustanon 250. weekly injections. Prescribed and legit. I had to really pull some strings. I will do a post on it once settled and see if it helps.

I have read some research papers and pills, opiates all reduce T esp if used a lot and high dose. Long acting like methadone and bupe are "apprently" even worse for lowering T and it makes you 5 times as likely to have low testosterone.

Maybe people like me experiencing symptoms such as low libido, focus, mood swings, etc could have low T.

I will let you know if it works. One thing for sure being on 8mg is much much better than 12. Thanks all I can see the light at the end of the tunnel.

Brb :)


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PostPosted: Tue Feb 14, 2017 12:58 pm 
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Could you please cite your research for bupernorphine and methadone making a man 5 times more likely to get low T?

Thanks!

Amy

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PostPosted: Tue Feb 14, 2017 3:05 pm 
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Hey Fresh,

Appreciate your updates. From my reading, opiate route of administration, dose and longevity did directly correlate with opioid endocrinopathy aka low sex hormone. For example, cancer patients receiving opiates via the spinal canal had a higher incidence than those taking orally. Seems most studies are done w pain patients and a few w heroin addicts. And yep, folks w 'low libido, focus, mood swings, etc could have low T.'

Wondering the same as Amy. I've never read of the 5Xs incidence w bup and methadone. In fact, have read the opposite. These quotes are from the April 2015 medical article linked below.

'Methadone did not affect testosterone differently than other opioids.'

'This suppression is not specific to methadone but to all opioids in general, whether it be for illicit or therapeutic use.'

'Buprenorphine, a synthetic opioid similar to methadone, is also used in substitute opioid therapy, and
was explored in a study by Bliesener et al. (2005). Although testosterone levels were greater in the
buprenorphine-treated group compared to methadone-treated patients and when compared to non-opioid users, these differences were not significant (Bliesener et al., 2005). This finding does potentially highlight the need for further studies with patients undergoing addiction treatment with buprenorphine that include larger sample sizes, in order to clarify this effect.' Imo, this means it would be interesting to see if perhaps bup users do maintain higher T levels than methadone.

http://www.drugandalcoholdependence.com ... 76-8716(15)00073-3/fulltext
Or the PDF http://www.drugandalcoholdependence.com ... 76-8716(15)00073-3/pdf Pits! I don't know why these links do not work here. Its open access. either should work if you copy and paste into any browser. Or into the upper right search field at top of this page. Its a well done review and worth looking at it. Another way to get it is https://www.ncbi.nlm.nih.gov/pubmed/25702934 . Then go to LinkOut and click Elsevier Science. Once at the article, click Full Text.

On bup, great that 'less is more' for you! Pleased you seem more hopeful and encouraged. Again, appreciate your posts. Look forward to more on your journey. Best, P

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PostPosted: Tue Feb 14, 2017 10:12 pm 
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I feel your pain brother, I have only been on them since august but was prescribed 16mg a day. Within a month I was taking like 1/4 a pill a day because knew eventually id be withdraling from them. I had no trouble weening down to even an 8th of a pill/strip now. But I cant for the life of me quit all together. At night time it wears off and i have trouble sleeping. I never get a good nights sleep and wake up feeling exhausted and cold as fuck. I have to cut my strip take it and wait in bed for aprox 40 mins before even trying to start my day. I quit going to the doc like 2 months ago but still have 25 8 mg strips. I feel the only way ill be able to quit is when i run out. Just figured id let you know im in the same boat hang in there man you got it! :wink:


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PostPosted: Tue Feb 14, 2017 10:17 pm 
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SisterMorphine wrote:
AFreshStart1 wrote:
I have heard of people skipping days on bupe. I would like to try this.


this is easy to do. bupe has such a long half life that you will still have some in your system even if you skip a day or dose. you could try skipping a pm dose if you take yours twice a day, then take your reg morning dose. there are tons of taper schedules that involve skipping days and even a kicker dose at the end.

Also i will say when i was taking 16 mg a day i could go 2-3 days without but with 1 mg it doesnt even get me all the way through the day


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PostPosted: Wed Feb 15, 2017 1:12 am 
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Thanks for the studies everyone. Everything I've read-- maybe 5 or 6 studies over the years--- shows LESS testosterone suppression from buprenorphine than from full agonists (which is what we would expect with a partial agonist).

Testosterone goes down in ALL men from aging, so it is hard to determine the amount of a decrease caused by buprenorphine without large samples and controls. I have patients with 'Low T' who have never used opioids.

While the TV commercials blame 'low T' for all sorts of things, realize that women manage to get through their days without testosterone. There is an association between loss of sex drive and low T, but doing all of the normal, healthy things, like getting enough sleep and exercising, will prevent many of the 'symptoms' of low T. Given the risks of untreated opioid dependence-- the lost savings, the risk of jail and prison, the break up of the family, the risk of hep C and overdose--- the effect on testosterone is not a huge issue for most men, at least in the patients that I see.


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PostPosted: Wed Feb 15, 2017 1:14 pm 
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Hi all these may be interesting.

From what im hearing.

Long acting opiods like meth are worse for low T than short acting. Methadone seema worse for it than bupe.

Clinical studies show a drop in T on a number of patients on methadone and bupe compared to those not on them

The 5x is stated in this bag somewhere and on other recovery forums.

Likely enough here for peeps to take an informed view. I'm certainly covinced both methadone and bupe "can" cause or contribute to low T in men.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4070102/

https://janaburson.wordpress.com/tag/te ... methadone/

http://www.sciencedirect.com/science/ar ... 1615000733

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951625/

http://www.ncbi.nlm.nih.gov/pubmed/15483091

http://drugabuse.com/does-methadone-tre ... d-addicts/

So much info on it.


Last edited by AFreshStart1 on Wed Feb 15, 2017 1:34 pm, edited 2 times in total.

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PostPosted: Wed Feb 15, 2017 1:18 pm 
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More Testosterone Research

Other studies have reported similar findings. Dr. Andrea Rubenstein presented her research last April at the American Academy of Pain Medicine meeting, which involved observing 81 men who took opioids for at least three months. She found that those who used long-acting opioids such as methadone were five times more likely to have low testosterone levels than those who used short-acting opioids, such as hydrocodone or immediate-release oxycodone.


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PostPosted: Wed Feb 15, 2017 1:31 pm 
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http://onlinelibrary.wiley.com/doi/10.1 ... 824.x/full

"Overall 54% of men (methadone 65%; buprenorphine 28%) had total testosterone (TT) <12.0 nm; 34% (methadone 39%; buprenorphine 11%) had TT <8.0 nm. Both methadone- and buprenorphine-treated men had lower free testosterone, luteinising hormone and estradiol than age-matched reference groups. Methadone-treated men had lower TT than bupreno"

I agree dying, families suffering, all the pain and heart ache that comes with addication is a prime comcern.

But lets face it feeling depressed, no sex drive, focus, energy, feeling emotionally flat, over long periods is not excatly fun. Plus strugging with Jobs and relationships.

Just good to know the risks and facts and at least make people more aware. Its unfair to fluff things up. I wish I had known :/ ive thought i was going mad. My levels are lower than a 90 year old man! No wonder I feel crap.* excuse my spelling eye sight is bad.


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PostPosted: Wed Feb 15, 2017 3:09 pm 
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Sorry I find all this quite interesting. Heres a safety warning from the FDA 2016 regarding warnings on all painkillers inc methadone and bupe. The link is long as its a pdf download.

https://www.google.co.uk/url?sa=t&sourc ... cjrsVrMOYg

The below will be clearly stated on all precription opiates.

• Taking opioids may lead to a rare, but serious condition in which the adrenal glands
do not produce adequate amounts of the hormone cortisol. Cortisol helps the body
respond to stress.

• Long-term use of opioids may be associated with decreased sex hormone levels and
symptoms such as reduced interest in sex, impotence, or infertility.

Adrenal insufficiency
• Cases of adrenal insufficiency have been reported with opioid use.
• Presentation of adrenal insufficiency may include nonspecific symptoms and signs,
including nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood
pressure.


• If adrenal insufficiency is suspected, confirm with diagnostic testing as soon as
possible. The patient should be treated with physiologic replacement doses of
corticosteroids and weaned off of the opioid to allow adrenal function to recover.
• If the opioid can be discontinued, follow-up assessment of adrenal function should be
performed to determine if treatment with corticosteroids can be discontinued.
• Other opioids may be tried as some cases reported use of a different opioid without
recurrence of adrenal insufficiency.
• The information available does not identify any particular opioids as being more
likely to be associated with adrenal insufficiency

Androgen deficiency
• Chronic use of opioids may influence the hypothalamic-pituitary-gonadal axis,
leading to androgen deficiency that may manifest as low libido, impotence, erectile
dysfunction, amenorrhea, or infertility.
• The causal role of opioids in the clinical syndrome of hypogonadism is unknown
because the various medical, physical, lifestyle, and psychological stressors that may
influence gonadal hormone levels have not been adequately controlled in studies
conducted to date.
• Patients presenting with symptoms or signs of androgen deficiency should undergo
laboratory evaluation.


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PostPosted: Wed Feb 15, 2017 3:50 pm 
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I don't think anyone was saying that buprenorphine doesn't possibly contribute to low T. I think the question was about the statement that methadone and buprenorphine are 5 times more likely to cause it. Especially since bupe is a partial opiate, not a full opiate.

I look at Dr. Junigs post above and would trust anything he says concerning buprenorphine and agree with him on bupe actually having a less effect than full opiates on low T.

That's all I have to say about the low T, I obviously don't know a lot about it and I'm not into all the studies and stuff, but I do know with suboxone...... The positives outweigh the negatives by a land slide imo :)

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PostPosted: Wed Feb 15, 2017 3:50 pm 
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We totally find it interesting as well! That's one reason we asked for it! The other was, of course, so we know that people who come here are getting the best info possible. :)

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PostPosted: Wed Feb 15, 2017 4:36 pm 
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Understand that the document you posted is not intended to provide information about specific opioids. The FDA document listed is a broad statement about a CLASS of drugs-- not information about a specific medication.

But reviewing that document, look down at the bottom, to reference #19-- the article on the list that pertains to buprenorphine. Here is the citation:

Bliesener N, Albrecht S, Schwager A, Weckbecker K, Lichtermann D, Klingmüller D.
Plasma testosterone and sexual function in men receiving buprenorphine maintenance
for opioid dependence. J Clin Endocrinol Metab 2005;90:203-206

Here is the Abstract-- i.e. the section that provides a brief summary of the methodology and results
(BTW, you can look most articles up on pubmed.com--for free-- and get at least the abstract, by searching for the title or authors. I have access to all journals that are in electronic format-- a list of tens of thousands of journals-- as my reward for volunteer teaching at the Medical College of WI)

The Abstract:

High-dose methadone is well known to cause testosterone deficiency and sexual dysfunction in opioid-dependent men. Buprenorphine is a new drug for the pharmacotherapy of opioid dependence. Its influence on the gonadal axis has not been investigated to date. We therefore assayed testosterone, free testosterone, estradiol, SHBG, LH, FSH, and prolactin in 17 men treated with buprenorphine. Thirty-seven men treated with high-dose methadone and 51 healthy blood donors served as controls. Sexual function and depression were assessed using a self-rating sexual function questionnaire and the Beck Depression Inventory. Patients treated with buprenorphine had a significantly higher testosterone level [5.1 ± 1.2 ng/ml (17.7 ± 4.2 nmol/liter) vs. 2.8 ± 1.2 ng/ml (9.7 ± 4.2 nmol/liter); P < 0.0001] and a significantly lower frequency of sexual dysfunction (P < 0.0001) compared with patients treated with methadone. The testosterone level of buprenorphine-treated patients did not differ from that of healthy controls. In conclusion, we demonstrated for the first time that buprenorphine, in contrast with high-dose methadone, seems not to suppress plasma testosterone in heroin-addicted men. To this effect, buprenorphine was less frequently related to sexual side effects. Buprenorphine might therefore be favored in the treatment of opioid dependence to prevent patients from the clinical consequences of methadone-induced hypogonadism.

I've seen a couple other studies that mirror this one.

As for adrenal insufficiency, yes-- that 'has been seen' with opioids. But you should note that people 'have been struck' by lightning. Hundreds of millions of prescriptions are written for opioids each year-- and almost everything you can think of 'has been reported'. In my 30 years of clinical medicine, I've never seen or even heard a doctor discuss treatment of a patient with adrenal insufficiency caused by opioids-- and most doctors would say the same, as it is RARE.

Dying from abstinence-based treatment for opioid dependence is many, many, MANY times more likely than getting Addison's Disease from an opioid. Worrying about that risk is like fearing a colonoscopy because a plane might crash into the surgicenter.

I also took the time to review the link that starts with 'online library', from the Journal of Andrology. I reviewed the entire article-- not the sentence or two posted above. This is the frustrating thing about hyping fear on internet forums... it is easy to pick a sentence that MISLEADS. I don't know if the person posting read the entire article-- but the article found NO significant difference between testosterone levels between people on buprenorphine vs. controls! That is even hinted at in the part posted above-- where it cites the significant difference in testosterone BETWEEN methadone and buprenorphine (i.e. LOW in methadone patients, NOT LOW in buprenorphine patients). The first part posted sounds like you are onto something, until you think about it-- 11% of bupe patients had levels below 'reference levels'. If you look at the general population you will have people above and below reference levels; we don't all have the same level of testosterone!

That is a messy study, as it looks at many hormone levels and lists which ones are 'abnormal'-- and as a secondary finding says that leutinizing hormone WAS lower in bupe patients. They conclude that 'A lack of suppression of testosterone by buprenorphine suggests that some opioids may have other types of effect on sex hormones than by hypothalamic/pituitary suppression.'

But even that LH finding is questionable, because when looking at multiple end results, the cut-off that determines whether something is 'significant' decreases as the number of results increases. This is a complicated statistical issue, but if the cut-off is 0.05, the standard for a single-result study, one would expect a false-positive finding once out of every 20 determinations (5 percent of 20 is 1). So if you are looking at a number of hormone abnormalities, a significant finding requires a cut-off lower than 0.05, since there is a much greater chance of getting a false positive. I don't teach statistics so I'm not great at explaining the issue, and it doesn't really matter, as LH levels are not linked to clinical symptoms in men.

In case someone is skimming this thread, the bottom line is that people on buprenorphine do not experience suppression of testosterone according to clinical studies-- including the studies in this thread.


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PostPosted: Wed Feb 15, 2017 8:07 pm 
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Thank you, Dr. Junig for really looking at the study. You are far better suited, and probably more thorough than any of us, except, perhaps, another doctor, and also know what to look for better than anyone too. I'm relieved that you looked at the articles so quickly, because I would have made an attempt to hash it out as well, and most likely would have missed important information.

Reason # 359 of the reasons I am grateful for your forum and your presence on it.

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PostPosted: Wed Feb 15, 2017 8:08 pm 
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Thx Dr. J.

Pelican here. We needed your expertise w this! Thank you.

In my prior post, I questioned OP Fresh's claim that long acting opioid users, notably including buprenorphine are 5X's more likely to experience low T. But, to include buprenorphine in the 5X's claim - is incorrect. I posted a link to a meta analysis which reviewed 50 studies with 34 excluded for various reasons, including Dr Rubenstein's, the source of the 5X claim.

I checked further into the 5X claim and found at the American Academy of Pain April 2012 meeting, Andrea Rubenstein MD who treats chronic pain patients, presented "Hypogonadism in Men Using Daily Opioid Therapy for Chronic Noncancer Pain is Associated with Duration of Action of Opioid" Poster 229. In this poster session she reported after controlling for daily dosage and body mass index, the study of 81 males found that the odds of having low testosterone were 4.78 times greater for men taking a long-acting opioid than a short-acting opioid. Dose was not associated with an increased risk of low testosterone.

The problem with OP Fresh's claim is in Rubenstein's pain patients, most if not all are on short or long term FULL agonists, NOT buprenorphine, a partial agonist. The long term full agonists include methadone, fentanyl, extended release and sustained release versions of the short acting opiates. So to include buprenorphine in the 5X's claim - is incorrect.

Fresh, with your long prior history of polydrug use including methadone and other opiates, its possible and maybe probable, your low T came from them. The good news is - you found it and are now treating it!
Hoping you start to feel better soon. Keep us posted! Best, P

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PostPosted: Wed Feb 15, 2017 11:22 pm 
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Thanks for clarifying that issue-- I was not familiar with that study. But these discussions show the problems associated with interpreting scientific articles. Most people who read studies look at the title, and maybe the abstract. When I say 'most people', I'm referring to physicians, and even the scientists who work in the field of study of the article being reviewed.

I have been a 'peer reviewer' for the Journal of Addiction and for the Journal of Academic Psychiatry for about 10 years. People trying to get their work pubished submit their papers, and then 3-4 peer reviewers are given about a month to review them, and either reject them or accept with or without revisions. Most of the submissions are rejected for a variety of reasons. Sometimes the statistics are bad. Sometimes the conclusions are not strongly supported by the data. Sometimes there are flaws-- maybe the groups were not randomized sufficiently, or maybe they were randomized but they are not equivalent, i.e one group has patients who are older or sicker than the control group.

When studies are rejected by the good journals, they don't just disappear; they show up in the bad journals. All scientists know which journals are first-tier and which are second-tier. If an article is published in JAMA or the New England Journal of Medicine, you know that it was put through a rigourous evaluation process. But for every good, reliable journal there are at least 10, and maybe 100, journals with lower standards.

I don't want to discourage people from doing their own research. But people should understand that interpreting a scientific study, as a layperson, would be like me doing an engine tune-up after reading an instruction manual, or buidling a garage after looking at a set of plans. In case anyone doesn't get what I'm saying, I would make a crappy garage!!

We've probably almost beaten this issue to death... but as several people have pointed out, Buprenorphine would be a great treatment even if it DID have a big effect on testosterone levels! We use meds to lower cholesterol, in order to reduce the risk of heart disease; those medications are MUCH more dangerous than buprenorphine, or methadone for that matter.

If you look at other life-threatening illnesses, e.g. cancer, we use meds with huge side effects... meds that cause sterility, that make hair fall out, that can themselves increase the risk for cancer... and we accept those risks because cancer causes severe morbidity and mortality. Addiction also causes severe morbidity and mortality-- and I don't agree with the earlier comments that a person's sex life is as valuable as sobriety. Again, buprenorphine has not been shown to strongly impact sexual function. But even if it DID, it is better to be alive, and celibate, than to count on the possibility of sexual encounters in the afterlife.


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PostPosted: Thu Feb 16, 2017 2:10 am 
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Well its certainly a healthy debate.

For "me" I know my own body, its history better than anyone.

I felt pretty good for 6 months on bupe. That desended over the next 18mths to a fatiqued, snappy, unhappy man who felt 90 not 40. Rlationships and jobs started to get very tough.I have had a good diet, excercise. This is the complete reverse of what I was like before bupe.

I found out on here about low T and I have it. Or dont. However you want to put it. My god what a relief. I now know why!! Im not going mad. There is light.

Lots of simliar stories. It would seem from "guys" on bupe and on High doses.

I believe my low T is caused by what I call long term use of a high dose of bupe. Thats it. I was only on meth a few weeks. When on short acting opiates like oxy i never felt this consistent flatness. Even in WD. It was a rollercoaster. Not a nice one albiet.

Your right this has now been flogged to death. I would like to know how many of the posters in this are female. Looks like you girls wont have this issue. Im sincerly pleased. Way to go!

I get frustrated as I feel people are not told all the facts, through iggorance, education. GPs and workers and could end up suffering for years without knowing why.

If your a guy on bupe, meth or have used opiates and feel very low, no sex drive, moody and in a nut shell "bloody awful" go and ask your doc to check your testosterone please. Its cheap and quick.

Also think hard about taking more than you actually need too. Less is more.

Most of all Bupe does a great job of getting you off opiates and IS a life saver. Just tread careful, be wise. Know your body and mind. Cheers all. Good weekend!


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PostPosted: Thu Feb 16, 2017 3:39 am 
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Fresh, for someone who posted a lot of links to a bunch of supposed scientific research to assert that buprenorphine was 5x more likely to cause low T than short acting opioids, you have certainly discounted Dr. Junigs careful scrutiny of the science and the evidence. That you dismissed his effort so quickly only to fall back on (and I'm paraphrasing) "I know my own body and I'm convinced it was the bupe and a lot of other men seem to say that too," without acknowledging that he refuted your evidence, seems petty and lame. Pelican also provided some salient information on the subject and you ignore him too.

"I get frustrated as I feel people are not told all the facts, through iggorance, education. GPs and workers and could end up suffering for years without knowing why."

There are low T quizzes all over the internet. If a man does not evaluate symptoms through a quick search online, and instead attributes all signs and symptoms to a medication that he's been on for a while, then I don't have much empathy for him. I've been on a birth control pill for a number of years. If I suddenly had no sex drive and was moody after years of using, I would not assume it was caused by my birth control pill. Why is it logical to assume new symptoms are caused by an old medication?

Oh, and speaking of birth control pills, I would be happy to trade an easily treatable version of hormone fluctuation like low T for the regular fluctuation a woman experiences from menstrual cycles, pain from cramps and childbirth, and postpartum depression. When should we swap?

Amy

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PostPosted: Thu Feb 16, 2017 10:56 pm 
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Thx Dr J, and agree. Thanks for all your efforts. Really appreciate you and your knowledge and expertise you freely give that benefits us all.

Hey all,

My half a penny before this goes away. Given Fresh's long term polydrug use, I think he seems far sicker than just low T.

In rehab, I was surprised at the higher number of folks who tested positive for Hep B, Hep C, HIV and/or TB. And they shared similar symptoms to Fresh -- anger and feeling 'bloody awful'.

Folks w his history of using drugs illicitly can have moderate-to-high infection rates and imo should get tested for Hep B, Hep C, HIV and TB. For example, TB does not require a cough as a symptom. His 'leg aches' could be from TB joint arthritis. His 'headaches' and 'mental changes' could be from swelling of the membranes that cover his brain. His 'nightsweats' and 'deep fatigue' are common TB symptoms. His 'blurry vision' and 'bad eyesight' could be from eye TB.

Of course, really IDK, nor have any medical expertise. But, if I had these symptoms and a wife and child depending on me and me keeping my job, I'd for sure check and not just incorrectly rely on blaming bup and low T.

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Dr. Jeffrey Junig, M.D., Ph.D.

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