T Nation

1 Year Update

Thank you guys for laying out the TRT info so clearly. I would have been lost without these forums.
I started on TRT a year ago. My initial symptoms were extreme fatigue, irritability, no drive, loss of muscle, minimal body hair. I could barely get out of bed. Before that I had always been very healthy/active.
After lots of idiot doctors, I finally found one who thought a Testosterone level of 193 might be related to my feeling like crap. (Range of 290 - 850)

These injections saved me but Im hoping to get off of them.
I started out doing 200mg every 10 days. I have reduced my dose to 40 mg Cyp E3D.
Currently taking .25mg Adex once a week. No HCG.
I realized I am an over responder to Adex. I was taking .5 EOD and felt like crap. Had some blood work done and the results said 1.9 with a range of 8-79.
I would like some input on my last blood labs. They were done in April.

ACTH 11 (range 9-52)
AM Cortisol 7 (range 5-23)
DHEAS 215 (range 168-592)
Estradiol 1.9 (range 8-79)
Testosterone 671 (range 280-1100)
SHBG 20 (range 13-71)
Free Test 157.4 (range 47-244)
%Free Test 2.3 (range 1.6-2.9)
Bioavailable 467.2 (range 131-682)
Alb 4.8 (range 3.3-4.8)

I feel like I�¢??ve got my injections and Adex pretty well balanced now. I definitely feel better than I did a year ago but still not 100%. My mental clarity, focus, drive, and energy are only be 75% of what they used to be.

Im looking for advice on two things:

  1. Adrenals- Two years ago I was in school and working fulltime. I didnt sleep enough, didnt eat well and relied heavily on caffeine. In addition, during my final semester of school we had a baby that had some complications and passed away. Lots of stress for a long period!
    I think its possible that I have adrenal fatigue but dont know how to pursue it. My current endocrinologist has been awesome for the TRT but does not think Adrenal Fatigue is legit.

  2. HCG- my balls went back to a more normal size when I reduced my Test dosage but Im wondering if HCG would help with my focus/mood etc. My doc may or may not be open to prescribing this.

I would appreciate any thoughts/comments on my labs and symptoms.
Thanks in advance.
Joe

(I couldnt add this post to my original case. If a thread is inactive for a while does it become un-editable?)

Sorry to hear about your baby, that must have been horrible.
I am an over responder to ADEX too, even .25 E3d crashed my E2.
Reading these forums made me try aromasin, I use a small does still 5mg every 3 days
and its like night and day for me.
Hope this helps.

Damn… sorry for your loss, dude.

Your symptoms are exactly what mine are. All I want to do is SLEEP! I have no energy to lift anymore. I start TRT here in about 10 days. Looking forward to getting 75% of MY energy back. I would take anything at this point, honestly.

Best of luck getting the rest of what’s going on resolved!

Hey thanks guys.
Didn’t mean to sound like a sob story. - Just wanted to emphasize the fact that there was more stress than just the day to day stuff and I think it fried my adrenals.
Thanks again though.

PK - I am going to look into getting Aromasin.

Beefy - good luck man. Be patient. You will see results.

search the forum for ‘adrenal fatigue’

Do a 4 sample 24 hour saliva cortisol test
AM cortisol is LOW. At what hour? Should be near 8AM.

do: TSH, fT4, fT3, rT3

read the advice for new guys and find points re iodine, iodized, sea salt, body temperture and respond to those points here

Tell us where you are located.

[You cannot edit your posts if you are not logged in.]

How old are you, btw?

As I read more on this site and try to pin point my sypmtoms, I’m realizing I have other issues that need to be addressed. - ie adrenals and possibly thyroid, not just testosterone.
I’m going to monitor my temperature this weekend and buy the book about adrenal fatigue mentioned in the stickies.

I had more bloodwork done this morning: TT, FT, E2, TSH, FT4, FT3, E2, DHEA-S, and Cortisol.
I always get bloodwork done between 7:30 and 8:00 am. I will post results when I get them.

Could someone explain the saliva test and why its preffered over the bloodwork for cortisol.?

I’m 29. 5’-10". 175lbs. Live in Utahr.

KSman - thanks for responding- I really value your input.

Lab Results for 8/31/12

fT3 3.0 (range 2.4-4.2)
fT4 1.21 (range .71-1.85)
TSH 2.20 (range .45-4.67)
DHEAS 230 (range 168-592)
Cortisol 11.0 (range 5-23)

Testosterone and E2 not available yet.

I don’t understand this stuff as well as many of you guys but from these results it seems my thyroid is okay and my adrenals need work.???

I appreciate any experience/suggestions you want to share.

[quote]Joey B wrote:
Lab Results for 8/31/12

fT3 3.0 (range 2.4-4.2)
fT4 1.21 (range .71-1.85)
TSH 2.20 (range .45-4.67)
DHEAS 230 (range 168-592)
Cortisol 11.0 (range 5-23)

Testosterone and E2 not available yet.

I don’t understand this stuff as well as many of you guys but from these results it seems my thyroid is okay and my adrenals need work.???

I appreciate any experience/suggestions you want to share. [/quote]

Your thyroid is actually pretty weak. With adrenal fatigue I would bet your rT3 is pretty high, minimizing what your FT3 can do. I had similar numbers and my rT3 was at the top of the range. I have been on low dose T3 only and my hypothyroid symptoms have been much better. I would say you really need to get your rT3 tested.

Got my other numbers

E2 12.4
Test 536 (range 280-1100)
SHBG 18 (range 13-71)
Free Test 133.3 (range 47-244)
%Free Test 2.5 (range 1.6-2.9)
Bioavailable 371.8 (range 131-682)
Alb 4.5 (range 3.3-4.8)

E2 is still low even at .25mg Adex per week. Should I just get off of an AI?

I talked with my doc. He thinks only my Testosterone needs treatment. From this last round of blood labs I know I need help with my Adrenal and Thyroid.

Question on thyroid numbers: My levels of FT3 FT4 and TSH are all pretty much right in the middle of the specified range - not at one end of the spectrum. So where do I want my numbers? At the higher or lower end?

PTownMike - what were your symptoms? Is T3 a pill or how is it taken? If I correct one of my Thyroid levels will the rest of them correct themselves? - I am worried I’m going to be on 5 different injections and a bunch of pills here pretty soon.

[quote]Joey B wrote:
Got my other numbers

E2 12.4
Test 536 (range 280-1100)
SHBG 18 (range 13-71)
Free Test 133.3 (range 47-244)
%Free Test 2.5 (range 1.6-2.9)
Bioavailable 371.8 (range 131-682)
Alb 4.5 (range 3.3-4.8)

E2 is still low even at .25mg Adex per week. Should I just get off of an AI?

I talked with my doc. He thinks only my Testosterone needs treatment. From this last round of blood labs I know I need help with my Adrenal and Thyroid.

Question on thyroid numbers: My levels of FT3 FT4 and TSH are all pretty much right in the middle of the specified range - not at one end of the spectrum. So where do I want my numbers? At the higher or lower end?

PTownMike - what were your symptoms? Is T3 a pill or how is it taken? If I correct one of my Thyroid levels will the rest of them correct themselves? - I am worried I’m going to be on 5 different injections and a bunch of pills here pretty soon.
[/quote]

I’m not an expert on thyroid but from my understanding you want your TSH around 1, anything over 1.5 you should look into, anything over 2 and there is a problem, anything over 3 and something is really screwed up. You want your Free T3 near the top of the range, I believe same for Free T4. With your weak adrenals you really need to get your reverse T3 tested. Most of the others on here can help you out much better with this, I’m just going off of my personal experience and what my integrative medicine doctor told me. Check out the stickies here there is a lot of good info.

My symptoms were kind of compounded with my low t symptoms, but they included brain fog, beig cold all the time, and the skin on the back of my knuckles always cracking off. My doctor started me supplementing my adrenals with something called Cytozyme-AD, B vitamins, along with many other vitamins and minerals for a month prior to starting me on my T3 meds (it’s just a little pill BTW). According to my doc you need to treat your adrenals prior to the thyroid. I slowly titrated up from 5mcg to 25 mcg a day on the T3 and now my cold temperatures are gone, and the skin on my hands is much better. My brain fog is gone, but how much of that is from the thyroid versus how much from getting my Testosterone raised up I don’t know. I’m supposed to get my labs back soon and we may adjust my meds if needed. BTW most doctors from what I have read treat Thyroid with T4 meds, which if you have a reverse T3 problem likely won’t do anything for you as the T4 will keep converting to reverse T3 rather than boosting your free T3 up to where it will help you. By treating me with T3 only it gives my body the T3 it needs while suppressing my T4 production, which helps to clear out the reverse T3. I’m sure I screwed something up in my explanation, again read the stickies as there is tons of great info on thyroid and adrenals here.

[quote]Joey B wrote:
Got my other numbers

E2 12.4
Test 536 (range 280-1100)
SHBG 18 (range 13-71)
Free Test 133.3 (range 47-244)
%Free Test 2.5 (range 1.6-2.9)
Bioavailable 371.8 (range 131-682)
Alb 4.5 (range 3.3-4.8)

E2 is still low even at .25mg Adex per week. Should I just get off of an AI?

I talked with my doc. He thinks only my Testosterone needs treatment. From this last round of blood labs I know I need help with my Adrenal and Thyroid.

Question on thyroid numbers: My levels of FT3 FT4 and TSH are all pretty much right in the middle of the specified range - not at one end of the spectrum. So where do I want my numbers? At the higher or lower end?

PTownMike - what were your symptoms? Is T3 a pill or how is it taken? If I correct one of my Thyroid levels will the rest of them correct themselves? - I am worried I’m going to be on 5 different injections and a bunch of pills here pretty soon.
[/quote]

T doesn’t look too bad, especially with your Free in good range. How are you feeling?

You want your Free T3/T4 to be in the upper 2/3 of the range. T3 is taken in pill form. Google Cytomel.

Thanks for the responses. I need to get my TSH down and FT3/FT4 up. Right?

Even though my Teststerone numbers are okay I feel only mediochre at best but I think its because of my other issues.
I’m realizing more and more than I need to focus on fixing my adrenals/thyroid now.

Is anyone on cortisol. Are cortisol injections the only prescribed treatment for adrenal issues besides lifestyle/diet changes and iodine?

I found an article by a guys who explains why stress on the adrenals affects the thyroid and hypothalmus/pituitary and eventually testosterone.

http://chriskresser.com/5-ways-that-stress-causes-hypothyroid-symptoms

Let me know what you think or if this stuff is even valid.
(somehow I trust you guys more than doctors)

Chris seems like a nice guy but there isn’t a single citation given. He literally could have woke up that morning and made every last sentence up off the top of his head. Not saying it’s not true…just asking how do you know?

Need those body temperatures. If fT3 and fT4 are near optimal, and they appear to be, and body temps are low, then you can assume that rT3 is blocking fT3 and rT3 lab would confirm or strike that diagnosis. We see guys with perfect fT3, fT4 labs and low body temperatures because of elevated rT3.

If you are not getting enough iodine, TSH can increase to compensate and fT3 and fT3 can then sometimes be good.

I asked: "read the advice for new guys and find points re iodine, iodized, sea salt, body temperature and respond to those points here "

Morning cortisol around 15 would be better. You do not want to go to a lab 4 times in one day to profile your cortisol tests and the lab will not be open at night. The four sample cortisol test allows you to take a snap shot of your daily cortisol profile.

Are there times of the day where you feel particularly fatigued?
Do you ever feel away or energized in the evenings?

As per stickies: adjust AI dose by 12.4/22=.56 to get E2=22pg/ml. We had one guy before who needed to take 1.8th mg/week. But, how exactly are you doing that and how are you dosing T and what is the timing for AI relative to T?

I will post my temps and look up those points.

Took my temps the past few days. They were fairly consistent from day to day.

6am 97.1
9am 96.9
12pm 96.7
3pm 97.5
6pm 97.5
10pm 96.2

Low AM temperature is indicative of Hypothyroid issues - not hyper?

Based on numbers, am I headed in the right direction - pursuing the Adrenal/Thyroid?

Response to other points:
Mornings- I feel only okay. - Not real sharp/alert without caffiene. (I tapered off caffiene recently.)
From about noon to 600pm I feel dead. Heavy, slow, lethargic, overheated. ? occasionally I feel a small boost right after lunch, but mostly dead tired.
Around 700 or 800pm I get a nice boost of energy for some reason. I?ll be slugging around my house then I?ll get the energy to go mow the lawn right as the sun starts going down. WTF
Wicked brain fog all the time.

Looking at my thyroid numbers and taking into account a thread entitled ?KSMAN has a thyroid problem? I have an iodine deficiency.
According to the post, an fT4 : fT3 ratio less than 5.0 indicates low iodine.
Using numbers posted above, my ratio is about 2.5 meaning I need to supplement.
Other related symptoms right now: fatigue, hot flash feelings, puffiness ?esp in the face, weight gain, dry skin, low body temps.

Is it odd that I feel warm/overheated even though my body temps are low?

KSMAN ?could you deeper explain your rT3 comment: ?We do know that this can be an expected complication with low cortisol levels (adrenal fatigue) and starvation diets. This can complicate the issues.?
Reason I ask- should I start with treating adrenals or thyroid?

What should my plan of action be?

Bump