T Nation

11 Weeks In, Still No Improvement. Updated Labs

Labs from 2/11.19
Total test 579 (264-916)
Free test 10.9 (8.7-25.1)
LH – 2.7 (1.7-8.6)
Estradiol Senitive – 7.4 (8-35)
SHBG 58.6 (16.5 – 55.9)
TSH 2.090 uIU/mL 0.450 - 4.500 01
Thyroxine (T4) 5.4 ug/dL 4.5 - 12.0 01
Triiodothyronine (T3) 81 ng/dL 71 - 180 01
Triiodothyronine (T3), Free 2.4 pg/mL 2.0 - 4.4 01
T4,Free(Direct) 1.23 ng/dL 0.82 - 1.77 01
Reverse T3, Serum A 13.8 ng/dL 9.2 - 24.1 01
Thyroid Peroxidase (TPO) Ab 18 IU/mL 0 - 34 01
Thyroglobulin Antibody <1.0 IU/mL 0.0 -0.9

-----Labs from 4/1/19--------
Total test 656 (264-916)
Free test 15.9 (8.7-25.1)
LH – 3.9 (1.7-8.6)
Estradiol Senitive – 12.6 (8-35)
SHBG not tested
Thyroid not tested

—Labs taken 4/15/19—
Testosterone, Serum 933 (264-916 ng/dL)
Free Testosterone(Direct) 18.2 (8.7-25.1pg/mL)
DHEA-Sulfate 436.9 (138.5-475.2 ug/dL)
Luteinizing Hormone(LH) 18.7 (1.7-8.6)
IGF-1 154 (88-246 ng/mL)
Estradiol, Sensitive 18.7 (8.0-35.0 pg/mL)
Free T3 - 2.6 (2.2-4.4)
SHBG - 73.6 (16.5-55.9)

My main symptoms are unexplained weight gain and inability to lose weight. With disciplined diet/exercise, I was single digit BF% my whole life, up until 18 months ago. Despite very calculated calorie intake and exercise, I simply cannot lose weight for the last ~18 months. I’ve crept up to 14% BF, despite exercising 6x per week and calories very much in check. I originally started treatment due to the weight, and lower libido. Erections are fine, mood in generally fine. The weight above everything else is what needs addressing.

IN March I began 12.5mg CLomid EOD. The labs tested on 4/1 are from 5 weeks of this treatment.

In April, I was increased to 25mg Clomid every day and given Armour Thyroid (mix of t4 and t3) to help with thyroid and weight loss.

The latest labs, from 5/15 are where I currently am at. Total test went up a lot, free T not much, LH not much, free T3 not much, SHBG went up a lot, IGF is still low.

After talking with the doctor, he gave me a lot of options, but didn’t give an exact recommendation. Given the weight issue being my main concern, he suggested the Thyroid is the main thing to address. He has perscribed cytomel (pure t3) to get my t3 numbers up, as they didn’t raise much with the combo of t3 and t4.

He did prescribe Testosterone and HCG, but said I could hold off on that, if I wanted. Remaining fertile is important to me, and if I it’s just the thyroid that needs to be addressed, I’d rather not have to be on TRT the rest of my life.

With my IGF being low (even lower than when I started any treatment), we talked of peptide therapy. He prescribed a peptide, saying it;s there if I want to order it. However, it’s quite expensive. I know other sites that sell it for less. Do other sources that sell it also provide the insulin needle and injection/mixing/storage instructions?

He suggests that I go off the clomid, given the SHBG. And just start taking 5micrograms cytomel, and bump Armour thyroid down to 1.5 grains (ive been taking 2 grains). He thinks this alone will address my weight issue, but prescribed the test/HCG I want to order it after a month of trying this approach. He also suggests that once I go off clomid, my testosterone will likely lower back to the 500s, but thinks clomid wasn’t helping me much, given the little the LH went, and how high SHBG went up. Thoughts?

Questions:

With weight being the main issue, would it suggest a thyroid issue more so than a testosterone issue?

What would you do in my case? Bite the bullet and get on the T train for life (I"m 33 years old)

Should I try peptide to raise IGF1?

  • Other remedies to increase LH and/or decrease SHBG?

I believe you are at the end of the road, TRT is your only chance at a normal life. You need to get Free T3 above midrange and Free T to the optimal ranges (20-26 pg/mL). You don’t have to start out on HCG, it’s mainly used for fertility and will increase estrogen and take away the effects of TRT then requiring the use of AI’s which really kills the benefits of TRT.

Blocking hormones always is bad for you, no amount of drugs is best.

Thyroid is a definite issue for you. The reverse T3 is killing you, and I think your doc is correct and a great doctor.I would hold off on TRT and see what the Cytomel does for you.

@systemlord - Is your response in regards to just raising LH/lowering SHBG, or in response to my whole dilemma (weight being the biggest one). If I can restore my metabolism and weight back to normal without TRT, that would be ideal. If I knew definitively that my only chance to get this weight off wasis to introduce TRT, then I’d do it right away. As far as estrogen, my body seems to stay resistant to it. Doing clomid 25mg every day for 4 weeks and it only crept up from 12.6 to 18.7.

And you say don’t have to start on HCG? My understanding is that TRT will lower sperm count, but paired with HCG, you will keep it from dropping too much?

@hardartery - You feel that the T3 supplementation will get the Free t3 and reverse t3 to a better ratio, and get my metobolism back in order? The doc said ideal Free t3 to Rev t3 ratio is 20%

I think that your problem is thyroid, not testosterone, so hopefully yes the Cytomel would fix it.

In your case you can only increase LH with clomid, but clomid will also increase SHBG lowering your Free T, Free T is your problem so you can’t have your cake and eat it to. Fixing the thyroid doesn’t usually net you more testosterone, actually Free T3 increases SHBG, so once you get Free T3 to the optimal ranges, SHBG will increase. So you see your situation is impossible.

LH is a better indicator of testosterone production, even if your SHBG was lower, Free T would still be suboptimal and you would still need TRT. The high SHBG is making the whole T situation look a lot better than it really is, that’s because what little T you do have is all bound to SHBG. If SHBG decreased, Total T would be below ranges and Free T inadequate.

HCG can complicate your TRT protocol, adding more estrogen sides that forces you to go for the anastrozole which will degrade TRT effects on your body. You can add the necessary evil when looking to have kids and even add FSH injections to greatly improve your changes at increasing sperm production.

You can always restart your HPTA using clomid to increase sperm production. You don’t have to be on HCG, you may not see a significant reduction in testicular size, most see a small 30% reduction, others a large reduction. It bothers some guys, mostly HCG is for cosmetic purposes.

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You can have your cake and eat it too. The trick is to eat one’s cake and have it too.

Seems like your e2 is too low given your high-ish SHBG. When my e2 was low because of over-AI use, I couldn’t drop weight to save my life, and cravings for sugary foods were insane. I tracked every calorie & macro, but no progress. When I got my e2 up into a higher range, it was like a switch flipped and my diet & exercise started to pay off and dropped 35 lbs. just a thought.

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Lollll exactly bahaha

Yup estrogen facilitated fat loss, addition of muscle and so much more.

Amazing how far we’ve come in past few years in regards to e2.

Now we know body builders didn’t even block estrogen until right before a show. It was to lower the water absorption and give that dry ripped look. The pros still use this tactic. Even stand the rhino says athletes he coached complained of joint pain and not being able to lose fat while on ai. When removed they were better and stopped complaining. This is why he stopped the ai himself.

So yes I appreciate your comment. I wish more would wrap their head around it.

Ai are only used when all other efforts fail: Dose, frequency, diet , fitness and lifestyle changes.

How would one address low e2? The doctor suggested with such a high SHBG, it’s holding my e2 back. He said he thinks I could be up to an e2 of 40 and still feel fine. He’s now suggested to stop the clomid to stop raising the SHBG, but that will also cause the testosterone to drop, and I’d imagine the e2 to begin to come down again?

If it were me I’d add in HCG small doses to create some e2 and drop Clomid, or stop trying to raise SHBG and run T only for 6 weeks and retest. If SHBG goes down you may need more frequent injections.

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@swoops39 You’re suggesting HCG & T treatment for 6 weeks. If things look good, I’ll need to continue this forever? I was thinking HCG monotherapy may be beneficial? When I spoke with the doctor from defy 6 weeks ago, he was up in the air of increasing Clomid dosage or HCG monotherapy, and ultimately went with clomid increase. The PA from defy suggested HCG would drop my LH to zero and I’d have to be on that forever. But from what I read, that is not true?

Would HCG monotherapy do the job of allowing SHBG to lower, keeping testosterone high and increase free T? How long would I need to be on HCG monotherapy? I’m going to speak with Defy again tomorrow, and hope to have enough information to help figure out how I would like to proceed.

This is beyond my depth honestly. I just wanted to comment on the weight loss/e2 connection. And I know adding HCG to a TRT program will almost certainly increase e2, which I think in your case could be higher given your SHBG levels.

What are your goals? If you want to raise testosterone levels and reap the benefits, then I think T injections is the best way to go. If fertility is a concern, add in Clomid or HCG.

There’s other guys on this forum that know way more than me when it comes to HCG or Clomid only therapy options. One of them will chime in I hope.

Either way, good luck to ya

Oh and yes, this is along term (life long for most of us) commitment to getting healthy again. I mentioned 6 weeks just to allow levels to stabilize before bloodwork.

No, HCG will not be enough to lower SHBG and increase Free T. TRT causes spikes in T & E2 and this mechanism lowers SHBG. If having a problem with chronic low E2, adding HCG can be a game changer. HCG monotherapy has its problems, HCG only stimulates half of the testicles and E2 can get out of hand inside the testicles that not even anastrozole can affect to any degree.

If on TRT and HCG, E2 is produced inside the testicles and is converted in fat tissue through the aromatization process. This is why E2 increases on TRT when adding in HCG to a TRT protocol.

Everytime you change your dosage it will take 6 weeks to build up in your system forcing your body to adapt which is a slow process.

The weight is my main concern here. What is undetermined by me is if my inability to lose weight is from the low free T, low e2, low IGF-1, or bad free t3. TRT would address free T, low e2, and IGF-1, but I’m wondering if just the thyroid needs to be addressed to get the weight in check? With absence of other low T issues (erections, depression, lethargy, etc…), I’m afraid of the TRT route and rely on it the rest of my life just to not feel miserable.

@systemlord You’re saying that TRT + HCG will result in fat gain, but TRT alone would not? I’m debating trying just thyroid med adjustment (adding Cytomel and lowering Armour thyroid) vs. thyroid adjustment + TRT + HCG to remain fertile. But if weight is the main concern, it sounds like this wouldn’t be the way to go?

As far as fertility - I’d be trying for a kid in the next 6 months. However, it’s a priority to get my physical condition in better order first.

TRT in isolation may make you infertile, adding HCG and when not enough adding FSH injections is your best chance at improving fertility on TRT short of stopping TRT and restarting the HPTA using clomid.

You can start clomid and deal with the side effects until you impregnate your wife, then go on TRT to improve your physical condition. Your best chance at fertility is the latter option.

TRT may increase IGF-1, if not there is always peptides which will increase your natural growth hormone/IGF-1 production.

Weight loss issues will be T3 related more than the others, and exacerbated by the low E2. Your body will increase SHBG in response to low test, if there are no other contributing medical conditions affecting that, and conversely keeping an elevated test level will over time lower your SHBG. When it’s low the body is trying to hold onto it for the most critical functions and it does that by increasing SHBG.

That is also my thought on SHBG, however I am curious to hear more about the mechanism behind low E2 causing weight gain/issues. I have low E2 myself and definitely have some abdominal fat due to it, my free T3 came back elevated though.