T Nation

20 Y/O TRT. Need Help w/Bloodwork And Situation In General


#1

This post ended up getting real long, but I’d really appreciate it if you guys could read it in it’s entirety. I’ve been fucked over by incompetent doctors for too long now and just want to feel normal again, I have nobody IRL to talk to about this so the support network here is invaluable to me. Thanks in advance.

Age: 20
Height: 5’10
Waist: 32’
Weight: 168 lbs

Body and facial hair:
Very hairy legs, stomach and chest. Arm and facial hair are both sparse, though have improved since starting TRT.

Describe where you carry fat and how it has changed:
From a young age I’ve always had very estrogenic fat distribution. This hasn’t changed since starting TRT, though estrogen control has been an ever present an issue (more on this further down). I store all of my fat on my ass/hips, even at the end of my bulk where I got up to 22% bf I still had a perfectly flat stomach.

Health conditions:
ADHD, low testosterone and x-linked juvenile retinoschisis.

Rx and OTC drugs, any hair loss drugs or prostate drugs ever
– real dangers!
Concerta 18mg for ADHD, no 5AR inhibitors ever. I was considering starting finasteride since I’m rapidly balding at only 20 but have decided I do not want to take the risk.

Diet:
Diet depends on whether I’m bulking or cutting but is generally clean either way. I’m currently running a 500 cal deficit on nSuns 5/3/1 LP, I’ve also recently moved over to a vegan diet.

Testes ache, ever, with a fever?
They don’t ache, but ever since a testicular surgery I had when I was younger they hurt to touch. They were also significantly smaller once the swelling from the surgery went down. I believe the trauma from the surgery is what caused my low T at such a young age.

Morning wood:
This is a strange one for me because I’ve never had morning wood once in my entire life. Even as a testosterone fuelled 14 y/o with severe acne and gynocomastia I never got them. My erections were always fine though as was libido (until the surgey). Haven’t had morning wood while on TRT either.

I started TRT at 19 Y/O and have been on for the last 15 months. Things haven’t gone well since starting due to a combination of a lack of bloodwork (resulting in poor estorgen management), ineffective medication and incompetent doctors. I’ve had constant erectile dysfunction, low libido, depression and a number of other syptoms for the majority of my time being on T.

The main issue is the lack of bloodwork. The doctor who prescribes me TRT is located four hours away because I had to go private in search of treatment (I’m UK based). My local GP refused to refer me to a urologist because I was still within the reference range. At 19 Y/O my pre TRT bloodwork was as follows (both tests blood was drawn first thing in the morning, and the two are two weeks apart):

Total Testosterone: 14.0 (10.0 - 38.0) nmol/L
SHBG: 25.2 (16.0 - 55.0) nmolL

Total Testosterone: 12.9 (10.0 - 38.0) nmol/L
SHBG: 24.8 (16.5 - 55.0) nmol/L

As you can see my pre TRT blood work was very limited. Because the NHS is undergoing massive cuts GP’s are reluctant to put you in for bloodwork that they don’t deem necessary. I requested estradiol, LH and FSH but because the first test showed that my testosterone was within range he refused.

After those results I met with my current private consultant who offered me a prescription based on my levels. I knew that I needed more bloodwork, but at the time I was just desperate to feel normal again and didn’t know if I’d get another chance to start TRT. Since then blood work has been near impossible to get for two reasons.

The first is that my private consultant is located four hours away which costs me £80 on the train, and another £120 for the blood work/follow up appointment. I wouldn’t mind paying this, but when requested he never sends me a copy of my blood work. I refuse to pay over £200 for bloodowork and take dosage recommendations from a doctor who has often displayed his incompetence (he prescribes E14D sustanon injections, 5000iu p/w HCG for testicular maintenance ect) without seeing the results myself.

I also couldn’t get bloodwork closer to home because the GP refused. He says that I shouldn’t be on, and that facilitating a dangerous and unnecessary practise would be ‘unethical’. But apparently letting a 19 Y/O with bottom range testosterone with a history of testicular surgeries live with erectile dysfunction, little muscle mass and low libido is perfectly fine.

This has left me living with permanent erectile dysfunction and low libido for over a year now because I’ve been unable to manage estrogen. I’m a naturally heavy aromatizer (pubertal gyno, estrogeneic fat storage) and I started on gels which are notorious for raising e, and then moved over to Sustanon injections which also raise e due to the shorter acting esters. I’ve experienced early signs of gyno and other e related sides multiple times since starting. My doctor prescribe me anastrozole to try and control it, but without being able to get bloods it’s been impossible.

However, I recently discovered that medichecks offer private bloodwork that isn’t the unreliable finger prick tests. I am now able to order my own bloodwork and travel to my local hospital to have the blood drawn and send it off myself. I also managed to persuade my doctor to prescribe me test E instead of sustanon despite his reluctance. These two changes have allowed me to finally start making strides towards dialling in my protocol and feeling like a normal person again.

My protocol for the last four weeks was based on the sticky for beginners and has been as follows:

50mg Test E E3.5D
250iu HCG EOD
0.5mg Anastrozole E3.5D

I had bloodwork done at trough. The blood was drawn at 10am, and my next injection was due at 8pm the same day. The results are as follows:

Hormones:

Testosterone: *36.6 (7.60 - 31.40) nmol/L
FT (calc): 0.918 (0.30 - 1.00) nmol/L
17-Beta Oestradiol (standard assay): 93.1 (0.00 - 191.99) pmol/L
SHBG: 28.46 (16.00 - 55.00) nmol/L
Prolactin: 211 (86.00 - 324.00) mIU/L
PSA: 0.979 (0.00 - 1.40) ug/L

Thyroid:

TSH: 2.06 (0.27 - 4.20) mIU/L
FT4: 14.7 (12.00 - 22.00) pmol/L
FT3: 5.08 (3.10 - 6.80) pmol/L

Haematology:

Haemoglobin: 168 (130.00 - 170.00) g/L
HCT: 0.500 (0.37 - 0.50) L/L
RCB: 5.43 (4.40 - 5.80) x10^12/L
MCV: 92 (80.00 - 99.00) fl
MCH: 31.0 (26.00 - 33.50) pg
MCHC: 337 (300.00 - 350.00) g/L
RDW: 11.9 (11.50 - 15.00) %

White Blood Cells:

WBC: 3.7 (3.00 - 10.00)
Neutrophils: *1.90 (2.00 - 7.50)
Lymphocytes: 1.35 (1.20 - 3.65)
Monocytes: 0.33 (0.20 - 1.00)
Platelets: 153 (150.00 - 400.00)
MFV: 10.1 (7.00 - 13.00) fl

Kidney Function:

Creatinine: 103 (66.00 - 112.00) umol/L

Liver Function:

Alkaline Phosphatase: 81 (40.00 - 129.00) IU/L
Alanine Transferase: 29.6 (10.00 - 50.00) IU/L
Creatine Kinase: *402 (38.00 - 204.00) IU/L
Gamma GT: 19 (10.00 - 71.00) IU/L

Total Protein: 75.1 (63.00 - 83.00) g/L
Albumin: 46.5 (34.00 - 50.00) g/L
Globulin: 28.6 (19.00 - 35.00) g/L

Ferritin: 99.83 (30.00 - 400.00) ug/L

Cholesterol Status:
Triglycerides: 0.83 (0.00 - 2.30) nmol/L
Cholesterol: 3.51 (0.00 - 4.99) nmol/L
HDL: 1.29 (0.90 - 1.50) nmol/L
LDL: 1.84 (0.00 - 3.00) nmol/L
Non-HDL Cho: 2.22 (0.00 - 3.99) nmol/L

Heart Disease Risk:
HDL % of total: 36.75 (20.00 - 100.00) %

First concern:

The first is how my TT so high considering I’m on a conservative protocol. My test dose is only 100mg p/w, and I wouldn’t expect the HCG to be making much of difference as I suspect that the cause of my low T is primary from the surgery I mentioned previously.

I’ve been on this protocol for four weeks now. The first three I had strong, consistent erections with high libido, but the last week I’ve had erectile dysfunction and no interest in sex.

How is that possible with testosterone so high and estradiol in check? My only idea is that with the assay being standard my estro is actually off, but since sensitive isn’t available in the UK I have no way of knowing.

Second concern:

My creatine kinase is double the upper end of the reference range…

From what I’ve read it indicates muscle damage. The night before the blood was drawn was a heavy deadlift session working close to my training max. Is it possible this is the cause?

I’ve also read that it can sometimes indicate an issue with the heart. Lately I’ve been experiencing chest tightness/sensations, though blood pressure and HR are in check (I average 125/70 and 65 BPM). I chalked it up to my moderate anxiety anxiety but now I’m concerned.

I also started the medication conerta on Monday after being diagnosed with ADHD. I’m not sure if that could have had an effect (heart sensations were present before starting the conerta). I know nothing about the liver so hopefully someone more knowledgeable can shine some light on the situation.

Third concern:

My RBC’s are starting to get on the high side so it’s time to donate blood. Problem is I’m on anastrozole, and you’re not allowed to donate blood if you take it. Anyone got any ideas for that?

My while blood cells are all on the low side. This has been like this for years now but doctors don’t seem concerned. Figured I’d mention it in case anyone has any ideas.

That’s about everything I think. Damn, that’s the first time I’ve been able to fully explain my current situation alongside supporting bloodwork. It feels good to have somewhere to get it all out since nobody in my life has the first clue about any of this.

If anybody has any suggestions about my current situation, my most recent bloodwork and the actions that I need to take to improve I’d really apreciate the advice. Thanks for the help.


#2

Creatine Kinase: this suggests muscle damage
https://en.wikipedia.org/wiki/Creatine_kinase

Something wrong here, please correct:
Triglycerides: 0.83 (0.00 - 2.30) nmol/L
Cholesterol: 3.51 (0.00 - 2.30) nmol/L

TT may be carrying above average amount of non-bioavailable SHBG+T. SHBG and liver function are factors. When you look at calculated FT, results are not high. Testicular response to hCG is unknown. Note of testes seem to get firmer.

E2=93 is not bad, E2=80pg/ml is the therapeutic target.

You can stop paying for PSA and prolactin labwork.

TSH should be closer to 1.0
fT4 is well below mid-range, suggesting iodine deficiency
fT3 is good, but need to check oral body temperatures as per last paragraph.
Thyroid affects mood, clarity of thought, libido, energy and fat gain/loss.

HTC needs to be tracked. Other items do not explain why HTC is up. Could you have been dehydrated for the lab work?
Try to avoid iron enriched foods or supplements, read labels.

Could concerta be unwise? Would have been good to see how your mind and focus would have evolved with TRT and E2 management. Your brain will be getting rewired by TRT. Many on TRT with properly managed E2 are calm and more analytical.

Cannot donate blood with anastrozole? Never have heard of that, things will be different here vs UK. Male dosing is 1/7th of what is used for breast cancer, regulations are not created to be rational, but absolute.

You can increase anastrozole dose by a factor of 93/80 by making up a solution of anastrozole 1mg/ml and dispense by volume.

Injecting subq will create smoother T levels which should be more favorable for anastrozole function and RBC.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.


#3

So am I right in assuming that it was simply from my workout and I have no reason for concern?

Sorry, the reference range for cholesterol should have been 0.00 - 4.99. I’ll edit my post now.

So I should keep my dose as it is then? No need to drop down despite being above the range?

My testicles don’t seem to have changed upon addition of HCG, though it’s hard to tell. Even pre-TRT they were small and soft ever since the surgery.

.
Could this be the cause of the erectile dysfunction and low libido that became present a week before the blood test? I am currently unable to achieve an erection right now.

The assay was also standard, not sensitive if that makes a difference. I’ve heard that standard is considered unreliable for men.

I bought an oral thermometer last week after reading the stickies. I’ll start logging my AM and PM temps and report back in a week

I do recall being dehydrated. I had a long bus journey to the hospital and was seen right away so couldn’t have a drink. I had to buy a bottle of water from the hospital canteen once I left the nurse’s office.

Is there anything else I should be doing other than retesting in another 4-6 weeks to monitor HTC?

I’ve had ADHD traits since early childhood. The psychiatrist that I saw said that I likely went unnoticed because I still managed to keep my grades up early on.

Once my four week trail is over I no longer have to take it daily and can take it on an as needed basis. I’ll discontinue use for a while to see how I respond to the improved estrogen management.

The last time I tried to donate they refused me because the medication was flagged up.

I might tell them I’m off of the drug and donate, then report that I’ve become ill so they dispose of the blood.

I feel bad abusing a charity but I don’t know what my other option is.

Is there a specific solvent I should use or would plain vodka be fine?

The times that I tried subq I seemed to suffer immediate low T symptoms like I wasn’t absorbing the oil. Though I never had bloodwork to verify, the symptoms were instantly remedied by switching back to IM.

I may have been using a poor injection technique since I am used to doing IM.

Thank you for your advice, it’s much appreciated.


#4

Anything that you read about an estradiol test needing to be sensitive or ultra sensitive is specific to each lab company and generalizations are impossible.

You would need to repeat Creatine Kinase labs before any changes. Be rested up with muscle fully recovered.

Do not take cholesterol to low with your diet.

Your T and E2 levels should support good libido. Something else is going on, thyroid perhaps.

Inject subq over upper leg with #29 1/2" 0.5ml insulin syringes, use same size for hCG also subq or #31 5/16" 0.5ml

Please provide history of using iodized salt. - probably none.
In UK, you are meant to get iodine in dairy and eggs, many guys from UK that come here seem deficient. Do you eat sea food?


#5

With a vegan diet I don’t think there is a way to still take in dietary cholesterol. I’ll keep monitoring it to make sure it doesn’t change.

I think my issues started around the same time I began to take concerta. It’s been making me very anxious which may be the cause of libido/erection issues since everything was fine last week.

I’ll take a day or two off and see if libido comes back while on the same protocol. I haven’t had much therapeutic benefit anyway, just an increased heart rate and a headache.

As far as I’m aware I am not actively consuming iodized salts. I don’t consume any form of dairy or seafood.

Are iodized salts a common supplement that are easy to obtain, or is there a specific approach I have to take to increase my intake?

Thanks again.


#6

Some shops in the UK have iodized salt.

Please heed the warning that you must have selenium. This means a multi-vit. Suggest a high potency B-complex multi-vit with trace elements including 150mcg iodine and 200mcg selenium.

Your diet does not allow for fish oil, but some take krill oil. Other than that, you can get EFAs from nuts and flax seed oil/meal. EFAs are just that Essential.

Vegan for ethical reasons or a perception that this would lead to better health?

You might need to relax your source ethics for some vitamin products. With this diet, B-12 deficiency is very possible. You are not getting any Vit-D3 in dairy, or your climate, so Vit-D3 supplements are needed. Suggest 5000iu Vit-D3 as tiny oil based capsules, take 25,000iu first 5 days, 5,000iu thereafter.


#8

My pharmacy can’t get my Enanathate due to issues on the suppliers end, and have no ETA as to when it will be back in stock. I have none left and my injection was due yesterday…

I’ve been to every pharmacy in town and they all say the same thing. Test E is extremely uncommon in the UK, most guys are on Sustanon or Nebido.

I’m considering moving over to HCG mono because Nebido isn’t a short term fix and I hate Sust.

I currently inject 250iu HCG EOD alongside 50mg Test and 0.5mg Anastrozole E3.5D. How should I adjust this for HCG mono?

My doctor told me to inject 1500iu M/W/F for mono which seems ridiculous. I was thinking moving up to 375iu EOD, would this suffice?

How should I adjust my AI, if at all?

I understand that this will only work if my testes are capable of producing T. My pre TRT bloodwork was very limited so I’m unsure if I’m primary or secondary, I’ll soon find out.

I also didn’t mean to delete my previous post on this thread, though it didn’t contain any important information on my case. Thanks.


#9

Following this. My total tesosterone is 10.1nmol/l and my doctor is being an absolute clown and wouldn’t give me more tests as he said it’s in range lol and you’re receiving trt at 12nmol/l


#10

Oh and also I am from England on the NHS.


#11

There’s your problem, you’re going through the NHS.

They won’t even treat people who are below reference range.

Even if they would treat you, they know so little about TRT you’d likely end up on a protocol that’d make you feel worse.

Do yourself a favour and find a private doctor in your area.


#12

Can’t afford a private doctor right now. I may be seeing Simon page at the NHS treatment center u was referred but he requested further blood results before I go see him. He specialises in diabetes and endocrinologist. Both doctors refused further tests I asked for after tesosterone came back at 10.1nmol/l which is 291ng/dl. Hopefully we both get the treatment we need.


#13

I’ll be pushing for some sort of injection, once they’ve diagnosed me and I find out what kind of.orofocol they put me on I may just go along with it and add in mynown bits that I’ve picked up from helpful people on here.


#14

Hi @KSman

I’ll be doing a larger update in three weeks with regards to my TRT protocol as a whole when I have some in depth bloodwork. After you commented on potential thyroid issues from my initial post, I got a thyroid specific panel done after implementing your recommended changes.

THYROID BLOODS FROM INITIAL POST (07/07/17):
TSH: 2.06 (0.27 - 4.20) mIU/L
FT4: 14.7 (12.00 - 22.00) pmol/L
FT3: 5.08 (3.10 - 6.80) pmol/L

I made a few changes based upon your recommendations after these labs. I started using small amounts of iodized salts with food, and also started to eat 33g of brazil nuts daily for selenium.

My oral AM temp over the last seven days has averaged at 35.9 celsius. Somehow I completely missed that you also requested PM temps so I haven’t collected data for those (I’ll be starting tomorrow). My current oral temp at 18:07pm is 36.8 celsius.

THYROID BLOODS (01/08/17):
TSH: 3.01 (0.27 - 4.20) mlU/L
FT4: 12.7 (12.00 - 22.00) pmol/L
FT3: 5.2 (3.5 - 7.7) pmol/L

FT4 is even lower though I’ve introduced iodized salts. What are your thoughts based upon the new labs and limited temp data?

Thanks in advance for your time.

edit: made a mistake with dates of new bloods and formatting issues, now updated.


#15

Hi @KSman

I’ve had further thyroid testing on top of what I have already posted yesterday. The results are as follows:

THYROID BLOODS (18/08/17):
TSH: 1.08 (0.27 - 4.20) mlU/L
FT4: 13.2 (12.00 - 22.00) pmol/L
FT3: 3.9 (3.5 - 7.7) pmol/L

The blood was taken at about 3pm. I hadn’t eaten all day because I partake in intermittent fasting, and am also eating at a 500 calorie deficit p/d to drop to a lower bf. I’m not sure if that is responsible for the lower levels.

My current symptoms are bad lethargy, waking up tired after eight hours sleep, cold hands/feet (logging both AM and PM temps now), dry flaking skin, moon face and thinning hair (only on top of scalp, likely just androgenic alopecia but can provide pics if needed). I’m also experiencing sexual dysfunction which symptoms suggest is low E2 as my joints are cracking/sore, but my in depth bloodwork for TRT in a few weeks will offer more insight into that.

Sorry for sending you a second message before you replied to the first. I saw that you’re away travelling, but just want to get all of my information together in one place. Hope you had a good trip, get to my case when you can.

Thanks for your help.