T Nation

23, Been at This for a Couple Years


#1

Hola,

Been trying to figure out what could be wrong with me since college, finally getting burned out on useless doctor visits. Main symptom is complete lack of spontaneous erections (no morning wood, etc.)

After the below blood test the doctor had me try HCG 3x week at 500iu for one month. Nothing changed. Doctor has floated the idea that I'm androgen resistant and may need more Test to function normally.

T looks to be at a good number so I could really use advice on how to proceed with my doc.

Thanks for any input!

Age: 23
Height: 5'9"
Waist: Size 36ish
Weight: ~200
Hair: Can't grow beard/mustache but do have to shave. Moderate armpit hair, hairy legs.
Fat storage: Stomach/gut
Health Conditions: ED (Had this since i became sexually active. can have sex with horseloads of viagra/cialis), Anxiety, Depression (off medication currently), Fatigue (I sleep more than anyone i know and am always tired. Had sleep study done recently because I was told I stop breathing in my sleep)
Drugs: Formerly Viibryd (anti depressant), Viagra/Cialis (as needed), Fish Oil, Vitamin D, Multivitamin,
Diet: Avoid carbs but otherwise I don't stress it right now. Have done Anabolic diet and Leangains in the past.
Training: Weightlifting 3x week.
Testes Ache: Sometimes after ejaculation. Never been able to notice a pattern.
Morning Wood/Nocturnal Erections: Almost never. If I wake up hard I'm generally surprised and super pumped about it. Less than once a month.

Lab Results: (All fasted)

Testosterone, Serum 804 ng/dL (Range: 348-1197)
Free Testosterone, Serum 185 pg/mL (Range: 52-280)
LH 2.9 mIU/mL (Range: 1.5 - 9)
Estradiol, LCMS, Endo Sci 30 pg/mL (Range: 8.0 - 35)
SHBG 20.7 nmol/L (Range: 16.5 - 55.9)
Prolactin 9.5 mg/nL (Range: 4.0 - 15.2)
Glucose, serum 89 mg/dL
Cholesterol, Total 170 mg/dL (Range: 100-189)
Triglycerides 150 mg/dL (Range: 0 - 114) OUT OF RANGE
HDL Cholesterol 47 mg/dL (Range: >39)
TSH 1.730 uIU/mL (Range: .45 - 4.5)
AST 25 IU/L (Range:0-40)
ALT 25 IU/L (Range: 0-44)

CBC

WBC 4.1 x10E3/uL (Range: 4- 10.5)
RBC 5.50 x10e6/ul (Range: 4.14 - 5.80)
Hemoglobin 15.2 g/DL (Range: 12.6 - 17.7)
Hematocrit 45.9% (Range: 37.5 - 51.0)
MCV 84 fL (Range: 79-97)
MCH 27.6 pg (Range: 26.6-33)
MCHC 33.1 g/dL (Range: 31.5-35.7)
RDW 14.1%(Range: 12.3-15.4)
Platelets 283 x10E3/uL (Range: 140 - 415)
Neutrophils 49% (Range: 40 - 74)
Lymphs 41% (Range: 14 - 46)
Monocytes 6% (Range:4 - 13)
Eos 3% (Range: 0 - 7)
Basos 1% (Range: 0 -3)
Neutrophils(Abs) 2.0 x10E3uL (Range: 1.8 - 7.8)
Lymphs(Abs) 1.7 x10E3uL (Range: .7 - 4.5)
Monocytes(Abs) .3 x10E3uL (Range: .1 - 1)
Eos(Abs) .1 x10E3uL (Range: 0 - .4)
Basos(Abs) 0 x10E3uL (Range: 0 - .2)
Immature Granulocytes 0% (Range: 0 - 2)
Immature Granulocytes(Abs) 0.0 x10E3uL (Range: 0 - .1)

Temperatures:
Waking: 96.4 F
Midday: 98.1 F
~5pm: 98.7 F

New Labs as of 7/16
LH 4.3 mIU/mL (Range: 1.5 - 9)
Estradiol 31 pg/mL (Range: 8 - 35)
Cortisol, Serum (8:00am) 19 ug/dL (Range: 8 - 19)
DHEA-Sulfate, LCMS 288 ug/dL (Range: 38 - 523)
IGF-1 187 ng/mL (Range (21 - 30years): 281 - 510 Mean: 371)
Vitamin D 55ng/mL (Range: 30 - 100)
ACTH, Plasma 25.2 pg/mL (Range: 7.2 - 63.3)
Prolactin 10.2 ng/mL (Range: 4.0 - 15.2)
Vitamin B12 444 pg/mL (Range: 211 - 946) <-----Doc said this is a little low but I'm probably fine. the internet would have me believe I need to go get a shot ASAP. Thoughts?

SALIVARY CORTISOL X4, TIMED
8am .498 ug/dL (Range: .025 - .600)
12pm .063 ug/dL (Range: <.010 - .330)
4pm .061 ug/dl (Range: .010 - .200)
12am .023 ug/dL (Range: <.010 - .090)

Thyroid Test Results
TSH 1.6 uIU/mL (Range .450 - 4.500)
Free T3 3.5 pg/mL (Range 2.0 - 4.4)
Free T4 1.29 ng/dL (Range .82 - 1.77) ng/dL
Reverse T3 25.2 ng/dL (Range 9.2 - 25.2) ng/dL <---Out of Range


#2

So are you injecting T as well as HCG or what? Your T looks fine...

Your E2 is on the high end of "normal", which isn't good. You might want to experiment with an AI, lower your T dosage to control your E2, or do something else. Anytime mine has gone above 30, I generally feel pretty crappy also.

Instead of taking the big doses of Cialis, you could try doing the smaller daily dose. Saw a study recently that guys taking small doses of Cialis over time had lower estrogen levels. If I take even a 5MG of cialis when my T levels are above 500, I get amazing erections for like 3 days straight and great recovery time. Helps me get over the bumps in the road on TRT.


#3

Post all of your lab work.
Need:
fasting cholesterol
fasting glucose
TSH, fT3, fT4 [not T4, T3]
DHEA-S
CBC
liver markers AST/ALT
prolactin
AM cortisol, at 8AM, no coffee
FSH should be done with LH, LH alone has poor diagnostic value.
blood pressure
body temperature data - see thyroid basics sticky. Do not assume that this does not apply to you.

You cause of depression or the drug cannot be ignored.

Please read the advice for new guys sticky and see if any of the side issues/causes apply to you.


#4

I was just injecting HCG. No change at all. Last doctor visit he talked about trying very small doses of T to raise it even more (basing that on the theory that I am androgen resistant and need more) without shutting down my body's natural production. Never heard of anything like that in all my reading so I'm VERY sceptical.

I've got some arimidex on the way!

I've actually tried the 5mg a day cialis a few times over this stupid journey. It does have some effect... my erections are slightly bigger/firmer, but still unusable without a super dose on top of it. I started it up again a few weeks ago in hopes that it will help repair my body's erection "rhythm".

Thanks for taking the time to respond!


#5

Posted all the additional labwork requested that I have. I'll talk about getting the other tests at my upcoming appointment.

The Thyroid sticky actually drove me to start supplementing iodine. Taking my temperatures today and tomorrow and will post that info as soon as I have it.

Thanks for taking the time to respond.


#6

Well. Took my temperatures.

Waking: 96.4 F (The sticky leads me to believe that this is very fucking low, is that right?)
Midday: 98.1 F
~5pm: 98.7 F

So I'm getting up there, but starting out pretty low.


#7

Another temperature reading the following morning came in at 95 degrees F... Got a feeling these can't be right, at least I hope so. Will probably get a new thermometer next week when I'm done travelling for work.

Regardless, I've started dosing 50mg of Lugol's daily as per this protocol (https://docs.google.com/document/d/139Xa8u8kgNVT-K17TxYvsM7qsSfusxyvloIXWbU92rg/edit#), in addition to taking Raw Thyroid and Raw Adrenal supplements. I've been on Iodine for a week now and don't feel much of a difference, but I'm going to stick with it and see what happens.

I've got a visit with my regular doctor on Monday, and hopefully a followup to my sleep study later in the week. Additionally, I'll be resuming physical therapy for lower pack/pelvic pain which can also contribute to ED. Happy to be attacking this from a number of angles, but it's just so exhausting.

This thread is acting as my treatment log I suppose, which is good, as I haven't been as meticulous as I should have been.


#8

Shocker, my doctor is an idiot.

After multiple go rounds where he refuses to order the tests I want (can't get him to do ft3 or ft4, etc), he has now prescribed me a T Gel and an AI in hopes that I am mildly androgen resistant and that the boost of T will fix everything. The AI I'll gladly take as my E numbers are at the top of the range EVERY. SINGLE. TIME. (I stopped taking an AI on my own so that my tests numbers would be unaltered.)

This guy looks at my test results and goes "hmmm... X is really borderline...but it's in range so I'm not going to do anything."

Symptoms have not abated. I had a day last week at work where from about 9am - 1pm I thought I was going to start crying for absofuckinglutely no reason. This is insane. I'm always tired, my concentration and memory suck, and my dick might as well be dead.

Frustrating. Appointment with a new doctor next week. New tests below, and I'll update the main post as well. As always, any thoughts are appreciated.

LH 4.3 mIU/mL (Range: 1.5 - 9)
Estradiol 31 pg/mL (Range: 8 - 35)
Cortisol, Serum (8:00am) 19 ug/dL (Range: 8 - 19)
DHEA-Sulfate, LCMS 288 ug/dL (Range: 38 - 523)
IGF-1 187 ng/mL (Range (21 - 30years): 281 - 510 Mean: 371)
Vitamin D 55ng/mL (Range: 30 - 100)
ACTH, Plasma 25.2 pg/mL (Range: 7.2 - 63.3)
Prolactin 10.2 ng/mL (Range: 4.0 - 15.2)
Vitamin B12 444 pg/mL (Range: 211 - 946) <-----Doc said this is a little low but I'm probably fine. the internet would have me believe I need to go get a shot ASAP. Thoughts?

SALIVARY CORTISOL X4, TIMED
8am .498 ug/dL (Range: .025 - .600)
12pm .063 ug/dL (Range: <.010 - .330)
4pm .061 ug/dl (Range: .010 - .200)
12am .023 ug/dL (Range: <.010 - .090)

Thanks again.


#9

Do you or did you watch a lot of porn?

My e2 was 34 and I had zero problems with erections.

This site is to caught up on estrodiol if you ask me.

My body when on T naturally went down to 20 and I felt the exact same.


#10

No FSH? LH varies test to test despite variables.

IGF-1 is consistently low. I don't know enough about suppressed IGF to comment, but it's a concern that should be addressed.

Steroid hormones appear to be ok. Adrenals appear to be ok; perhaps a bit hypo.

Your variation in temperatures indicate an issue with your thyroid. You need the complete thyroid panel to figure this out. TSH alone will not get you there.


#11

It sounds like this has been rough on you but stick with it and eventually you'll find the cause and you'll get to feeling better.


#12

Used to, yes. Early on in this process I thought maybe that could be the root of everything so I cut down drastically. Why do you ask?

Interesting about the estradiol... Some of my symptoms (the emotional stuff) SOUNDS like estradiol issues so that's why I'm fixating on it.


#13

Yeah, FSH is one of the tests my last doc refused to run.

Yeah the IGF-1 number seems messed up to me but I've been having trouble running down opinions on that thus far. Keeping my eye on it though.

Agreed re: Thyroid. It's what makes the most sense to me right now. Rather than waiting to find out if my next doctor is a moron or not, I think I'm going to just order those labs myself and start taking them in with me.


#14

I appreciate that man. Admittedly I haven't been making getting healthy my main priority but now I'm all in and ready to figure this shit out.


#15

Go to the site. mybrainonporn.com

Your doc is an asshole for not testing fsh and you should have told him you were worried about fertility.

I'm not saying E2 isn't a worry. I'm saying its made to big of a deal here and doesn't solve everything just as Trt doesn't. Dop

Keep an I on the prolactin

If you think e2 is high and igf-1 is low this is pointing us to the liver. I have a case study on nafld causing suppressed igf-1


#16

Stop porn all together for 2 months... It may have to be longer bro


#17

Thyroid Test Results
TSH 1.6 uIU/mL (Range .450 - 4.500)
Free T3 3.5 pg/mL (Range 2.0 - 4.4)
Free T4 1.29 ng/dL (Range .82 - 1.77) ng/dL
Reverse T3 25.2 ng/dL (Range 9.2 - 25.2) ng/dL <---Out of Range

Looks like I could have a problem in my ratio of T3 to Reverse T3...hoping the new doc (going to a naturopath next week) has some thoughts.

Edit: Ratio is 13.89, Stop the Thyroid Madness says people should have 20 minimum.

Any advice appreciated!


#18

Why is fsh not being tested? This is wrong...

Ferritin and serum iron should be tested

Check the adrenals

Cortisol
ACTH
Glucose
Insulin
C-peptide

If igf-1 is low ask for a gh stim test.

Look up Wilson's syndrome

Adrenal fatigue

Pick your poison but a time released t3 med has been known to fix this rt3 problem. Neither are considered medical diagnosis but something not right so I think the naturopath maybe ur best bet or a open minded endo and good luck with that..