T Nation

24 yo TT: 264, FT: 15.2 (range 4.3 - 30.4 pg/l)


#1

Related symptoms:
- exhaustion (physical/mental)
- VERY poor recovery to exercise (increases mental/physical exhaustion the following day)
- height: 5'11''
- waist 32
- weight: 180
- subcutaneous fat (increased over last 3 years of CONSTANT stress)
- mental health: depression/anxiety/depersonalization/panic attacks
- diet: bacon/eggs/cruciferous veggies, sub sandwiches, turkey + brown rice + veggies, fruits.
- testes have slight ache
- little -> no morning wood before TRT
- I look normal, grew facial hair/chest hair/pubic hair before TRT and seemingly moreso already.

I just started 100mg/day compounded cream cost at $33.00/month.

Basically, I'm looking for advice. I have the same perspective on doctors as the general consensus of this forum so I'd like some general advice. I've read the stickies and am somewhat overwhelmed.

I am guessing the CAUSE of my low-T has to do with the 4+ years of constant stress and frequent panic attacks that I've experienced. I've had very emotionally toxic relationships and I believe that my adrenals are fucked. My general plan for overcoming this is staying on T supplementation while getting on an SSRI to help with the emotional/life stress while my adrenals recover. I am somewhat uncertain as to whether low-T made it difficult to cope with the increasing stress/emotional demands of life as I turned 18 and moved out of the house but that's when a lot of these symptoms started OR perhaps it's that simply having too high of stress demands of life along with a preexisting anxiety condition contributed to the low-T.

My plan is to find a doctor to prescribe me hCG and take that and see if I can feel normal on it and get more normal labs. If that doesn't work I'd add the test cypionate and arimidex.

The chicken-or-the egg debate for me is a source of confusion.

This is overwhelming, so any advice would be appreciated.


#2

Please consider that thyroid function may be bogus. Check your oral waking and mid-afternoon body temps as per the thyroid basics sticky.
This is important and I often have to ask more than once.

Do you get cold easily? Not been using iodized salt long term? Thyroid looks enlarged?

Labs:
CBC
TT
FT
E2
Prolactin
LH/FSH - from before, cannot do now while on TRT
AM cortisol, do at 8AM
TSH
fT3
fT4 [please not T3, T4 - need the free readings]

Please do not do SSRI’s now. Try Wellbutrin first, it does not re-wire your brain or give you the shits.

hCG may work at your age

Also see the advice for new guys sticky for a broad intro to basics that you need to know.

Read Wilson’s book on adrenal fatigue. [Thyroid basics]
Note references to iodized salt, iodine, rT3


#3

Hi KsMan,

Thanks for the reply!

Thyroid:

I took my temps, and I woke up yesterday with 96.4, and today with a 96.1. It’s a crappy thermometer but I took five readings both times and if it’s inaccurate it’s consistently inaccurate… never reached 98.6 the highest I’m getting is the low 98’s.

Is there a reason you chose 500-700mg for your iodine replacement? I’ve been reading pubmed studies saying that you can have hypothyroid from too little AND too much. Is the way you decide when to stop when your temperatures normalize?

If I regain thyroid function is TRT beneficial in any way? Are there benefits to having higher in the normal range than mid-range? Also, my naturopath claims that at the dose she’s prescribed for TRT it won’t shut down endogenous production so I don’t run the risk of infertility or shrinking testes. Is there truth to this?


#4

Hypo from iodine is not correct. Higher doses of iodine create temporary higher levels of TSH and that is a rather narrow definition of hypo.

There are claims that the human body can store up to 1.5 grams of iodine so I thought that half of that would be OK. But others state that very much less is stored. In any case, much is simply excreted.

You can’t deliver mid-range+ results, good if it happens.

A new thermometer seems in order.

Symptoms:
feel cold easily
thyroid feels or looks large, lumpy or symmetrical
outer eyebrows can be sparse
dry skin
low energy
depressed
some of these are the same as low T

We often see that guys with low thyroid function cannot absorb transdermal T. So your cream may not work and you would then have to self inject.

Not been using iodized salt long term?
Not been using iodized salt long term?
Not been using iodized salt long term?
Not been using iodized salt long term?


#5

“You can’t deliver mid-range+ results, good if it happens.”

What, you mean with just correcting a thyroid issue? Or you can’t consistently maintain mid->high (within normal range) test levels using TRT? AND that doesn’t improve quality of life?

Symptoms:
feel cold easily - nope
thyroid feels or looks large, lumpy or symmetrical - feels normal
outer eyebrows can be sparse - nope
dry skin - nope
low energy - yep
depressed - yep
some of these are the same as low T

Others that I DO have:

  • Genetic history on both parents sides.
  • “hit a wall” really low energy with the TRT
  • tinnitus

"We often see that guys with low thyroid function cannot absorb transdermal T. So your cream may not work and you would then have to self inject. "

Maybe it’s a nice placebo but it seems to have a good effect on focus as well as morning wood.

“Not been using iodized salt long term?
Not been using iodized salt long term?
Not been using iodized salt long term?
Not been using iodized salt long term?”

No, only infrequent 200-something microgram supplements.

^^ This website is pretty interesting and says that the thyroid can’t recover properly with bad adrenal fatigue/low cortisol.

edit: the iodoral seems to be helping with my symptoms. That, and lots of vitamin C.


#6

mid=range+ was referring to T3, T4 levels and with iodine replenishment, getting there would be good, but does not always happen.

remember that selenium is critical for healthy thyroid function.

Nice to hear that iodoral is working for you!


#7

[Removed 'cause not helpful, summary: “replenishing iodine didn’t fix symptoms”]


#8

KSMan,

I saw a good TRT doctor, at least one who would prescript your regimene with the following changes:

  • .5/week anastrazole
  • 300 mg t-cyp/week!!!

This is insanely high, right? This would ramp up e2 as well as mess with my already fatigued adrenals?!

If so, I plan on doing 100mg/week as per protocol and going up 5 weeks from now after getting my levels tested. I HAVE been on the cream for four weeks and now I am injecting SQ but I assume it’ll take 5 weeks to get a stable reading.

Can I divide up the doses and just take on M/W/F? Is 2 days off hCG fine? Otherwise, I have to deal with the complexity of having an odd number of days in a week so EOD would be 4 days on one week and 3 on the other and I don’t know whether to alternate dosages so I’d evenly get 100mg/week or just divide 200mg/7 days of dosing in 2 weeks to get my daily dosages…

  • You said in your ‘protocol’ post to not use 1mL syringes. Was the only reasoning for preferring a .5 injection speed? I have a lot of unused 1mL ones that I’d rather make use of…

  • hCG recipe? The compounding pharmacy gave me a compounded version with BA water and “irrigation water”. You might’ve mentioned a pharmacy I could order online in the ‘protocol’ thread. What would I need to mix in order to make this. I’m paying $70 for a 40 day supply of hCG where it sounds like you were getting a better deal. I do have my Test and Anastrazole free through insurance, though, which is nice…

Also, I’m storing my test at room temperature while hCG in the fridge. Is that okay?

Thank you for your help on this!


#9

KSMan,

The overall strategy I’m taking is doing TRT on for 3 months while I complete a summer internship where I want to be the optimum me. Additionally taking the supplements and incorporating some lifestyle changes from the 21 first century adrenal fatigue book. Then, I’ll go off and get better baseline bloodwork as my original dr didn’t do a near well enough. I’m going to go off for 1 MONTH in order to restore baseline LH/FSH. Then I’ll go from there. Wanted to update the strategy involved in my case instead of just saying I’m going on TRT indefinitely without the cause for my low-T known and not just assumed.

One tip I wanted to mention. Vitamin C is the rate-limiting cofactor in the conversion of dopamine to noradrenaline. So, if you want to address your fatigue issue try doing 1g/hour for ~5 hours. I mix 5g vitamin C crystals in my water and drink it throughout the day. It has a STIMULANT effect (as that’s what stimulants do, ne?). I also have a good recipe for optimizing dopamine production through precursors and other stuff if you’re interested. Learned it from a ph.d neurobio student.

Thanks,
K_


#10

Your proposal for hCG is fine.

Larger syringe piston diameters lower developed pressure, thats all.

When you stop TRT, you can be measuring the damage from HPTA shutdown, so the answer that you get may not be what you were expecting. You will need to study what a HPTA restart is [search here].

Whats up with body temperature and energy/alertness?


#11

Thanks for the reply KSMan,

"Whats up with body temperature and energy/alertness? "

BBT’s are high 97’s.

I have more physical energy and I am able to go on runs now and not feel an insane mental energy crash that saps my ability to articulate and gives me very bad anxiety. I feel the antidepressant effects of running. TRT has helped with: confidence, anti-anxiety, motivation so at least I think I can differentiate test levels.

Mental energy/alertness is still an issue. I never quite feel “awake”. I’m seeing a sleep doctor to rule out a sleep issue but whether it’s cortisol or thyroid there’s still something going on…


#12

Low body temperatures lower energy levels, which can mimic all of the symptoms of low-T. You have low thyroid function and perhaps more labs would be useful.


#13

Hi KSMan,

Thank you again for your help.

I did thyroid labs and luckily the lab had a nice turnaround. Here are the results:

fT3: 4.4
ft4: 1.1
TSH 1.36

…where to go from here? If I don’t have sleep apnea I’m thinking I might just go for longterm TRT and wellbutrin… or maybe chock it all up to adrenals and do my best to change the adrenal fatigue situation…


#14

Anyone else have an opinion on this?


#15

Thyroid problems undermine every system in your body.

How are body temperatures now?


#16

I got a quality ($20) thermometer, and I trust this one.

They’re still low - AM/BBT are in the high 96’s (was 96.9 today). PM varies but recently has been ~97.9.

As far as AI’s go do you think I need one? I’ll get my e2 levels checked but in the interim subjectively I feel better WITHOUT an AI (and seem to have more libido without one).

One last thing: I was on ritalin for ~7 months but have been off of it for about 4 months. Could this be a large part of the cause?

Thanks KSman.


#17

FT3 well above mid-range and low body temperatures suggests elevated rT3 that is blocking fT3.

Thyroid levels may be OK, but cells not getting the signal.

In the thyroid basics sticky, note references to:

  • temperature
  • fT3
  • rT3
  • stress
  • adrenals
  • adrenal fatigue [low energy]
  • “Wilson’s book”

fT3 regulates body temperature by regulating mitochondrial metabolic rate. Mitochondria also need CoQ10 and anti-oxidants. R-lipoic acid is also part of the equation. These items may not be causing the problem, but could be a factor. At your age, those things should not be a factor.

Stimulants can contribute to Adrenal Fatigue [Ritalin ].


#18

Does TRT help or hurt recovery from adrenal fatigue? One site said that adrenal test production is suppressed while on TRT, true?


#19

Did you post your Vit-D results? I didn’t see them reading through this.

Probably want to check that and supplement if deficient or borderline.


#20

Something I suppose I can look into.

Typically, I take 4kiu and 2kiu in the summer.

Otherwise, I’ve officially ruled out sleep apnea as a cause for the stress that caused the adrenal fatigue.

How, in modern life, can one drastically lower their stress?! I already meditate and do yoga. I just work a stressful job that I can’t quit and have a contemplative personality.

c’est la vie