25, Going on 60

Pharma / TRT Testosterone Replacement
1

“Existence precedes essence.” - Jean Paul Sartre

Age: 25
Height: 5’3"
Waist: 34"
Weight: 156#

Hair: Moderate jew-beard; visibly receding hairline. Moderate body hair covering chest, stomach, legs, arms.
Fat: Mostly carried in gut, love handles and really bad in the chest. I’ve been skinny-fat my entire life, though now I have a modest amount of muscle.
Junk: No testes ache. Considerably less frequent morning wood.

Symptoms: Lethargy, chronic fatigue, mood swings, diminished libido, 80% erections, social withdrawal, difficulty gaining strength / losing fat, depression, anxiety. Bad gyno, but no lumps or tenderness.

Rx/OTC Drugs: None currently. I took Doxycyclene for several months in an unsuccessful attempt to treat some pretty bad bacne. This was up until around July.
Diet: The usual. High protein, carbs/fats cycled depending on the day. Minimal processed food. Chicken, beef, eggs, oats, sprouted grain bread, protein shakes, rice, etc.
Training: Typical 4-day bodybuilding split. I sustained a low back injury recently, so this is my first time doing a training cycle without squat/DL variations. But other than that, it’s pretty generic. Moderate volume.

Lab Results:

Sodium: 140 [136-145] mmo/L
Potassium: 4.1 [3.6-5.0] mmo/L
Chloride: 104 [98-107] mmol/L
CO2: 26 [ 22-28] mmol/L
BUN: 18 [6-20] mg/dL
Creatinine: 0.91 [0.7-1.3] mg/dL
Glucose: 94 [74-100] mg/dL
Clacium: 9.2 [8.6-10.3] mg/dL
Total Protein: 6.8 [6.0-8.3] gm/dL
Albumin: 4.6 [3.5-5.0] gm/dL
ALT/SGPT: 26 [10-35] U/L
AST SGOT: 17 [14-50]
Alkaline Phos: 73 [53-128] U/L
Bili Total: 0.9 [0.3-1.2] mg/dL

Vit D Total 25-Hydroxy Level: 31 [32-100] ng/mL
Vit D2 25-Hydroxy Level: <1 ng/mL
Vit D3 25-Hydroxy Level: 31 ng/mL
Cortisol: 22.3 [3.1-22.4] ug/dL (Fasted; seems high?)
DHEA-Sulfate Serum: 251 [85-690] ug/dL
LH: 2.7 [1.5-9.3] IU/L
Vitamin B12: 819 [180-914] pg/mL
Free T4: 1.61 [0.86-1.51] ng/dL
TSH: 3.585 [0.3-4.0] mUnits/L
T3 Free: 3.4 [2.3-4.2] pg/mL

Sex Hormone Binding Globulin: 26 [11-80] nmol/L
T3 Uptake: 38 [28-41] %
T4 Total: 6.62 [5.10-14.10] ug/dL
FTI Calculation: 2.5 [1.7-4.2] Unit

Free Testosterone: 117 [47-244] pg/mL
% Free Tesosterone: 2.2 [1.6-2.9]
Total Testosterone: 542 [300-1080] ng/dL

One month ago (different lab):
Total testosterone: 446 [250 - 1100]
Free testosterone: 89.0 [35 - 155

They also ran a Hematology report. I’m not sure if that was done on purpose. Everything was in range except:
Platelet Count: 132 [140-440] x10’3
Please let me know if I should post the entire thing.

2

By the way, I wasn’t “allowed” to get E2 tested, since it was deemed unnecessary. I can’t afford to test it out-of-pocket right now, so sorry for the incomplete info.

3

First thing to note is your Vit D is low. Find a good bioavailable brand and start taking 6,000 iu/day. Retest and adjust as necessary. You want to be in the upper 20% of the range.

Your thyroid tests are a little confusing. One month ago, your Total T4 was on the lower side. Now this month, your Free T4 is above range. Even while FT4 is above range, your TSH is elevated indicating your body needs more thyroid hormone. This leads me to believe something is screwy with your thyroid.

You need to get the Thyroid antibodies tested (Thyroid Peroxide AB, Thyroglobulin AB). These are indicators of thyroid diseases such as Hashimotos and Graves. This is very important, IMO.

Your low platellet count is a bit troubling as well. Seems to correspond to your lowish SGOT. You should familiarize yourself with:

and take appropriate steps as necessary with your doctor to address or rule out.

You can also google Thrombocytopenia and Hashimoto’s together and find some websites demonstrating a correlation between the two.

4

Thanks for the help, VT. I have a follow-up appointment this Monday, so I’ll be sure to research these all things beforehand. Let me just point out, though, that the only results from last month were the free and total T. I’m not sure if that changes anything, but I’ll edit my post to make it more clear.

How do the T numbers strike you? They seem to be on the moderate side of low, so I’m not sure if there’s reason for concern.

5

Oops you’re right, I must have looked at the OP wrong with Free T4 and Total T4. My mistake. It is still a bit whacky though and something to look into.

I have a hard time getting upset when I see Total T in the 500’s and Free T higher than bottom quarter of range. It could certainly be a little higher, but is very hard to address at that point. You will probably see some improvement by sorting out other issues first.

6

Under 500 at 25 is a crapshot life experience the other option is very bad too.

7

[quote]vinaydm3 wrote:
Under 500 at 25 is a crapshot life experience the other option is very bad too.[/quote]

You’re right (if I understand you correctly); it doesn’t seem ideal for a 25 year old, but I’m not sure if it’s quite low enough to justify HRT. But if I were offered HRT and turned it down, would that mean continuing to feel like shit, and just waiting for my levels to plummet over however many years until they’re “low enough”?

It’s a tricky situation, but I’m going to try to address the out-of-range figures first, as VT said.

8

my thoughts would be to focus on high TSH first.

Extra tests like Reverse T3, ferritin, total iron would help. as would a saliva x4 Cortisol test. Antibody tests are a must.

what are your CHOL #s?
CHOL drives Pregnenolone which drives all other hormones.

9

[quote]PureChance wrote:
my thoughts would be to focus on high TSH first.

Extra tests like Reverse T3, ferritin, total iron would help. as would a saliva x4 Cortisol test. Antibody tests are a must.

what are your CHOL #s?
CHOL drives Pregnenolone which drives all other hormones.[/quote]

Thanks for stopping by, PC.

It’s weird, I could have sworn my doctor requested CHOL to be tested, but apparently that’s not the case. I’ll be sure to bring it up with her on Monday.

I’m not sure if these figures are what you’re referring to, regarding antibody tests:

Auto ABS Neut: 2.24 [1.5-8.0] x10’3
Auto ABS Lymph: 1.93 [0.8-4.0]
Auto ABS Mono: 0.41 [0-1.2]
Auto ABS Eos: 0.09 [0-0.3]
Auto ABS Baso: 0.01 [0-0.3]

Auto % Neut: 47.9 [37-80] %
Auto % Lymph: 41.2 [16-51]
Auto % Mono: 8.8 [0-12]
Auto % Eos: 1.9 [0-8]
Auto % Baso: 0.2 [0-3]

10

No, I think he was talking about the TPO AB and TgAB (thyroid anditbodies) that I had already mentioned.

11

[quote]VTBalla34 wrote:
No, I think he was talking about the TPO AB and TgAB (thyroid anditbodies) that I had already mentioned.[/quote]

Ahh, that makes sense. Thanks.

12

sorry. yes thyroid antibodies… I’ve been on again off again answering posts for too long. so in an attempt to keep posting for a longer period of time this go around and to avoid burning out, I have started trying to only post short snippets rather than my typical long rambling posts (but it is still a work in progress) - and sometimes I leave certain details off.

13

[quote]PureChance wrote:
sorry. yes thyroid antibodies… I’ve been on again off again answering posts for too long. so in an attempt to keep posting for a longer period of time this go around and to avoid burning out, I have started trying to only post short snippets rather than my typical long rambling posts (but it is still a work in progress) - and sometimes I leave certain details off.[/quote]

It’s OK, I should have been able to connect your post to what VT had said previously. I appreciate any advice you can give, no matter how terse.

14

Had a follow-up today. First let me say thank you again for all of the info, as it made the appointment run much more efficiently, and made me sound way smarter than I actually am.

The doc was very receptive to what I had to say, and we both agreed that treating my thyroid and running further tests should be the next step.

I’ve been prescribed Armour @ .5 grain/day for a week, followed by 1 grain/day after that.

I’m continuing with 6,000iu Vit D for three months, and lowering it to 2,000 iu thereafter.

In about five weeks, I’ll be testing:
E2
free and total testosterone
lipid panel
thyroid panel
thyroid peroxidase

Then another appointment #3, which will apparently be 15 minutes long. :confused:

15

sounds good. just make sure to get your blood test results BEFORE your visit. Post the results here, and go in armed to have an actual conversation.

No reason to spend time and money just to have the doctor tell you the results of the test. Make it an actual joint discussion appointment.

16

Well, apparently this new lab also tested the wrong stuff. I think they did the wrong thyroid panel, and forgot to test TSH. Should get the additional info soon.

Cholesterol, Total: 240 [125-200] mg/dL
HDL Cholesterol: 63 [>40] mg/dL
Triglycerides: 48 [<150] mg/dL
LDL Cholesterol: 167 [<130] mg/dL
CHOL/HDLC Ratio: 3.8 [<5.0]

TSH: 1.71
T3 Uptake: 35 [22-35%]
T4 (Thyroxine), Total: 5.5 [4.5-12] mcg/dL
Free T4 (T7): 1.9 [1.4-3.8]

Thyroid Peroxidase Antibodies: 14 [<35] IU/mL

Estradiol: 34 [<39] pg/mL

Testosterone, Total: 523 [250-1100] ng/dL
Testosterone, Free: 105.9 [35-155] pg/mL

I told her that after starting Armour, I had a period of a few days where I felt better before feeling really shitty again. I asked her if she thought I should up the dose, but she said no. She tried to prescribe me Wellbutrin for my depression/anxiety symptoms, but I declined. She instead prescribed “TravaCor” and “Balance D”. I can’t link to them, but they are neurotransmitter supplements made by NeuroScience, Inc.

She didn’t want to prescribe an aromatase-inhibitor, so she also prescribed an indole-3-carbinol supplement.

I’m really hoping I didn’t get ripped off with these overpriced supplements. I was leery of the fact that they sold them from their office.

She also told me to cut out wheat/gluten. I think that might have been because of the cholesterol, though I will note that she had a copy of “Wheat Belly” in her office.
After my post-Armour emotional crash, I began feeling really self-destructive. I started eating more junk, drinking more, smoking cigarettes. Pretty strange. I’m sure that had a deleterious effect of some kind.

17

There’s no good way to evaluate your health if you are putting shit into your body like cigarettes.

18

You’re right, but that phase was fugacious and has since ended. I’ve eliminated fast food and smokes, and am down to a glass of wine once or twice a week.

19

starting off good on Armour and then feeling crappy again…

one possible scenario - the T3 gave you an initial boost, but then as your T4 supply continued to grow, your body didn’t have enough cortisol to call upon and so it shunted the extra T4 to Reverse T3 which then blocked your FT3 from working. you can easily confirm with a blood test for FT3, RT3, and 8am cortisol.

20

Thanks for your input, PC. I’ll be sure to request those tests.

My doc just e-mailed me with my TSH: 1.71. Lower, but because of the persisting symptoms she’s decided to increase my Armour dosage to 90 mg.

I’m curious as to whether you have any thoughts on Indole-3-carbinol versus something like Arimidex, for lowering E2? Her reasoning for avoiding the latter was that she didn’t think a young guy should have to use it. But that was the same logic behind her not wanting to test my E2 in the first place…