T Nation

26 Y/O, Considering TRT After Labs and Symptoms


#1

-age: 26
-height: 5’9
-waist: 28-30 size pants
-weight: 158 lbs
-describe body and facial hair: facial hair okay, today noticed that my upper thighs have way less hair
-describe where you carry fat and how changed: was a fat kid growing up, but as i lost it, was most stubborn around waist
-health conditions, symptoms [history]: past 12 months have had a declining libido (12 mo ago might desire sex 2-4 times with wife, now seldom want it once a week), not getting turned on by attractive women like i used to, fatigue and tired most days of week, demotivated with career and life, lack of mental clarity— feel not as sharp as i used to. Much more irritable, at things that normally wouldn’t bother me. Sleep pattern disturbed, hard to fall asleep once a week. Also seem to be accumulating fat and losing muscle mass. Just feel off.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: no
-lab results with ranges:

First Test @ 1 pm, 2/14/18

Testosterone = 196 (264-916)
TSH = 1.680 (0.450-4.5)

Second Test, Fasted 12 days after, @9 AM

Testosterone = 315 (264-916)
Free T = 9.17 (5.0-21.00)
Free T % = 2.91 (1.50-4.20)

LH = 2.0 (1.7-8.6)
FSH = 4.0 (1.5-12.4)
Prolactin = 5.4 (4.0-15.2)
Prostate Antigen= 0.4 (0.0-4.0)
Gonadotropin = <10 (no reference)

Metabolic and CBC panel normal range.

-describe diet:

Currently targeting under 75 g of net carbs per day, rest is protein and healthy fats. Protein shake once a day with strawberries, berries 200g worth. 3-4 eggs a day. Spinach, broccoli, chicken salmon staple. 15 g of stevia based dark chocolate a day.

Supplement: 300 mg omega3, 5000mg d3
Caffeine: 5-6 grams of loose leaf green tea before 10 am

-describe training:

I do the workout for natural lifters posted on this site: https://www.t-nation.com/workouts/the-best-damn-workout-plan-for-natural-lifters-part-2

M-F walk my daughter to and from school, get about 10-12k steps every weekday

Sleep anywhere from 7-9 hours per night

-testes ache, ever, with a fever?

Past 3-4 weeks they started aching ever so slightly, no fever

-how have morning wood and nocturnal erections changed

I’m lucky to wake up with one semi boner per week.

My primary doctor has ruled out TRT since my second test came in the normal range. I hit up agelessmen in the bay area, gave them my labs and they immediately approved me for treatment, wanted to start me out with @150 mg injections per week. I requested lowering to 125 mg per week. They agreed but I have to get my shots there for at least one month before they’ll let me take it home.

After reading the sticky im concerned about starting without knowing my SHBG and E2 level, which my primary doctor did not check. But I’m going to be pretty honest I’m getting pretty desperate and currently scheduled for the first shot this coming Tuesday. It seems to be messing with my mood and had much more lately.

I’m also clueless as to how I’m supposed to get HCG? I know the sticky recommended combining T injections twice weekly, with hcg every other day, and the estrogen blocker… It’s pretty overwhelming…

Any thoughts and guidance would be much appreciated.


#2

Your current doctor probably has no idea what HCG is if he/she failed to test for SHBG and E2, this doctor is incompetent and your situation will not improve until you find a doctor that is skilled in male hormones. SHBG is the gold standard for sex hormone testing and you doctor has no idea about it one way or the other, not good!

How is this doctor supposed to balance your hormones, luck? You’re going to have to leave the diseases healthcare system if you want proper care, it’s that simple. Insurance based doctors have no guidelines to tell them what labs to run and how to administer TRT properly, all of them will struggle with understanding TRT.

If SHBG is low then your dosage is all wrong and you will continue to suffer. Not all insurance companies cover HCG as it’s a fertility drug. You need to inject 50mg twice weekly and hold off on the AI. It’s going to be a real challenge to find a doctor who is skilled at TRT.


#3

Eval thyroid via oral body temperatures, see below.
Do not think that this is trivial. TSH should be close to 1.0, thyroid lab ranges are useless.

If using sea salt, stop using that and use iodized salt. Iodine deficiency is a serious problem for you, your wife and your child.

We need lab ranges, please directly edit your post above and add that data. Anything else tested? We need to see labs, normal or not.

Anything on the things that damage your hormones sticky that applies to you?


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.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re Thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab numbers and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#4

Cheers mate, would you start the TRT protocol on Tuesday or wait to have SHGB and E2 results in?


#5

Hey @KSman, have added the reference ranges, and will shortly upload images of my lab. My bilirubin reads high, but that’s because I have Gilberts syndrome.

Thanks a lot for your input, and will swap out sea salt with iodized salt. Will also look at the Thyroid sticky.

As for the sticky with things that damage hormone, the only one applicable to me is iodine… I know we don’t have any iodine salt in our house.


#6

Have been monitoring my temps for 5 days now… and holyshit, think I am Iodine deficient. Started IR. Supplementing with:

Lugols 5% Iodine x 1-8 drops (working my way up to 8 drops = 50mg)
Selenium x 200 mcg
Magnesium x 250 mcg
Celtic Salt x 1/2 tps
Vitaminc C x 3000 mg

Temperature measured orally:

Day 1

Night = 96.9 F (I ate 4 packs of my daughters sea weed @ lunch, only iodine in house)

Day 2

Morning = 96.6
Mid Day = 96.6
Night = 96.6

Day 3

Morning = 96.3
Mid Day = 96.9 (Took 6.25 mg of Iodine @ 1PM, temp checked at @2:30PM)
Night = 97.1

Day 4

Morning = 97.2 (Took 12.5 mg of iodine)
Mid Day = 97.1
Night = 97.2

Day 5

Morning = 97 (Took 18.75 mg of Iodine)
Mid Day = 97.2
Night =

Mental clarity has jumped insanely. Started feeling this 3-4 hours after first dose. Insane feeling, like the fog has lifted. I have no day time fatigue – no crashing. Second day my testes were hanging like they used to! Today, mental clarity still rock solid and alert. Though testes have crawled back up lol. Libido still has not improved, hands and feet still cold, but the quality of life boost from my mental state, really have no words to describe.

I’m working my way up to 50mg, increasing by a drop everyday, and will load there for 2 weeks.

@KSman thanks for getting me to check my temps… my doctor never even asked me to do this. 2 months ago I checked my temps and they were around 96.5… concluded I was just colder than most.

Still concerned about my T levels, given my age, but going to do IR and retest T levels, etc.