T Nation

28 Y/O fluctuating T and FT ( Updated 12/19 with labs from 12/13)

T Replacement
#1

So, had some concerns (detailed more below) and wholeheartedly decided to get tested halfway thinking I was being ridiculous. I went to a Low T Center and for the $50 basic/initial test special just to see if I should pursue. Results came back 285ng/dL. I immediately started scouring this forum and other sources I could find, found a PA that posters suggest is decent in my area for TRT, and scheduled and appt for next week. Needless to say i havent been very productive while trying to figure out what is going on and how i csn address it.

This thread may be a bit premature, but the reality is I was to be proactive going to meetings with my doctor so that I don’t have to wait for retests, etc. I have been through all of the stickies, but this stuff is dense and there is a lot of material to try to internalize.

age: 28
-height: 5’10
-waist: 35
-weight: 210-215

-describe body and facial hair: moderate throughout. Facial hair can grow into a neckbeard, but takes awhile.

-describe where you carry fat and how changed. I’ve always had a bit of s linebacker build. Played ball in high school/undergrad(not a large program), so even though I haven’t kept up lifting I have a decent muscle base that makes me look less fat than I really am. I would say tons of weight ends up in my thighs.

-health conditions, symptoms [history]: asthma as a child, outgrew it. Nothing else really except family history of ADD and I got diagnosed a few months ago.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: no hair loss or prostate drugs. Recently have been taking 10mg XR Adderall, but I don’t take it every day, don’t take on weekends, will take a week off, etc.

-lab results with ranges

All I currently have is 285ng/dL with no ranges. More testing to be done next week but thrtr will be a 7-10 day turnaround. I will try to get body temps in the next few days.

-describe diet: probably average American diet. Fast food 2-3 x per week. Decent amount of protein and lots of carbs, but have been better/healthier about choices since this started.

-describe training: 1-2 times per week I will lift, but pretty inconsistent. Hardly ever cardio except as a 10 minute warm up.

-testes ache, ever, with a fever? No.

-how have morning wood and nocturnal erections changed:

Here is what started my concern. Wife and I have a pretty great/advenurous sex life. But, baby arrived somewhat recently, so for the past year or so, it has been kind if meh… I thought my lack of interest was just due to her pregnancy/exhaustion…but, baby is sleepiing thriujgh the night now and things haven’t really gone back to normal. Also, I sometimes have an issue with Delayed Ejaculation, but it was never really problematic and I didn’t think much of it. Used to get morning wood all the time, in hindsight I really haven’t much lately.

I didn’t really start thinkijng about this though until recently. I was at a conference and picked up a hot side piece (wife knew and was cool with it). Despite going at it for 2 hours and having a strong erection the whole time, I couldn’t ejaculate. I chalked it up to alchohol. I got a chance to redeem myself the next night - I did finally get the job done with it essentially turned into a chore it took so long.

Since I returned and for the past two weeks I have not had morning wood or any random wood I am accustomed to. I can hardly even get wood when my wife or I try, and it doesn’t really get us anywhere because my libido is low.

Mood wise I’m generally good, but the libido/DE issues are dealbreakers and caused me to get tested. Noe that I know this could be an issue, I am booth excited that there may be a resolution, but terrified about starting TRT at this age.

12/4 lab update:

Initial tests have returned, and they are not what I expected to say the least. If anything, this has certainly warned me away from the free T clinic variety of treatment (they originally report test value of 285ng/dL). The summary is that I have borderline low HDL, very high Homocystein, high AST and slightly high ALT, slightly high RT3, in-range but low B12, barely Vitamin D deficient, very high E2. I have a follow-up appointment on Thursday. I have been taking Vitamin D, Iodine, and Selenium since immediately after having my blood drawn (so the past 2 weeks or so), and have seen a very minimal improvement in the ED/libido department, but even that improvement is inconsistent at best. I would love to hear thoughts on recommended steps forward that I may keep in mind for my follow-up.

Full results are:

Test/SHBD
T: 596 (250-1100)
Free T: 123.7 (35-155)
SHBG: 15 (10-50)
Cholestorol Total: 141 (<200)
HDL Cholesterol: 40 (>40)
Direct LDL: 91 (<100)
Homocysteine: 18.7 (<11.4)
Apolipoprotein A1: 108 (94-176)
Apolipoprotein B: 64 (52-109)

Comprehensive Metabolic Panel
Glucose: 92 (65-99)
Urea Nitrogen: 20 (7-25)
Creatinine: 0.91 (0.60-1.35)
eGFR NON-AFR 114 (>=60)
eGFR AFR: 132 (>=60)
Sodium: 139 (135-146)
Potassium: 4.4 (3.5-5.3)
Chloride: 101 (98-110)
Carbon Dioxide: 29 (20-31)
Calcium: 10.1 (8.6-10.3)
Protein, Total: 7.5 (6.1-8.1)
Albumin: 4.8 (3.6-5.1)
Globulin: 2.7 (1.9-3.7)
Albumin/Globulin Ratio: 1.8 (1.0-2.5)
Bilirubin, Total: 0.7 (0.2-1.2)
Alkalin Phosphatas: 51 (40-115)
AST: 50 (10-40)
ALT: 48 (9-46)
Hemoglobin Alc: 5.1 (<5.7)
Magnesium: 2.1 (1.5-2.5)
Phosphate (as phosphorus): 3.6 (2.5-4.5)
Uric Acid: 5 (4-8)
Bilirubin, Direct: 0.2 (<=0.2)
Amylase: 36 (21-101)
TSH: 0.72 (.40-4.5)

T4: 8.8 (4.5-12)
T4 Free: 1.4 (0.8-1.8)
T3: 112 (76-181)
T3 Free: 3.5 (2.3-4.2)
RT3: 27 (8-25)
Thyroid Peroxidase Antibodies: <1 (<9)
Thyroglobulin antibodies: <1 (<=1)
Thyroglobulin: 4.9 (2.8-40.9)
Progesterone: <.1 (<=0.3)

White count: 7.4 (3.8-10.8)
Red Count: 5.50 (4.20-5.80)
Hemoglobin: 16.6 (13.2-17.1)
Hematocrit: 46.3 (38.5-50)
MCV: 84.2 (80-100)
MCH: 30.2 (27-33)
MCHC: 35.9 (32-36)
RDW: 12.6 (1-15)
Platelet Count: 23 (140-400)
MPV: 11.2 (7.5-12.5)
Absolute Neutrophils: 4810 (1500-7800)
Absolute Lymphocytes: 1835 (850-3900)
Absolute Monocytes: 651 (200-950)
Absolute Eosinophils: 67 (15-500)
Absolute Basophils: 37 (0-200)

Ferritin: 264 (20-345)
Vitamin B12 375 (200-1100)
Folate Serum: 10.3 (>5.4)
C-Reactive Protein: 1.8 (<8)
Cortisol Total: 14.1 (4-22)
DHEA Sulfate: 158 (85-690)
FSH: 3.1 (1.6-8)
Growth Hormone: 2.7 (<=7.1)

Vitamin D, 25-OH, Total, IA: 19 (30-100)

Estradiol, Ultrasensitive: 49 (<=29)

IGF 1, LC/MS: 245 (63-373)

PSA, Total: 0.5 (<=4)
Insulin, Free/Bioactive: 5.8 (1.5-14.9)

12/13/17 update:

So, I have been on the RX and supplement protocol KSman suggested, plus 5mg of T3 2x/day.

I had a few days of feeling great, but apparently fell through the E2 sweet spot. I felt like I crashed my E2 after my second dose of AI, and felt terrible, so I decided to hold off an AI and iimmediately went and got my E2 (and Test because I was curious) tested.

Results for E2 were as expected, but the interesting thing I can’t explain are the Test results are back to breing low…

12/13/17
T: 368 (264-916)
FT: 12.5 (9.3-26.5)
E2: 9.4 (8-35)

So, my T, FT, and E2 were ALL low, which makes no since to me given the protocol I’ve been on.

Could anastrozole causing the crash in E2 also leave to a T crash? If not, my T numbers seem to fluctuate wildly… any thoughts as to an explanation?

#2

Ejaculations problems where to first symptom I had, I had to go back a start over to ejacualte and had to do this 3 different times. Whenever you end up below mid 400 ranges is when you start having erection troubles. 285 is low no matter the lab ranges you’re going by. When you start TRT you should notice your libodo increase, most don’t notice the small decline over the long term, so once you get your T levels up you’ll realize what’s been missing and wonder how you didn’t even notice. Most go through a TRT honeymoon phase where for a few weeks you notice incredible results and then boom, it’s all gone. This is because your pituitary gland is shut down do to the pituitary gland seeing high T in your blood, it’s going to take months to adjust.

#3

Can you clarify? After the honeymoon stage my pituitary gland will shut down because it senses the T, which you are saying leads to a loss of libido and ED would return? So are you saying long term that TRT would not help?

#4

I’m saying your HPTA will eventually shut down and when it does you will experience a crash, no libido or erections but it’s not permanent though. Your pituitary gland secretes LH hormone that tells your testes to produce testosterone, TRT lowers or eliminates LH and the testes will shrink a little since there no longer receiving LH hormone. In other words you can’t have both the natural and injected T since your body always attempts a balancing act, once your body adapts to the injected testosterone things will return to normal, but it will take time.

The honeymoon period can last for days to weeks, we see guys coming in all the time wondering what happened to erections and libido, we tell them the same thing, give it time. Also high estrogen needs to be monitored because it can kill libido/erections, you’ll know if your high E2. You can do a few things to lower E2, inject more often and lower dose, if that fails an AI is needed. You really want to stay away from only one injection a week unless your SHBG is super high, otherwise twice weekly is best, more if low SHBG. This is where my doctor failed me, I have low SHBG and should never have been put on one injection a week. It wasn’t until injecting EOD that I really started feeling the effects of T.

#5

I understand. Since I am young I am considering asking for HCG right off the bat (fertility, etc). Is there s downside to this, and would it no keep at least my base level of libido going in the meantime?

#6

No there’s no way to avoid the crash, some guys just for some reason can’t handle HCG, we don’t yet know why. Being young does have it’s advantages so maybe you’ll end up one of those who recovers fast, some guys respond very fast to T-Cyp.

#7

Thanks. So would you advise for or against immediately jumping on HCG? Is there specific other hormones it has an effect on or side effect it causes that lead to some people not being able to handle it?

#8

Me personally I would rather go on TRT and reach a point where I feel good, then add HCG down the road. Some guys stop the HCG and for whatever reason feel better without it, so if you add it later and you lose that good feeling you’ve have for awhile, you know it’s because of the HCG and not another factor. You also need the best endo out there to be able to spot the differences in symptoms and factor in what is causing them, most endo’s are clueless so I have little faith among those in the field of endocrinology and with good reason.

These Low T Centers often start guys on dosages that are too high, their protocols are too aggressive. There cookie cut for everyone instead of being tailored to a specific patient, their idea, let’s shoot for the moon with the highest weekly dosages, 200mg is the limit for weekly dosages and unless you’re a hyper T metabolizer it’s going to be too much for you.

#9

At your age you must do some diagnostics:
LH/FSH - must be done before TRT
DHEA-S
prolactin - no sex/orgasm, hugging [babies, kittens, puppies] for a few days as these cause prolactin release
testicular exam for cancer or vascular abnormalities
TSH
fT3
fT4
fasting glucose
fasting cholesterol
AM cortisol - at 8AM or one hour after waking up

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 number 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.

#10

Thanks to you both. I have the lists from the sticking and one of the articles for what to test for prior to starting… But all the lists don’t agree. I am more than happy to pay for everyday that may be even somewhatijnstructive before I go down this road. Could you please help me put together a comprehensive list?

One source says:

Testosterone, total
Testosterone, bioavailable
Testosterone, free
Estradiol (sensitive assay)
Steroid Hormone Binding Globulin
Follicle Stimulating Hormone (FSH)
Luteinizing Hormone (LH)
Dihydrotestosterone (DHT)
Complete Blood Count (CBC)
Prostate Specific Antigen (PSA)
Blood Chemistry Panel
Metabolic Panel

Another says:

-LH and FSH [LH/FSH]
-TT
-FT or bio-T
-E2
-Prolactin [optional in most cases]
-DHT [sort of a waist of time and blood if your testosterone levels are low]
-PSA
-DRE: the dreaded digital rectal exam, doc gives you the finger

And your post provides yet another list. Sorry if some of this is already common knowledge on the board, doing my best to catch up and figure out what I need to know…

#11

I guess I need another thermometer or i don’t know how to correctly check my temperature… We got one of those “smart” kinsa thermometers a while back. I just took my temp about 10 times an your after waking and ended up with a Low result of 96.8 and a high of 99.8…pretty useless.

#12

So I got s new thermometer and have been monitoring temps. Definitely running low. Regardless of the time of day I have not got in the 98s (except for one errant 99 that seemed like a fluke). Just took temp at 2pm and it was 96.9.

I have my first conmorehensive lab appt times. I have ordered iodine, selenium, and D3 to start taking immediately after blood draws are taken. The sticky suggested that iodine can be taken at 5mg per day, but the article linked in the sticky stated adverse effects could be seen above 1mg… I think I am going to stick with 1mg per day to be safe, is there a recommended dose of selenium I should be taking to accompany this level of iodine supplementation?

After more crawliing of the forums the below is what I have out together as a "wish list to give my Dr. For labs to run… I want as much information as a baseline as possible before I starting messing with stuff… Anything I am missing on here or anything that you would consider an absolute waste?

LH and FSH
TT
Free Test
bio-available T
E2 (Estradial)
Prolactin
DHT
PSA
Hematocrit
Estimate Glomerular (eGFR)
Liver Enzymes
TSH
T3 (Total and Free)
T4 (Total and Free)
HDL
Reverse T3
Thyroglobulin Antibodies
Thyroid Peroxidase
DHEAs
Saliva cortisol
Comprehensive Megabolic Panel w/ EGFR
Vitamin D (25 (OHD) test)
Folate andVitamin B-12
Serum Iron (Total Iron)
Percent % Saturation of Iron
TIBC (Total Iron Binding Capacity)
Ferritin
Fasting glucose
Fasting cholesterol

#13

Initial tests have returned, and they are not what I expected to say the least. If anything, this has certainly warned me away from the free T clinic variety of treatment (they originally report test value of 285ng/dL). The summary is that I have borderline low HDL, very high Homocystein, high AST and slightly high ALT, slightly high RT3, in-range but low B12, barely Vitamin D deficient, very high E2. I have a follow-up appointment on Thursday. I have been taking Vitamin D, Iodine, and Selenium since immediately after having my blood drawn (so the past 2 weeks or so), and have seen a very minimal improvement in the ED/libido department, but even that improvement is inconsistent at best. I would love to hear thoughts on recommended steps forward that I may keep in mind for my follow-up.

Full results are:

Test/SHBD
T: 596 (250-1100)
Free T: 123.7 (35-155)
SHBG: 15 (10-50)
Cholestorol Total: 141 (<200)
HDL Cholesterol: 40 (>40)
Direct LDL: 91 (<100)
Homocysteine: 18.7 (<11.4)
Apolipoprotein A1: 108 (94-176)
Apolipoprotein B: 64 (52-109)

Comprehensive Metabolic Panel
Glucose: 92 (65-99)
Urea Nitrogen: 20 (7-25)
Creatinine: 0.91 (0.60-1.35)
eGFR NON-AFR 114 (>=60)
eGFR AFR: 132 (>=60)
Sodium: 139 (135-146)
Potassium: 4.4 (3.5-5.3)
Chloride: 101 (98-110)
Carbon Dioxide: 29 (20-31)
Calcium: 10.1 (8.6-10.3)
Protein, Total: 7.5 (6.1-8.1)
Albumin: 4.8 (3.6-5.1)
Globulin: 2.7 (1.9-3.7)
Albumin/Globulin Ratio: 1.8 (1.0-2.5)
Bilirubin, Total: 0.7 (0.2-1.2)
Alkalin Phosphatas: 51 (40-115)
AST: 50 (10-40)
ALT: 48 (9-46)
Hemoglobin Alc: 5.1 (<5.7)
Magnesium: 2.1 (1.5-2.5)
Phosphate (as phosphorus): 3.6 (2.5-4.5)
Uric Acid: 5 (4-8)
Bilirubin, Direct: 0.2 (<=0.2)
Amylase: 36 (21-101)
TSH: 0.72 (.40-4.5)

T4: 8.8 (4.5-12)
T4 Free: 1.4 (0.8-1.8)
T3: 112 (76-181)
T3 Free: 3.5 (2.3-4.2)
RT3: 27 (8-25)
Thyroid Peroxidase Antibodies: <1 (<9)
Thyroglobulin antibodies: <1 (<=1)
Thyroglobulin: 4.9 (2.8-40.9)
Progesterone: <.1 (<=0.3)

White count: 7.4 (3.8-10.8)
Red Count: 5.50 (4.20-5.80)
Hemoglobin: 16.6 (13.2-17.1)
Hematocrit: 46.3 (38.5-50)
MCV: 84.2 (80-100)
MCH: 30.2 (27-33)
MCHC: 35.9 (32-36)
RDW: 12.6 (1-15)
Platelet Count: 23 (140-400)
MPV: 11.2 (7.5-12.5)
Absolute Neutrophils: 4810 (1500-7800)
Absolute Lymphocytes: 1835 (850-3900)
Absolute Monocytes: 651 (200-950)
Absolute Eosinophils: 67 (15-500)
Absolute Basophils: 37 (0-200)

Ferritin: 264 (20-345)
Vitamin B12 375 (200-1100)
Folate Serum: 10.3 (>5.4)
C-Reactive Protein: 1.8 (<8)
Cortisol Total: 14.1 (4-22)
DHEA Sulfate: 158 (85-690)
FSH: 3.1 (1.6-8)
Growth Hormone: 2.7 (<=7.1)

Vitamin D, 25-OH, Total, IA: 19 (30-100)

Estradiol, Ultrasensitive: 49 (<=29)

IGF 1, LC/MS: 245 (63-373)

PSA, Total: 0.5 (<=4)
Insulin, Free/Bioactive: 5.8 (1.5-14.9)

#14

I suppose i should have given a bit more unformatuon on myh current thoughts and give somresoecific questions. I obviously think I do not need TRT in any form at this time given myg numbers, but I was wondering:

  1. What effect can I expect Vitamin D supplementatiokn have on E2 and homocystein levels?

  2. Given how high homocystein and E2 levels are, would you expect any prescription medications to be required to address the issue or should I be able to resolve with supplements? If so, specific recommendations?

  3. The slightly high liver enzymes are concerning because I just have no idea what to make of them. Any knowledge of it these could be out of what just due to hormone imbalance or shouldni be expecting another more concerning root cause?

  4. Do you see any sign of thyroid issues based on my results?

KSman is Here
#15

Elevated AST/ALT can be from sore muscles.
Can be part of elevated E2 from low E2 liver clearance. Some meds, Rx or OTC, can reduce E2 liver clearance.

Cortisol should be ‘AM cortisol’ at 8AM or 1 hour after waking.

GH should not be used for random screening! Use IGF-1 to eval GH status. GH is released in pulses with a very short half-life.

IGF-1 indicates good GH status.

Find 5000iu Vit-D3, take one per day, 25,000iu for first 5 days.

Homocysteine is specific to arterial inflammatory processes, aka heart/artery disease. Need lower E2 as E2 irritates the arterial lining, endothelium, one cell thick. Lower DHEA is not helpful.

Cholesterol is too low, better near 180, <160 associated with increased all cause mortality. That been said, some are simply lower. Cholesterol is made in the liver along with your [low] SHBG.

Supplements:
25mg DHEA - freely available in USA
fish oil and/or flax seed meal/oil
1000mg Vit-C
natural source Vit-E
Vit-D3 as above
high potency IRON-FREE B-complex multi-vit with 25mg zinc plus trace elements including iodine+selenium. [will help with HDL]
more eggs and cholesterol in diet

Rx for E2=49:
0.25 mg anastrozole twice a week
retest E2 after 10 days
see stickies for more re anastrozole and over-responders

Lower TSH, good fT3. Lowish body temperatures speak to rT3 which is then high as expected. You need to read thyroid basics sticky referring to:
stress
illness, infection, inflammation, chronic
adrenal fatigue
Wilson’s book

Adrenal fatigue: Your cortisol status unclear when not AM cortisol. Cortisol can be high then drops later on. DHEA is also an adrenal hormone and also low. While rT3 is up, TSH is oddly not. So this situation may be somewhat borderline. Life style and stress need contemplation. Progesterone is also adrenal in males. While low, the labs resolve poorly. Sometimes progesterone cream can be helpful if cortisol is low as progesterone–>cortisol. Your cortisol number seems OK at any time. Your DHEA adrenal hormone is low for your age.

#16

I must admit that I didn’t read this whole thread in its entirety so I apologize in advance if what I’m about to mention had been resolved. If you still experience depression and fatigue despite increasing your testosterone to a good level, your rT3 is most likely the cause. Mine was just about where yours is now and I felt like I was dying even though I was on trt. My depression was severe, nearly impossible to handle. That was fixed right up with synthetic t3 medication. Depression gone. Poof. Can finally get out of bed when I wake up now. Highly recommended. Can’t believe I lived like that for years.

#17

Okay. So follow up went great. I have a great doc because he mirrored the supplement and RX recommendstiokns provided here (including .25mg arimidex 2x weekly and T3).

Question, since the T3 seems like an iffy call fovrn mky levels, are there anyh potential negatives/sides with taking T3 I should be aware of? Any long term effects on shutting anything doennin my system?

Also, he did not suggest DHEA, but was not opposed to it. Given my already high E2, do we thiink DHEA might cause more problems than it’s worth at this point given it is in range (but on the lower end)?

#18

Thanks for the advice so far everyone. The first day on this protocol the ED/lidibo issues disappeared. Sensitivity is also way up and delayed ejaculation is not an issue. I think credit goes to the anastrozole. Anyone have thoughts on my question regarding T3 use? I am currently taking 5mcg 2x/day - should I have any concern about long-term effects this may have on my ability to naturally produce T3/etc?

#19

So, I have been on the RX and supplement protocol KSman suggested above, plus 5mg of T3 2x/day.

I have a few days of feeling great, but apparently fell through the E2 sweet spot. I felt like I crashed my E2 after my second dose of AI, and felt terrible, so I decided to hold off an AI and iimmediately went and got my E2 (and Test because I was curious) tested.

Results for E2 were as expected, but the interesting thing I can’t explain are the Test results are back to bring low…

12/13/17
T: 368 (264-916)
FT: 12.5 (9.3-26.5)
E2: 9.4 (8-35)

So, my T, FT, and E2 were ALL low, which makes no since to me given the protocol I’ve been on.

Could anastrozole causing the crash in E2 also leave to a T crash? If not, my T numbers seem to fluctuate wildly… any thoughts as to an explanation?

#20

Those E2 ranges look like there (non-sensitive assay) for females similar to labs corps 7-42 range. Your E2 is likely lower. Anastrozole inhibits the conversion of T->E2, it doesn’t inhibit T.