T Nation

28 Y/O, Low T


#1

Hi all. I am turning 28 soon. I have always ate well and worked out routinely since I was 18. I have never had any chronic health issues. That all changed when I took Propecia for 6 weeks starting in August...I discontinued use late September because of insomnia and frequent urination. Nothing has improved. More after effects are showing up. Post Fin 6 week labs are below and show hypogonadism.

28
5'9''
31'' waist
150-155 pds
Leg hair, very little facial hair
-describe where you carry fat and how changed
Stomach, ass, hips and chest but never anything significant unless I let myself go diet wise. Nothing has dramatically changed yet
-health conditions, symptoms [history]
PFS, Post Finasteride Syndrome

Insomnia
Frequent Urination
0 libido
Weak erections
Minor tinnitus, ear sensitivity
Minor brain fog
Pleasureless orgasm
Minor testicular shrinkage
Dry/thinning skin
Anxiety
Depression
Minor joint ache

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Finasteride 1mg for 6 weeks back in September
Lorazepam 0.5mg only for 1 month for insomnia.
Anastrozole 1mg for 2 days for HPTA restart attempt

Currently taking QD
Vit D 5000 U
Fish Oil
Green Tea Extract
Mybetriq (Mirabegron) for over active bladder
OTC sleep aid (Melatonin, Valerian, Calcium, etc)
ZMA

-lab results with ranges
See below
-describe diet
Eat as unprocessed as I can
-describe training
Bill Starr, Rippetoe
-testes ache, ever, with a fever?
Slight ache during and post propecia
-how have morning wood and nocturnal erections changed
Absent or weak

CBCs
Nothing irregular

TSH 0.545 (0.450-4.5)
T4, Free(Direct) 1.5 (0.82-1.77)

Lipid Panel Never had abnormal values prior fin
TC 219 HIGH (100-199)
TG 84 (0-149)
HDL 78 (>39)
VLDL 17 (5-40)
LDL 124 HIGH (0-99)

Serum Test 239 LOW (348-1197)
Free Test 5.7 LOW (9.3-26.5)

LH 1.2 LOW (1.7-8.6)
FSH 3 (1.5-12.4)

DHT Pending
3A Androstanediol-G Pending

DHEA-Sulfate 371.2 (138.5-475.2)

Cortisol 13.6 (2.3-19.4)

Prolactin 3.5 LOW (4-15.2)

Estradiol 9 (7.6-42.6)

Androstenedione Pending

Prostate Specific Ag 0.5 (0-4)

IFG-1 191 (98-282)

Vit D 15.2 LOW (30-100)

Insulin 5.3 (2.6-24.9)

Ferritin, Serum 371 (30-400)

Triiodothyronine, Free, Serum 1.9 LOW (2-4.4)

SHBG, Serum 40 (16.5-55.9)

Urologist prescribed Anastrozole 1mg QD for HPTA restart. I thought Clomid was the standard but did not want to challenge. Urologist probably thinks I am already crazy because he does not believe in PFS. Anastrozole triggered my tinnitus although that could have been Finasteride related. I have discontinued use after 2 days. Morning erection and general erection quality did come back 2nd day of use. However, I am wary of any pharmaceutical intake at this point.

My key concern at this point is treating my drug induced hypogonadism. Any advice would be well appreciated. I do not want to attempt any HPTA restarts. I have not found any success with them with PFS sufferers. Mentally I have accepted that my HPTA might be permanently wrecked which will require lifelong HRT. I have always planned on going on HRT later in life. Poor decisions in life have forced me to go on earlier than expected.

My current plan is to suggest the stickied TRT protocol to a doctor.

100mg test cypionate or ethanate injected per week with two or more injections per week.
250iu hCG SC EOD [every other day]
1.0mg Arimidex/anastrozole per week in divided doses. (I already have this but really do not want to take)

  1. I have read many positive reviews with test propionate. Any thoughts on this form of test vs cyp/eth?
  2. Stickied TRT protocol includes anastrazole for E2 control. Any OTC alternatives? I realize nothing OTC can compare.
  3. Can I make do without anastrozole until my next set of blood tests? If my E2 comes back high >30, I will reevaluate my risk/reward with anastrazole. Or will the TRT + HCG increase E2 so much that I will have no choice from the get go?
  4. DHT and DHT metabolites are still pending. I should find out on Saturday. If these are low as a result of finasteride damage to 5AR enzyme, any suggestions for additions to stickied TRT protocol? TRT should increase DHT levels? If only minor DHT increase after first set of labs post TRT, should there be need for inclusion of Proviron/Masteron to protocol?
  5. Any thoughts on thyroid levels? (Still attempting to digest thyroid sticky)

Thank you in advance.

Alex


#2

DHT will be low and really does not matter at this point. DHT will recover with TRT.

Thyroid is a problem. Please report your long term use of iodized salt and/or vitamins that list iodine. Any history of feeling cold easy? Report body temperature when you fist wake up and also mid-afternoon. Doc will think that thyroid is good based on lab ranges. Ft3 and fT4 should be near mid range. Your TSH is lowish, should be closer to 1.0. That seems strange and TSH would be expected to be higher, not lower.

Vit-D3: find tiny oil based 5,000iu caps, take 25,000 per day for five days and 5,000 thereafter.

Sleep: release of melatonin is a dark environment, when melatonin levels drop, that makes you wake up. Melatonin has a short half-life and when you take melatonin, that can make you wake up 4 hours later. Look for a time release product.

Prop VS Cyp: Both yield bio-identical T after the ester groups are removed. If you inject often, there is not advantage to prop and cyp is generally least cost.

Proviron/Masteron are not Rx, you would be on your own and hair loss may accelerate.

OTC for AI: Never seen anything effective in a TRT context


#3

Thanks for the advice KSman.

Updates:

Thyroid
I have had very little salt intake over the years outside of restaurant food. I used to take NOW ADAM which has insufficient amounts of iodine as per your sticky. Morning temperature readings ranged from 96.5-97.5. Mid day readings did not reach 98.6 I have begun IR with Iodoral 2 x 12.5 mg for 1 month. Then I will reduce dosage to 6.25mg QW.

Vit D3:
I did the Vit D3 load as you suggested and currently take D3 5000U QD

Sleep:
I have switched over to Melatonin timed released

TRT:
Urologist would not prescribe me any test due to my age. He wrote me a script for HCG 1000U 3x per week. HCG must be filled at specialty pharmacy as per my insurance policy so that will take 5-10 days to get here. Between scheduling appointments with doctors and getting meds, it seems I will never be on an optimized TRT protocol. Any advice? Can I make due with HCG monotherapy? 250U EOD? Should I try to find a new doc? I’ve been taking NOW tribulus since I have nothing else at the moment.

Thanks.

Alex


#4

I would not do 3,000iu hCG and you have probably read why. - also costly
Desensitization of LH receptors would be a huge step backwards.
hCG needs to be supplied dry, with BA water [0.5% benzol alcohol] NOT saline water!

Restaurants do not use iodized salt, ditto prepared foods.

I have updated references in the thyroid basics sticky to include strong language that selenium must be in your diet to avoid thyroid auto-immune diseases that can occur when taking iodine when selenium deficient.

You can try hCG 250iu and see that happens.

You have low body temps, low TSH and low ft3. There are two implications

  • pituitary cannot properly release TSH
  • fT4 was good, fT3 is low, you are not converting fT4–>fT3, rT3 might still be a factor
    – ferritin is not low, so that is not the problem

See what iodine does for you, get multi-vits ASAP with selenium and iodine.

Has sleep improved?


#5

HRT:
Will start on 250U SUBQ EOD once received by pharmacy and retest BW in a month. If no significant improvement, hopefully doc will see need to add exogenous test.

Thyroid:

I have been taking selenium 200mcg with the Iodoral 25mg.

Insomnia:

Sleep was ok first night on Melatonin timed released. However past 2 days have not been great.

Antiaging:

Any thoughts on adding Hgh peptides to TRT protocol? IGF level was ok on previous BW. I do not really get deep sleep anymore and it shows. Vision, hearing, skin, muscle degradation is progressing at an interesting rate not common to the regular low T guy. I am interested mostly in starting off with ipamorelin 1U before bed since it has the least sides. If well tolerated, will add CJC no dac to complement.


#6

The catabolic state of low T can reduce collagen in the skin, makes it thin, inelastic and frail. Don’t need low GH for that.

Low thyroid function also leads to dry skin.

Improved T and thyroid function will improve all organ systems and GH might improve just from that.

When one injects GH, it takes around 6 weeks to note that things are better. So your ipamorelin would require dedicated use to see if working.

GH levels are regulated with a negative feedback loop. When one injects or induces more GH, the first amount simply replaces your own production. So you cannot just add a bit of GH, you have to first replace your own production before you get any increase. So the benefits and benefit:cost favors the truly deficient.

I think that you should not mess with GH, see what the other measures can do first and then check IGF-1 later.


#7

BW 10 weeks off post fin, pre HCG monotherapy

Free T3 2.8 (2-4.4)
Free T4 1.35 (0.82-1.77)
TSH 2.5 (0.450-4.5)

Vit D 23.7 (30-100) LOW

E2 13.7 (7.6-42.6)

Prolactin 4.6 (4-15.2)

FSH 3.3 (1.5-12.4)
LH 2.1 (1.7-8.6)

Serum Test 338 (348-1197) LOW
Free Test 10.5 (9.3-26.5)

OTC Test boosters gave some minor lab value improvement but not feeling it physically/mentally

Current plan:

Retest hormone panel after a month of monotherapy HCG 250IU EOD
Test full thyroid panel with RT3
Test progesterone
Test cortisol with 24 hour saliva test
Test hair mineral analysis

  1. Should I bump the Vit D to 10,000U QD?

  2. Any thoughts on above thyroid values? I am still doing Iodine 12.5mg QD w/ Selenium 200mcg QD. I have not been taking daily temperature but still start again soon. Hands and feet are still randomly cold.

  3. Skin especially on hands continues to increasingly become wrinkly and has lost elasticity. As previously mentioned in above post, this could be from low T. I realize skin takes time to recomposition. My thinking is high cortisol could also be a factor here (cortisol breaking down muscle, collagen, tissue) PFS seems to induce adrenal fatigue in a lot of guys. The symptoms are very similar. Should adrenals be focused on next? I ordered cortisol saliva test and hair mineral test. My findings are that poor thyroid function usually comes with poor adrenal function?

Thank you.

Alex


#8

yes, take more vitamin d3


#10

No improvements other than sleep. What are your symptoms?


#13

I didn’t respond to hcg after many months. Seems like I’m insensitive to androgens or anything that directly or indirectly increases their levels.

If you want to go the pharma route, hit up Dr Goldstein in San Diego. No other Dr is worth it

If you want to do the nonpharma route, look up pfs on the swole source forums.

Your symptoms could be a lot worse. Some get better. Most don’t. Good luck