First off, I really appreciate all the information and guidance you all have been providing free of charge. I've been lurking here for the past few weeks, and in that very short time your opinions, analysis and experiences have proven EXTREMELY helpful in my attempts to change my life.
Short bio data - I am a 28 YO male, 5-11, and 339 lbs (down from 415 in January of this year, and 394 on July 1st of this year). I am currently following an ultra low-carb diet (<20 grams of carbs / day) to lose weight, as well as exercising 5x a week for 50-60 mins on an elliptical trainer.
Starting about 10 years ago, I began feeling totally exhausted, foggy-headed, and just "out of it" pretty consistently. My academic performance suffered greatly - once a fantastic straight-A student, I graduated college with barely a 2.7 GPA. I had no sex drive (frankly, I didn't even know what a sex drive was until this year, when my therapist asked if I'd ever had a girlfriend). I had a great group of friends that stuck by me even as I slowly withdrew from all social activities, always complaining that I was exhausted or just "not feeling up to" doing things that should have been fun and exciting for me. I took up smoking cigarettes, drinking copious amounts of coffee, and just generally chastising myself for not being able to keep up with my peers, and this turned into a variety of really negative thoughts/self-talk that I am currently in CBT to get a hold of.
Somehow, even with all this going on, I was able to push through and get a pretty good job after graduation...which lasted all of 3 years, with my mental/physical state continuously deteriorating, until I quit and proceeded to spend the next 2.5 years literally locked in my apartment, overeating and sleeping at odd hours of the day, avoiding everyone I knew (including family), and just generally being depressed and exhausted.
Jan 1st of this year I moved home in an attempt to figure out what the hell was going on with me. My thyroid/blood/blood sugar was checked (everything normal - even at 415 lbs), I was told I was depressed, and began psychotherapy and taking Wellbutrin 300mg daily in May. I also discovered I had severe sleep apnea, which is now being successfully treated with an APAP machine (according to the data the machine keeps, my sleep is now perfect, with no apnea events so long as I am sleeping with the mask on). I have been using the APAP since June 1st of this year, and although it reduced some of the daily exhaustion I have, I am still brain-fogged, unmotivated, and mostly just dog tired all the time.
On the advice of my therapist, in early September she suggested I get my testosterone levels checked, as my symptoms seemed to correlate well with low testosterone. Lo and behold, my levels were extremely low - 250 - and my GP immediately ordered more tests as well as informing me that he wanted to put me on testosterone cyprionate injections of 200 mg 2x a month. After reading up here, I asked him to order some more tests before we started with injections, thinking that it would be best to have as much information as possible before starting with such a serious program.
Below are all of the tests I've had done so far - they are all within the past month, and hopefully they will be of some assistance. Additionally, I have been taking my waking body temperatures this past week, and literally every single morning the past 7 days the value has been 96.9 F - no change day to day.
Testosterone / Other Hormone Tests
Testosterone: 2.5 (2.2-7.8 ng/ml)
Testosterone Free: 55 (30-140 pg/ml)
SHBG: 28 (13 - 90 nmol/L)
Estradiol: 38 (0-47 pg/ml)
Prolactin: 6 (0-14 ng/ml)
FSH: 3 (0-14 mIU/ml)
LH: 6 (0-14 mIU/ml)
PSA: 0.4 (0-4.00 ng/ml)
Comprehensive Metabolic Panel
A1C: 5.5% 4.0-6.0%
Sodium: 135 135 - 145 mEq/L
Potassium: 4.0 3.6 - 5.2 mEq/L
Chloride 100 98 - 108 mEq/L
Carbon Dioxide 25 22 - 32 mEq/L
Anion Gap 10 4 - 12
Glucose 82 62 - 125 mg/dL
Urea Nitrogen 12 8 - 21 mg/dL
Creatinine 0.91 0.51 - 1.18 mg/dL
Protein (Total) 7.3 6.0 - 8.2 g/dL
Albumin 4.0 3.5 - 5.2 g/dL
Bilirubin 0.4 0.2 - 1.3 mg/dL
Calcium 9.7 8.9 - 10.2 mg/dL
AST (GOT) 17 9 - 38 U/L
ALKPHOSPHATASE 74 35 - 109 U/L
ALT (GPT) 16 10 - 64 U/L
TSH: 1.67 (0.4-5.000 uIU/ml)
Triiodothyronine (T3): 93 (73 - 178 ng/dL)
Thyroxine (T4) Free: 1.2 (0.6 - 1.2 ng/dL)
WBC 11.08 4.3 - 10.0 THOU/uL
RBC 4.95 4.40 - 5.60 mil/uL
Hemoglobin 14.1 13.0 - 18.0 g/dL
Hematocrit 42 38 - 50 %
MCV 85 81 - 98 fL
MCH 28.5 27.3 - 33.6 pg
MCHC 33.5 32.2 - 36.5 g/dL
Platelet Count 373 150 - 400 THOU/uL
RDW-CV 15.0 11.6 - 14.4 %
Current Prescriptions / Vitamins
Wellbutrin 300 mg (Daily)
Vitamin D 5000iu (Daily)
NOW Foods Multivitamin (Daily)
There is a family history of goiter and general thyroid issues in my family (mother had a small goiter and is diagnosed hypothyroid, grandmother had a goiter, father had two small thyroid nodules). I was once a very skinny kid, and then suddenly, out of the blue, got fat around 8 years old. I have always carried most of my fat in my chest (have had manboobs since 8, they are massive now), and didn't really start growing a gut until partway through college, when I ballooned from 240 to 300 lbs. Additionally, I was a very active kid and played soccer, ran track (believe it or not, I was a hell of a sprinter even being overweight), and football, until a devastating knee injury my Junior year of high school (Posterolateral Knee Dislocation - ACL, PCL, LCL, meniscus all torn, hamstring torn from its anchor behind the knee, shattered fibula, secondary damage to the peroneal nerve resulting in foot drop that I deal with to this day).
My questions are as follows:
1) Does the treatment protocol my GP wants to start me on (200 mg Test Cyprionate Injections every 2 weeks) make sense given the above data?
2) Are my waking temperatures abnormally low? (96.9 on the dot every day the past 7 days) Should I start on Iodoral?
3) What else should I be doing diet / exercise / life-wise to get this weight off, start feeling better, and get my life back?
4) Does anything in my test results pop out at you as something to investigate (besides the low testosterone result)?
Thank you all again for all your help. I'm hoping to learn as much as I can from you, and contribute what I can to others as they join this site and I increase my knowledge.