T Nation

30 Y/O on TRT Wants His Life Back


#1

First off I would like to thank everyone for the quality of this forum. I have already learned so much. I think I'm done lurking and would like to submit my own case for your feedback and advice.

I'm currently seeing my PCP. He is very open to all of this and will listen to any input I might have. He is admittedly undereducated on at least HCG but I think he could use some work on the overall HPTA. He did not order all the necessary labs before placing me on TRT.

A little background: I have had the usual low T symptoms consistantly for at least 3 years (I thought it was just how I was and i would have to live with it). Before that it was just on and off. Brain fog, memory, blurry vision, no ambition, no joy in the things I used to love, lethargy, weakness, etc. The non-existant labido and ED has been happening for 18 months. This was what pushed to the point to find a fix.

My doc offered prozac 6 weeks ago while we were waiting for the lab results. I thought since the zoloft helped before maybe this was it. I took the prozac for 3 weeks and decided that my hormones were where i needed to focus. After my labs came back (attached) my doc offered transdermals. I went with Testim 5mg a day for 2 weeks. I felt nothing.

So after doing research for those 2 wks I asked to be placed on test cyp 50mg E3D. I have been doing this for 2 weeks. week 1 one pretty good. Less foggy overall better feeling but still no labido. Morning wood for a few days but nothing that I got too excited about. Then i crashed for a few days. Now I'm just ok. No nipple sensitivity but a little more moody and emotional. My doc did give me a rx for arimedex but I have not used it yet. He is cuurrently looking into how to rx HCG.

30 Y/O
5'9"
32" waist
180 lbs
body and facial hair- all normal, no back hair
I carry my fat in the lower mid section- hips and waist
Hx- was on zoloft for a few years (2003-2006) Labido was great while on it but climax became a problem. INH for 9 months due to possible TB exposure. Doubtful on the TB believe it was a false pos.
Other than that zero health issues.

I take daily: fish oil and multi vitamin. Just started taking D3 and B12
Diet is good. No fast food. Most clean meats and veg and potatoes.
Training was better up until a year ago. Weights and boxing. Have started more on the cardio only side the past couple of months. I don't have the will for the gym or much boxing anymore.
negative ache in testes/fever
morning wood has been non-existant for probably 2 years now.

I have my next appt in one week. I will ask to have labs done in reference to the sticky. I am also thinking of 250 iu E3D of HCG and dex as needed. Following Chrislers protocol.

Should i be questioning adrenals or thyroid?
Thank you in advance! You guys have opened my eyes to the possibility that I can feel good again and enjoy the great life that I know is there.


#2

welcome onboard.

yes - you should always test your thyroid (TSH if > 1.5 then ask for free T3, Free T4, Reverse T3) and adrenals (8am Cortisol) as well as your estradiol, ferritin, D25-OH, (etc. etc.)

what test results do you have? can you post the results and the lab ranges?

talk with the doctor's office and get an order for the lab tests BEFORE you see the doctor. that way it is not a wasted trip. the visit with your doctor should be to sit down and discuss the blood tests results - not to simply determine what tests you need (that is just a waste of time and money).


#3

Thanks for getting back to me so quick. I attached my labs (edited my personal info) as a "attach image" I guess that didn't work. I'll try attaching as pdf. If that doesn't work I will type it all out.


#4

OK, here is everything I have for my recent labs. Collected 6 weeks ago at quest.

Testosterone, total, lc, ms, ms ; 295 -- 250-1100 ng/dl
Free Test ; 53.4 -- 35-155 pg/ml
FSH ; 1.9 -- 1.6-8.0 mIU/ml
Estradiol ; 22 -- 13-54 pg/ml
PSA, total ; 0.5 -- <=4 ng/ml
TSH 3rd generation ; 1.4 -- 0.4-4.5 mIU/L
T4 Thyroxine, Total ; 9.5 -- 4.5-12.0 mcg/dl
T4 free ; 1.2 -- 0.8-1.8 ng/dl
T3 total ; 97 -- 76-181 ng/dl

Glucose ; 90 -- 65-99 mg/dl
Urea Nitrogen ; 21 -- 7-25 mg/dl
creatinine ; 1.00 -- .79-1.33 mg/dl
egfr ; >60 -- >60
sodium ; 139 -- 135-146 mmol/l
potassium ; 4.3 -- 3.5-5.3 mmol/l
chloride ; 102 -- 98-110 mmol/l
co2 ; 25 -- 21-33 mmol/l
calcium ; 9.8 -- 8.6-10.2 mg/dl
protein, total ; 7.7 -- 6.2-8.3 g/dl
albumin ; 4.7 -- 3.6-5.1 g/dl
globulin ; 3.0 -- 2.1-3.7 g/dl calc
albumin globulin ratio ; 1.6 -- 1.0-2.1 calc
bilirubin total ; .6 -- .2-1.2 mg/dl
alkaline phosphate ; 71 -- 40-115 u/l
ast ; 20 -- 10-40 u/l
alt ; 23 -- 9-60 u/l
creatine kinase, total ; 157 -- 44-196 u/l
myoglobin, serum ; 18 -- <=50 mcg/
prothrobin time inr ; 1.0 -- .9-1.1
pt ; 10.6 -- 9-11.5 sec

CBC (incl diff/plt)
white ct ; 8.6 -- 3.8-10.8 thou/ul
red ct ; 5.03 -- 4.2-5.8 mil/ul
hemoglobin ; 15.8 -- 13.2-17.1 g/dl
hematocrit ; 45 -- 38.5-50 %
mcv ; 89.6 -- 80-100 fl
mch ; 31.4 -- 27-33 pg
mchc ; 35.1 -- 32-36 g/dl
rdw ; 13.2 -- 11-15 %
platelet ct ; 242 -- 140-400 thous/ul
abso neutrophils ; 5848 -- 1500-7800 thous/ul
lymphocytes ; 1944 -- 850-3900 cells/ul
monocytes ; 619 -- 200-950 cells/ul
eosinophils ; 129 -- 15-500 cells/ul
basophils ; 60 -- 0-200 cells/ul
neutrophils ; 68 --
lymphocytes ; 22.6
monocytes ; 7.2
eosiniphyls ; 1.5
basophils ; .7

vit B 12 ; 893 -- 200-1100 pg/ml

ana ifa screen w refl to
titer and pattern
ana screen, ifa positive -- negative

antinulear antibodies
titer and pattern
ana pattern nucleolar


#5

Secondary hypogonadism.

T3 total is useless, should have been fT3

Thyroid is not right. Best if results are mid range and TSH closer to 1.0

Iodized salt?
Iodine in vitamins?
Check body temp when you wake up and a few times during the day for a while, record and post back here.
Dry skin?
Chilled easily?
Nail/hair/skin problems?

If your testes are healthy, hCG monotherapy might work.

E2 level seems great, but in the context of your T levels, there estrogen dominance. E2=22pg/ml is the target when on TRT. As you are starting from there, TRT will increase E2 and you very likely will need anastrozole/Arimidex to manage E2.

Read the stickies please.


#6

Iodized salt when used. I very rarely add salt. My multi contains 150 mcg's of iodine which is 100% rda. Neg dry skin but I do live in FL so it stays pretty humid. Neg chills. As far as nail/hair/skin the only thing would be; Cracked toe nails on both big toes. All other nails are very strong and clear. I will take my temp and record as you instructed.

I am understanding the correlation between T, E2, and the need for anestrozole more and more but it looks like I need to read up alot on Thyroid issues. So, assuming the temp readings show a thyroid problem, how would I know if the thyroid treatment is working since I've already started Test? This is probably why educating myself, prior to treatment from a doc who doesn't know exactly what he is doing, is important..... I kinda knew that but was too excited to wait longer to feel better. It's tough when you read the success stories, made me a little too impulsive.

Thank you KSman and PureChance for your interest and advice.


#7

Feeling excited with the prospect of feeling better is a great thing, that does great things for your brain and mind.

If there is a thyroid issue associated with a poor iodine intake, then the great thing is that you can increase iodine intake and that might be very helpful.

150mg RDA was a great attempt to eliminate goiter. http://www.google.com/images?hl=&q=goiter

But that RDA was never intended to be in any way a recommendation of an optimal level. And the RDA for vit-D3=400iu was intended to prevent rickets. http://www.google.com/images?hl=&q=rickets

So are doctors concerned about optimal iodine or vit-D3 intake? Historically not and mostly not today.

We have some good evidence that E2 should be near 22pg/ml when on TRT. But we cannot put any clinical evidence in the faces of docs and very rarely are they able to grasp the functional medicine implications and think for themselves.

We have to manage our own health care.


#8

Copy that KSman. Thats one reason I am really happy with my doc. He will give me the reigns in my decisions and he doesn't get all self righteous when I suggest treatments or bring in papers from other sources on the subject.

Temps

3-31-2011

7 am - 96.7
1 pm - 96.5
5 pm - 97.5
930 pm - 96.8

04-01-2011

730 am - 96.4
10 am - 96.3
1 pm - 96.5
5 pm - 97.0

04-02-2011

630 am - 96.5
10 am - 97.0
4 pm - 96.5
930 pm - 96.7

04-03-2011

8 am - 96.1
6 pm - 97.6


#9

I can't believe these temps! I feel like my brand new thermometer is is a piece of garbage.
Any further instructions on this?

I am getting some labs done on Wednesday April 5th. As stated above, I have been on Testim for 2 weeks and then Inj of 50mg test cyp E3D for 3 weeks. Is it too early for labs? I read that its usually 6 weeks after beginning inj.

Anything i should add to this:

TT
FT or bio-T
E2
Prolactin
DHT
LH/FSH
PSA


Maybe these?

Thyroid labs
TSH
fT3
fT4

Adrenal labs
Cortisol four sample saliva testing [the gold standard]
Pregnenolone
DHEA-S


Or should I use (KSman or HAN's list?) this list?

fT3
fT4
rT3
THS 3 rd generation
tpo,
tgab
ferritin
SHBG
TT -total testosterone
bio-T
cortisol am and free
DHEA-S
vitamin D 25 oh
progesterone
DHT
prolactin
estradiol sensitive assay
CBC
CMP
B-12/folate serum

Thank You for any advice. I have been reading through the stickies but would like to clear up some of my confusion due to my new low temp realization.

Again thank you.


#10

the body temps seem very reasonable for a person with hypothyroidism. you may want to try out a different thermometer just to confirm the readings are accurate.

what tests do you feel you can get away with? what can you convince your doctor to run? It is usually a struggle to get what you need. I would shoot for the moon and fall back to the essentials if you have to.


#11

If costs are an issue, the male panel at lef.org is on sale for April-May $199

Check to see if the thermometer hits expected levels with someone else.

The fast acting thermometers can really create some odd readings. I don't like most of them.

If you think that iodine levels are not good, might make more sense to correct that before investing in thyroid labs.


#12

Cost is not an issue, I just have a copay. I am fairly confident that my doc will test what I ask for. I just don't want to go crazy or order anything that will be useless due to the fact that I have already started trt.

While confirming my temps today with a thermometer from work, it looks like my thermometer was reading around one degree low consistently.

Thank you