T Nation

31, Started TRT, New labs 5/31/16


#1

Hello! Just found this website after starting TRT. I’ve already found some great information in the stickies, and I’ve scheduled a televisit (basically a Skype session) with my endocrinologist. I’ll put some of the important info below, but I’m looking for input on whether I’m on the right track and whatever advise you might have for the discussion with my doctor.

Age: 31
Height: 5’11"
Waist: 36"
Weight: 255 lbs

Body and Facial Hair: Full beard, hairy chest/stomach/arms/legs, patchy hair on back, hairline receding/thinning up front.

Carry Fat: Around mid-section. I have a big chest and broad shoulders, but my stomach sticks out an inch or two further than my chest. Also carry around the “love handles”. This has changed in that I am carrying more of it, but I still seem to carry in the same places as before.

Health conditions: Low T (around 200 or lower for at least 5 years), Low Vitamin D, back injury in 2009 (lumbar strain), back surgery 11/2015 L4-L5 microdiscectomy, herniation of L3/4 and L4/5, migraines, had asthma as a child but “outgrew it”, always tired regardless of sleep, low sex drive, difficulty losing weight, difficulty focusing.

Rx and OTC drugs: Orange Triad Multi-Vitamin, joint, digestion and immune formula, Aleve 220 mg NSAID, Excedrin Migraine as needed, 24 hour allergy relief Cetrizine Hydrochloride Tabs 10 mg.

Labs (as of 3/28/2016)
Testosterone, Serum 146 (348-1197 range)
Testosterone, Free 4.88 (5.00-21.00 range)
% Free Testosterone 3.34 (1.50-4.20 range)
Testosterone % Free+Weakly Bound 43.0 (9.0-46.0 range)
Testosterone Free+Weakly Bound 62.8 (40.0-250.0 range)

DHEA-Sulfate 403.6 (138.5-475.2 range)
FSH, Serum 5.1 (1.5-12.4 range)
LH 3.9 (1.7-8.6 range)
TSH 2.310 (.450-4.500 range)
Thyroid Peroxidase (TPO) 9 (0-34 range)
Triodothyronine (T3) 109 (71-180 range)
SHBG, serum 13.8 (16.5-55.9 range)
Vitamin D 25-hydroxy 19.9 (30.0-100.0 range)
Estradiol 11.0 (7.6-42.6 range)
T4, Free (Direct) 1.04 (0.82-1.77 range)
Prolactin 17.5 (4.0-15.2 range)
ACTH, Plasma 32.5 (7.2-63.3 range)
Cortisol 13.5 (6.2-19.4 range morning)

Hemoglobin A1c 5.7 (4.8-5.6 range)
Glucose, serum 101 (65-99 range)
AST (SGOT) 37 (0-40 range)
ALT (SGPT) 79 (0-44 range)

Diet: I have a problem with portion control and sweets. Ideally, I eat eggs in the morning (2 eggs in a breakfast taco or 3 eggs by themselves), chicken breast with white rice and vegetables for lunch, almonds and fruit for snacks, and some form of protein with veggies for dinner (steak and green beans or fish and spinach, something along those lines). That being said, I lack a lot of self-control and my wife is currently pregnant so there is a lot of junk around me that gets consumed almost daily.

Training: After my back surgery in 11/2015, I have been slow to get back into working out. Until recently, I had only been walking short distances, stretching 30 minutes or so daily, and resting. Now I am getting back into some strength movements, but nothing too much because my back is still a concern. I workout about 5 times a week for approximately 45 minutes each workout.

Testes ache? I have had some aching in my testes but not often.

Morning wood? I still have morning wood about half of the time. Erections in general don’t feel full though.

Treating with Testosterone Cypionate 200 MG/ML 1x every two weeks (self-injected with 23G x 1-1/4 needle in the quad).

Also, sent me to a sleep doctor to test for sleep apnea, and I had MRI of my pituitary to check for a mass (nothing to report on that yet).

So far, the discussion I want to have with him includes:

  • more frequent injections with a smaller needle (IM or not?)
  • addition of hCG and arimidex/anastozole

Anything else I should discuss with him on Friday?


KSman is Here
#2

You may want to consider going to a different gauge needle, 25ga is good but others get away with 29ga and slinpins. It will do a lot less damage.

I’m not good at all of the totals, but you should keep an eye on your A1c - I believe 5.7 is pre-diabetic. It’s weight dependent, so if you can lose a few lbs it should improve.

Finally, whassup with your ALT? Did you work out close to the time of the blood test? If not, you may want to keep an eye on that as well.

And, you should get a baseline PSA.

Good luck.


#3

I’ll definitely be asking for a smaller needle. First injection left me sore for almost 3 days.

Glucose and A1c were both at pre-diabetic levels. This was the first time I’ve tested that high, and my dad died from all the issues he had with diabetes so I know it’s serious. Doc recommended losing 10 lbs a year until I’m at a normal BMI.

Did not work out prior to blood test. Saw the Doc and had blood drawn first thing in the morning. I work out at lunch time. The little bit of research I did talked about possible liver damage, so that’s concerning…

I was thinking the doc ordered that test, but I guess not…

Thanks for the input Myth!


#4

Your prolactin is high. Consider getting tested for a pituitary tumor.

TSH is higher than it should be. Read the thryoid sticky, measure your morning temps, consider supplementing with iodoral.

Supplement D3, you are low. 5000iu.

Address those three issues and your T may resolve on it’s own.

Your LH/FSH is lowish. You could be secondary hypogonadism, treatment with SERM could be effective.

E2 is low. I’d wait on the AI until you experience symptoms, but have it on hand if you can.

Fixing your T will also help with the pre-diabetic levels.


#5

Prolactin secreting pituitary adinoma can lower LH/FSH and thus T. But you are also showing signs of primary hypogonadism.

fT3 is what gets the job done and needs to be tested.
Thyroid problems can be from not using iodized salt.
TSH should be nearer to 1.0, thyroid lab ranges are useless.

Please read these links found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics explained - post oral body temperatures as suggested

Take 5000-6000iu VitD3

Ask for metformin 500mg and take twice a day. This has good health benefits beyond insulin sensitivity issues. Also very inexpensive.

Liver is a concern with AST/ALT

Get #29 0.5ml [50iu] 1/2" insulin needle and inject twice a week. Can be SC or IM. SC avoids decades of muscle damage. Insulin needles do not need an Rx in many jurisdictions. At Sams/Walmart you can get a box of 100 for ~$14, their Relion house brand. Get prep pads too.


#6

Original post edited to better conform to the sticky requirements. Will start monitoring oral body temperatures and edit post again to report.


#7

Care to expand on that? A quick search shows it is a type 2 diabetes drug that helps control blood sugar levels, but there are warnings not to take it if you have liver disease. Specifically, my questions are 1)What are the additional good health benefits you mentioned, and 2) With the AST/ALT, wouldn’t I want to stay away from metformin?


#8

Here’s what I have lined up for discussion with the doc tomorrow:

Injections

  • From 23ga x 1-1/4 needle to #29 0.5ml (50iu) ½” insulin needle
  • From 1 injection every 2 weeks to 2 injections per week (0.25ml twice weekly?)
  • From IM to SC
  • Add 250iu hCG SC EOD
  • No need for arimidex/anastrozole until E2 comes up, but need to monitor

Supplements

  • Making sure I use iodized salt to get iodine
  • Current Multi includes 150 mcg iodine
  • Increased Vitamin D – currently taking 2000 IU, may need 5000-6000 IU

Tests

  • Need baseline PSA
  • Need fT3
  • pituitary MRI (already done, waiting on results)
  • liver? High AST/ALT

Metformin? May help but concern about indications of possible liver damage interacting with drug

Anything I’m missing? Any other points of note to help get my point across would be appreciated.


#9

There is no risk for a healthy liver with good lifestyle habits: http://www.ncbi.nlm.nih.gov/pubmed/20452916

Your AST/ALT probably high from training, muscle soreness etc.

Metformin benefits: It has good anti cancer properties and other things as well as: http://www.life-enhancement.com/magazine/article/2970-is-metformin-the-metabolic-holy-grail
Search “metformin benefits”


#10

Good information. Just trying to be as informed as possible before my conversation with the doc tomorrow. Thank you for taking the time to respond.


#11

I’m still hesitant about relating those numbers to training. I’ve been very limited in what I could do for exercise as my back has been healing from surgery 6 months ago. It wasn’t until this week (after my first shot) that my back was feeling good enough to work out with strength exercises. Up to that point I had been doing mainly stretching and light cardio/walks. I’ll try to get a second test soon to see if the numbers change at all.


#12

Conversation with my Endocrinologist went about as well as it could considering his unwillingness to prescribe the recommended protocol. He said everything I brought up was legitimate and valid, but he wasn’t comfortable given the lack of documented long-term effects of hCG and arimidex. He didn’t want the credit down the road–whether it be good or bad. While he could have stopped there or insisted we continue with what he has prescribed. He recommended a guy across the street that has “literally written the books on all the stuff you’re talking about.” A little research and he seems very well versed on this stuff. I have an appointment with him next Thursday, and I’ll report back then.

Thanks again for the ammo I needed to go into that appointment and hold my own.


#13

I met with the new Urologist last week, and he was everything I could have hoped he would be. He was right inline with the protocol suggested here without me needing to even bring it up. He also has an excitement about him when discussing this topic, which I like. Only difference was he prescribed twice as much hCG as recommended here, 3 times a week. His reasoning was that his research showed 250 to be the “just enough” amount, but they found 500 to be more effective.

He also did some more blood work, the results of which were a bit concerning to me but I have yet to discuss with him. Note, blood was taken 9 days after 200 mg test cyp shot.

PSA 1.03 (<4.00 NG/ML range)
PSA, Free 0.44
PSA, % Free 43

Vitamin B-12 696 (250-1100 PG/ML range)

Vitamin D 25-Hydroxy 25 *up from 19.9 4/1/16

WBC 6.3 (4.0-11.0 K/UL range) *down from 6.4 4/1/16
Red Blood Cell Count 5.32 (4.10-5.70 M/UL) *down from 5.50 4/1/16
Hemoglobin 16.0 (13.0-17.0 G/DL) *down from 16.2 4/1/16
Hematocrit 46.2 (37.0-49.0%) *down from 46.6 4/1/16
Mean Corpuscular Volume 86.8 (80.0-100.0 fL) *up from 85 4/1/16
Mean Corpuscular Hemoglobin 30.1 (27.0-34.0 PG) *up from 29.5 4/1/16
Mean Corpuscular Hemoglobin Conc 34.6 (32.0-35.5 G/DL) *down from 34.8 4/1/16
Red Cell Distribution Width 13.8 (11.0-15.0 %) *up from 13.2 4/1/16
Neutrophils % 56 (40-74 %) *up from 53 4/1/16
Lymphocytes % 37 (19-48 %) *same as 4/1/16
Monocytes % 5 (4-13 %) *down from 7 4/1/16
Eosinophils % 1 (0-7 %) *down from 2 4/1/16
Basophils % 0 (0-2%) *down from 1 4/1/16
Platelet count 199 (130-400 K/UL)

TSH Reflex 1.2 (0.5-4.7 UIU/ML) *down from 2.310 4/1/16
Free T4 0.96 (0.73-1.95 NG/DL) *down from 1.04 4/1/16

Prolactin 18.8 (3.0-30.0 NG/ML) *up from 17.5 4/1/16

FSH <0.3 (1.3-11.4 MIU/ML) *down from 5.1 4/1/16
LH <0.1 (1.2-7.8 MIU/ML) *down from 3.9 4/1/16

IGF-1 Somatomedin-C 236 (84-313 NG/ML)

Estradiol 24 (<=63 PG/ML) *up from 11.0 4/1/16

Testosterone Level 113 (300-1080 NG/DL) *down from 146 4/1/16
SHBG 14 (16.5-55.9 NMOL/L) *up from 13.8 4/1/16
Calc Free Testosterone 3.1 (4.8-25.7 NG/DL) *down from 4.88 4/1/16


#14

500iu hCG EOD is “more effective” and twice the cost.

When injecting T, this is the least expensive way to increase T and you inject more T if more T is needed. You don’t want to use higher amounts of hCG to increase T because of the cost. More hCG could lead to high T–>E2 inside the testes.

500iu hCG EOD might work better for hCG monotherapy. But sort of pointless as as long as you are injecting, injected T is still more cost effective.


#15

Any concerns over the increase in E2 and decrease in T?


#16

Your E2 is right where you want it. Of course, changing your protocol will undoubtedly change this level.

I agree with ksman, injecting that much hcg will increase the amount of T your testes produce which will cause more T–>E2 in the testes which isn’t controlled by anastrozole! If the new doc insists, you can still inject less.


#17

E2 up from prior T shot and T down from E2 repression of HPTA.

FT4 well below mid-range
still no fT3

thyroid basics explained - post oral body temperatures as suggested

Have you been using iodized salt long term?