T Nation

31 Y/O, Lifelong High Fat Body Set Point


#1

Age - 31yo
Height - 5'11"
Waist - 34
Hair - I'm Indian; plenty of hair.
Fat - Carry fat around waist and chest. Carried weight in these areas since puberty. Enough chest fat to get comments, but not tits.

Symptoms - fatigue, memory, anxiety, depression (post-puberty, cyclical), motivation, difficulty concentrating, smell loss, body set weight high.
Drugs - None
Diet - 3-4 eggs at 10AM, Cooked Meats and Vegetables with Rice around 2PM, same around 8PM.
Training - Dropped in last 3 months. Sleeping 8-10 hours per day.
Very consistent prior to last 3 months. Running. Body-Weight exercises. Yoga. Meditation. Energy levels so low now difficult to maintain that protocol.
Testes - No symptoms.
Morning Wood - None for last 3 months at least. Erections strength and ability to maintain and orgasm strength diminished markedly in last 16 months

Temperatures - Haven't Checked.
Salt - Just regular Table Salt

DHEA-Sulfate: 289.2 (138.5-475)
Estradiol: 33.6 (7.6-42.6) Slightly High Perhaps
Free T (Direct): 11.6 (8.7-25.1) Looks Ok?
Testosterone, Serum: 367 (range for lean men up to 40: 348-1197) Looks Low.
LH: 2.9 (1.7-8.6) Low.
FSH: 2.1 (1.5-12.4) Low.
Hemoglobin A1C: 5.5 (4.8-5.6)
TSH: 2.21 (.45-4.5)
Vit D, 25-Hydroxy: 21.2 (30-100) Below Range. Needs To Be Supplemented
Progesterone: .6 (.2-1.4)
SHBG: 14.9 (16.5-55.9) Below Range.
Thyroxine T4, Free, Direct: 1.19 (.82-1.77)
Trilodothyronine, Free, Serum: 3 (2-4.4)
Ferritin, Serum: 115 (30-400)
LDH: 111 (121-224) Below Range, not sure how relevant.

I suspect many of these numbers would look better if I cut some fat (for example; LDL, E2 and SHBG). Unfortunately that seems to be a sisyphean task for me, as I bounce back to a high body fat % easily.
I've had this body type since pre-puberty despite being active in sports; swimming, martial arts, basketball, etc. I feel like that 10-14 year old body and psychic condition is the magnet I am constantly drawn back to, and that a medical hormonal intervention might be the only way to permanently change my unfavorable homeostasis condition.

During the teen years I suffered depression, which repeated itself in college, mid-20's, and now again in early 30's. The depression is characterized by near-total withdrawal from activity and people.

When I am not in the every few years recurring depressed state, and I am engaged in activity and relationships, my day to day living is stressful due to social anxiety which prevents me from being the generally outgoing person I feel myself to be. My internal experience of life is stressful, even when outwardly things by any relative marker things would appear to be ok.

In my mid 20's I was maintaining a low glycemic load diet, HIIT and Olympic lifting and this put me in relatively good shape (compared to my baselines), but it always just felt like I was just at the edge of a cliff, ready to slip back at an any moment. Additionally despite the cardio and the sports-specific training, I was never able to get rid of this shakiness and tremors, which were most pronounced while lifting. To me it indicated some nerve related issue. Nor was I making the strength gains that others were making with similar training. Additionally, the physical regime and disciplined diet did nothing to reduce my social anxiety and hypervigilance. It is worth noting though that I did not have any sexual problems during that period between 26-28. I desired to and could perform multiple times a day and had morning erections etc.

Since the beginning of this year, I have become completely withdrawn, and have been again practically bed-ridden. My diet is not terrible, but it's certainly not as good as it could be, but I have not getting little to no physical activity. These last few months are reflected in those labs, which were drawn on May 8th, 2015.

What I have to work with now is: 1) my current quality of life is low 2) It is likely that I am going to continue oscillating between these states unless I make a drastic change and 3) TRT is a possible way out.

I am also planning an appointment with Dr. Mariano, who many have referenced on these threads, next month.

Based on the above labs I am beginning to supplement with Vitamin D, eat healthier, but getting active again currently doesn't feel possible.

Other Labs:
Glucose, Serum: 89 (65-99)
Uric Acid: 6.5 (3.7-8.6)
BUN: 17 (6-20)
Creatine, Serum: 1.27 (.76-1.27)
Sodium, Serum: 142 (134-144)
Potassium, Serum: 4.1 (3.5-5.2)
Chloride, Serum: 100 (97-108)
Calcium, Serum: 9.8 (8.7-10.2)
Phosphorous, Serum: 4.2 (2.5-4.5)
Protein, Total, Serum: 6.8 (6-8.5)
Albumin, Serum: 4.8 (3.5-5.5)
Globulin, Total: 2.0 (1.5-4.5)
A/G Ratio: 2.4 (1.1-2.5)
Bilirubin, Total: .5 (0-1.2)
Alkaline Phosphatase, S: 74 (121-224)
AST: 18 (0-40)
ALT (SGPT): 21 (0-44)
GGT: 11 (0-65)
Iron, Serum: 91 (40-155)
Cholesterol, Serum: 171 (100-199)
Triglycerides: 91 (0-149)
HDL Cholesterol: 41 (>39)
LDL Cholesterol: 112 (0-99)
T. Chol/HDL Ratio: 4.2 (0-5)
Homocystine, Plasma: 9.6 (0-15)
PSA: 1.2 (0-4)
C-Reactive Protein: .3 (0-3)
WBC: 4.3 (3.4-10.8)
RBC: 5.22 (4.14-5.8)
Hemoglobin: 15.2 (12.6-17.7)
Hematrocrit: 45.3 (37.5-51%)
MCV: 87 (79-97)
MCH: 29.1 (26.6-33)
MCHC: 33.6 (31.5-35.7)
RDW: 13.4 (12.3-15.4)
Platelets: 251 (150-371)
Neutrophils: 2.4 (55%) (1.4-7)
Lymphs: 1.5 (35%) (.7-3.1)
Monocytes: .3 (7%) (.1-.9)
EOS: .1 (2%) (0-.4)
Basos : 0 (1%) (0-.2)


KSman is Here
31 Y/O Began TRT This Week - Feeling Tired
#2

Salt - Just regular Table Salt

  • this can be iodized or non-iodized in the USA. Can you be specific?
  • if in doubt, go buy iodized salt and discard what you have
  • you may also need higher strength iodine supplements.

Please get body temps ASAP. !!!

fT3 and fT4 are a little low, should be nearer to mid-range. TSH=2.21 should be closer to 1.0

You need vitamin D3. Find 5,000 iu tiny oil based caps. Take 25,000 per day for 5 days and 5,000 thereafter.

Any potable events in the 6-3 month ago time frame? Accidents, illnesses, medication?

You are quite estrogen dominant at this point which causes problems with energy and weight. You can expect thyroid problems to add to that.

Have you read the:

  • advice for new guys sticky?
  • thyroid basics
  • things that damage your hormones

Additional labs:

  • prolactin
  • AM cortisol, do at 8AM
  • rT3 if you have a profile of stress, infections, surgeries etc

#3

I am going to proactively supplement with iodine and selenium while also tracking morning temperatures to check if thyroid symptoms exist.

I’m curious for any reasons why my SHBG might be suppressed and what that might indicate in the context of the other hormones. LH, FSH and Total T are all at the low end of the range. My Free T seems to be in middle of range thanks to SHBG being subdued.

I assume you suspect high prolactin levels based on some of the sexual symptoms. I have been having some vision related issues, my eyesight has been deteriorating in the past few weeks. I thought that this had more to do with my staying in too much and reading or looking at computer screens. The prolactin test might help rule out any anterior pituitary issues.

There hasn’t been any particular event per se in the last 3-6 months.

Will check the AM cortisol levels as well. With the hypervigilance and social anxiety I feel, I suspect high levels.

Next Steps:

  1. Check Temperatures in Morning to confirm that Thyroid issue exists.
  2. Proactively adding Iodine: 35mg/d for 14 days
  3. Adding Selenium: 6 Brazil Nuts/day
  4. Adding Vit D3: 20,000IU/5 days, then 5,000/day
  5. Taking Prolactin and AM Cortisol Test.

#4

[quote]Magister06 wrote:
My understanding so far:
Iodine needed to create thyroid hormones. TSH elevated (2.2 rather than optimal 1) as it is overworking to produce right amounts of T3 and T4, possibly because of low iodine in diet. T3 and T4 are a little lower than mid-range so could be boosted.

I am going to proactively supplement with iodine and selenium while also tracking morning temperatures to check if thyroid symptoms exist.

However, my LH, FSH, and Total T all seem to be subdued. Because my SHBG is also suppressed my Free T is coming out an ok level for my age. An increase in any of the low levels is likely not to be beneficial in any case, as I seem to be a high estrogen convertor. I suspect that?s why you asked if I read ?Things That Damage Your Hormone? Sticky? To see if I have any xenoestrogens in my diet? I don?t as far as I can tell.

The body fat is contributing to the estrogen dominance. But it?s a chicken and egg game there isn?t it? Like if I attack the estrogen with aristozole or through some other means, I could cut the body fat, which would result in a better hormone factory.

I assume you suspect high prolactin levels based on some of the sexual symptoms. I have been having some vision related issues, my eyesight has been deteriorating in the past few weeks. I thought that this had more to do with my staying in too much and reading or looking at computer screens. The prolactin test might help rule out any anterior pituitary issues.

There hasn?t been any particular event per se in the last 3-6 months. Just an overall sense of failure I am experiencing of being a man and a productive citizen. I suspect that this is also contributing to the condition, but again I feel like it is a chicken and an egg game. From my reading, social animals in high stress environments with low status also end up with low Testosterone profiles, etc. It seems to be one of those positively reinforcing or negatively reinforcing cycles. It is only because this seems to be a recurring cycle in my life that I am suspecting underlying biological cause for it.

Will check the AM cortisol levels as well. With the hypervigilance and social anxiety I feel, I suspect high levels.

Next Steps:

  1. Check Temperatures in Morning to confirm that Thyroid issue exists.
  2. Proactively adding Iodine: 35mg/d for 14 days
  3. Adding Selenium: 6 Brazil Nuts/day
  4. Adding Vit D3: 20,000IU/5 days, then 5,000/day
  5. Taking Prolactin and AM Cortisol Test.

[/quote]

Sorry but some of this advice is ridiculous. There’s no reason for you taking more than 10,000 IU of Vitamin D every day. A dose that high should be ingested weekly, not daily.

Taking 5000 IU for a month would put you in a healthy range of around 30-40 ng/dL.

Your body isn’t just a dumping site for vitamins/minerals. If you’re deficient in something, slowly build up a dose.

You don’t have a thyroid problem, and you shouldn’t test prolactin. Some people just don’t produce a functional level of testosterone; it’s idiopathic.

What I recommend your doing is

  1. Dropping to a healthy bodyfat.
  2. If that doesn’t alleviate your problems, talk to your GP/endo about restarting your HPTA.

#5

Abars,

There are docs who have folks taking 50,000iu vit-D3

An important long term study in the UK had folks taking 300,000iu vit-D3 a few time per year.

We evolved to store vit-D3 created with summer sun exposure and that is consumed over time in the winter and many are depleted by early spring.

We have had guys in this age range and hormone profile with prolactin problems. It is good to test in some cases if only to take that possibility off of the table.

Idiopathic is a terminology for insufficient diagnostic effort. One should characterize the problem. If the testes do not produce, that can be narrowed down to a number of problems and if blood flow, that can often be surgically corrected. If secondary hypogonadism, adinomas need to be recognized; prolactin secreting adinomas can be managed with 0.5mg Dostinex/cabergoline per week. Untreated adinomas can progress to the point that optic nerves are damaged. Many efforts to diagnose hormone and libido problems disclose causes where the primary problems are symptoms. Testicular cancer needs to be regarded as a possibility.

You attitude is not helpful.


#6

[quote]KSman wrote:
Abars,

There are docs who have folks taking 50,000iu vit-D3

An important long term study in the UK had folks taking 300,000iu vit-D3 a few time per year.

We evolved to store vit-D3 created with summer sun exposure and that is consumed over time in the winter and many are depleted by early spring.

We have had guys in this age range and hormone profile with prolactin problems. It is good to test in some cases if only to take that possibility off of the table.

Idiopathic is a terminology for insufficient diagnostic effort. One should characterize the problem. If the testes do not produce, that can be narrowed down to a number of problems and if blood flow, that can often be surgically corrected. If secondary hypogonadism, adinomas need to be recognized; prolactin secreting adinomas can be managed with 0.5mg Dostinex/cabergoline per week. Untreated adinomas can progress to the point that optic nerves are damaged. Many efforts to diagnose hormone and libido problems disclose causes where the primary problems are symptoms. Testicular cancer needs to be regarded as a possibility.

You attitude is not helpful.[/quote]

It’s not a matter of attitude. It’s a matter of misinformation. 99%+ of people who take 5000 IU of Vitamin D a day will have functional levels of Vitamin D unless something is wrong specifically with that receptor. Why advise somebody to take 25,000 IU a day when there is a risk for toxicity and hypercalcemia? The “individuals” you are referring to are, like I said, taking 50,000 IU a week for a very short period of time.

Prolactin secreting adinomas are incredibly rare, and, if they do exist, they’re usually small and, like you said, can be treated with a dopamine agonist. I don’t think that’s the problem of the OP. If an individual did have a prolactin problem, the secondary hypogonadism and FSH/LH, or lack thereof, would be largely reflected on their bloodwork.

I don’t agree with your protocol of looking at an individual’s bloodwork and making very broad, sweeping generalizations of how their TSH NEEDS to be around 1.0 or their Estradiol NEEDS to be around 22 pg/mL. People respond differently to the hormonal environment they’re in, and I’ve spoken to many endocrinologists, who unlike you, have studied and researched this stuff for several decades.

If you look at the OP’s situation, it should be pretty obvious that he may be “estrogen dominant” (I hate that term) because of his weight. There’s no reason to suspect he’d have an adinoma (something that has an occurence rate in literature of 1/10,000) or a thyroid problem.


#7

Just wanted to give a little update:

I have ordered prolactin and cortisol tests to be taken in the week.

Since 5/15, Protocol/daily:
12.5mg Lodorol
10,000 Vit-D
4 Brazil Nuts
5mg Melatonin (night)

Results So far:
On 5/18 Felt a significant energy boost throughout day.
Felt euphoric, energetic, lively. Felt like MOVING.
Temperature of 99.3 in afternoon.

Unable to isolate whether cause is Iodine or Vit-D.


#8

For those curious, or worried, about supplementing with Vitamin D, take a look at this paper.

Search for Figure 2 which displays a dose-response curve for Vitamin D. The data indicates that 10,000IU/day does not result in intoxication, and that serum levels below 200 nmol/l do not create intoxication.

This is inline with the research that suggests that full-body sun exposure (how we were living when we didn’t have clothes, etc) results in a serum response that is equal to 10,000-20,000IU D3. Our bodies are evolved to handle that dosage.

There are multiple studies where doses of 100,000 to 300,000IU were administered bimonthly or semiannually with no toxic results.

The logic of administering a higher dose initially is to get the blood serum levels to their optimum range faster. Continued supplementation, at a lower dosage, is required to keep you in that range, as there is a half-life for the serum in the blood of between 30-60 days.

Hence the logic of five days of 25,000IU, followed by 5,000IU daily.


KSman - having issue with thermometers precision and accuracy. One’s at home seem to give me results all over the place.

I haven’t seen anything on the forums recommending a particular brand. Maybe you could make a recommendation in the Thyroid Sticky?


#9

Started on 5/31:

Levothyroxine, T4, (50mcg)
Liothyroxine, T3, (10mcg) (Take 5mcg again at 1PM)
Bupropion, Wellbutrin (75mg)
DHEA (100mg)
SAM-e (400mg)
Copper (4mg)
Omega-3 (720mg) 2 Cod Liver Unspecified
Ultimate Iron (2 at night)
Iodoral rather than Potassium Iodide (12.5mg)
Multivitamin with Iron (2)
P-5-P (1)
Selenium (200 mcg)
Vitamin A (24,000IU)
Vitamin B-100 Complex w/Vit C (1)
Vitamin B12 (5000mcg)
Vitamin C (2000mg morning and 1000 mg night)
Vitamin D3 (10,000IU)
Zinc (50mcg) (night)
Melatonin 5mg (night, not sure about this one).


#10

Abars: We are programmed to make vit-D3 in summer months with skin exposure to sunlight and we store vit-D3 as reserves for seasons where sun exposure is low. If one has low vit-D3 levels, more vit-D is needed to kick start stored vit-D3 levels. Data on dose response for steady state dosing is not the issue.

Low LH/FSH in younger males should be a trigger of concern for younger males if no other reason comes to mind. The consequences of untreated adinomas can be severe. We have seen a few guys here with these adinomas, sometimes subsequent to suggestions that they test for prolactin, as many competent doctors do. Not so rare, at least with those who self-select to be here.

E2=36 does not stand out as a sole driver of low T. But still elevated. ALT/AST do not suggest that liver clearance of E2 is an issue of liver health. His meds and supplements do not suggest a med induced reason for low LH/FSH or reduced E2 liver clearance.

Magister: No suggestions re thermometer models. I often wonder about how one uses thermometers.
Good to hear about your positive results. I suspect that this is mostly an iodine issue based on your body temperature response.
As you probably are aware, your darked complexion decreases your vit-D3 response to sunshine and is a significant issue if living in a colder latitude.


#11

Temperature running really high this morning upon waking.

99.9.

Possible that the iodoral already got my thyroid functioning properly, and now the new prescription to T3/T4 is kicking me into over-drive.

Wondering if doc should have just let me stay on the iodoral for a few weeks and re-test thyroid levels before getting me on Levothyroxine.


Also noticed since the second day of adding the supplement program listed above, constipated loose stools in the mornings. Constipation during the day.

Understand that’s possible an effect of the iron.


#12

Hi KSman,

Quick question. Got my cypionate prescription yesterday, and took my first 40mg shot (doing E3D w/o HCG or anastrozole to start out).

My question is, I have a 10ml (200mg/ml) bottle. I realize this is suspended in a bunch of oil that could potentially go rancid. This bottle should last me a long time - but how do I keep it clean?

Is storing it in my pantry in a brown paper bag with the cap on sufficient?

Or do I need to do something else?

I tried searching around for this, but people seem to have widely differing opinions. The idea that the bottle is only good for 30 days after opening doesn’t make any sense.

Am confused.

Thank you.


#13

Store T vial in the box that it came in. Bacteria will not grow in the oil, it has benzyl alcohol as a preservative. Keep away from light.

30 days has nothing to do with product stability.