T Nation

32y/o, TRT Symptoms? Dr. Said He Doesn't Know, Gyno


#1

Back in November I finally got an appointment with an Endo for symptoms of poor sleep, lack of energy, lack of motivation, difficulty with erections, difficulty losing weight and general depressed mood. Im 6’1" and I have gained 40lbs in the last year out of no where. Current weight 241lb. Labs were as follows:

-11/14/2013 Testosterone, Total Males : 279 ng/dL <241-827 ng/dL>

-8/18/2016
GLUCOSE 96 65-99 mg/dL
Fasting reference interval
UREA NITROGEN (BUN) 15 7-25 mg/dL
CREATININE 1.00 0.60-1.35 mg/dL
eGFR NON-AFR. AMERICAN 100 > OR = 60 mL/min/1.73m2
eGFR AFRICAN AMERICAN 116 > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO NOT APPLICABLE 6-22 (calc)
SODIUM 140 135-146 mmol/L
POTASSIUM 4.4 3.5-5.3 mmol/L
CHLORIDE 104 98-110 mmol/L
CARBON DIOXIDE 28 20-31 mmol/L
CALCIUM 10.0 8.6-10.3 mg/dL
PROTEIN, TOTAL 7.0 6.1-8.1 g/dL
ALBUMIN 4.7 3.6-5.1 g/dL
GLOBULIN 2.3 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 2.0 1.0-2.5 (calc)
BILIRUBIN, TOTAL 0.9 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 54 40-115 U/L
AST 45 H 10-40 U/L
ALT 100 H 9-46 U/L
CBC (INCLUDES DIFF/PLT) NL1
WHITE BLOOD CELL COUNT 5.8 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.25 4.20-5.80 Million/uL
HEMOGLOBIN 15.8 13.2-17.1 g/dL
HEMATOCRIT 46.4 38.5-50.0 %
MCV 88.2 80.0-100.0 fL
MCH 30.1 27.0-33.0 pg
MCHC 34.1 32.0-36.0 g/dL
RDW 13.0 11.0-15.0 %
PLATELET COUNT 227 140-400 Thousand/uL
SEX HORMONE BINDING GLOBULIN 9 L 10-50 nmol/L NL1
TSH W/REFLEX TO FT4 1.38 0.40-4.50 mIU/L NL1
TESTOSTERONE, TOTAL, LC/MS/MS 323 250-1100 ng/dL

-11/07/2016

IRON, TOTAL 95 50-180 mcg/dL NL1
AST 48 H 10-40 U/L NL1
ALT 119 H 9-46 U/L NL1
CBC (INCLUDES DIFF/PLT) See Endnote 1 NL1
WHITE BLOOD CELL COUNT 5.9 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.54 4.20-5.80 Million/uL
HEMOGLOBIN 16.5 13.2-17.1 g/dL
HEMATOCRIT 47.9 38.5-50.0 %
MCV 86.4 80.0-100.0 fL
MCH 29.8 27.0-33.0 pg
MCHC 34.5 32.0-36.0 g/dL
RDW 13.2 11.0-15.0 %
PLATELET COUNT 219 140-400 Thousand/uL
MPV 7.9 7.5-11.5 fL
ABSOLUTE NEUTROPHILS 2649 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 2348 850-3900 cells/uL
ABSOLUTE MONOCYTES 643 200-950 cells/uL
ABSOLUTE EOSINOPHILS 189 15-500 cells/uL
ABSOLUTE BASOPHILS 71 0-200 cells/uL
NEUTROPHILS 44.9 %
LYMPHOCYTES 39.8 %
MONOCYTES 10.9 %
EOSINOPHILS 3.2 %
BASOPHILS 1.2 %
FSH 4.6 1.6-8.0 mIU/mL NL1
LH 4.4 1.5-9.3 mIU/mL NL1
PROLACTIN 6.4 2.0-18.0 ng/mL NL1
TESTOSTERONE, TOTAL, MALES (ADULT), IA 252 250-827 ng/dL

8/2016 PCP wanted me to start on Lisinopril because of the weight gain causing bp to climb to 140-90. Up until 4/2016 bp hung around 120/70

On 11/20/2016 The Endo started me on 4 pumps of Androgel 1.62% and by 12/26/2016 I was more tired than before. Androgel stopped. 1/9/2017 Endo started me on test cypionate 200mg EW 25g x 5/8th needle in the glute…though with no one around I had to do quad for injections 2-4.

My concern is this. Injections done on Sundays, Last weekend 1/28-1/29 I felt my self getting cranky before my next injection, and noticed my feet swelling a little as well as face. My bp was up to 150/80 and still is up there. I called the Endo and he told me doesnt know what that could be , no other males of his have the issue. Said to go ahead with the appt we have in late April, keep doing the test injections and do the blood work in late March.

My concern is could test cypionate causing me to have elevated bp and why? Is it e2 creeping up? Maybe erythropoiesis? 1 month of injections too soon for those things to likely be happening? Just concerned because high bp is nothing to mess with, especially when your Dr. says “Gee I dont know what that could be.” If there is an issue with either e2 or erythropoiesis… do I have that long to wait for a blood test?

Also SHBG is low, how is this helping or hurting me?

Thanks,

J


#2

I’m always amazed at how ignorant so many endos seem to be. Your e2 is likely elevated, which will negate the effects of optimal T levels. If you Dr won’t test, you can type discountedlabs.com in web browser and find a labcorp near you and pay for male sensitive e2 test. I think its only $20-$30 and you can then present that info to Dr.

SHBG levels can be driven down by being over weight, hypothyroidism and TRT itself.

Are you under a lot of stress? A full thyroid panel would be useful along with body temps with oral thermometer, taken one in morning and once in afternoon before eating, drinking, showering, working out. Post those here. Also on top of tsh which you already have get ft4, ft3 and rt3 tested.

Do you lift a lot? If not your liver numbers show that your liver is stressed, likely due to inflammation, likely due to diet and stress. If you worked out hard a day or two before your blood tests then its not as pertinent.


#3

But E2 would jack my bp this quickly into treatment? I have a urologist for an unrelated issue, who seems pretty aggressive in regards to fixing things, watching what my endo does with a hawk eye… perhaps I should get him to test e2 and ft4,ft3,rt3.

I have started to lift a lot but I suspect my elevated liver numbers are due to a fatty liver… thus 40lb weight gain.

I am exposed to a decent amount of stress but I feel im managing it ok. I dont get anxiety about it, or dwell think about it all the time.


#4

Low SHBG could be an insulin sensitivity problem, have A1C checked.

AST/ALT elevated may be indication of liver issue.
Did you have sore muscles from injury or training.
What meds, Rx and OTC are you using?
Other health issues?

Please read the stickies found here: About the T Replacement Category

  • **advice for new guys**
    
  • **things that damage your hormones**
    
  • protocol for injections
    
  • finding a TRT doc
    

Eval overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. The two are connected.

TRT can increase E2 quite quickly and all the more if any liver issues that reduce E2 clearance.

Labs:
TT
FT
E2
A1C
CBC w hematocrit
CRP
If body temps are low
TSH
fT3
fT4 [not T3, T4]
rT3 now or later if fT3 is midrange with low body temps

More thyroid:
have you always used iodized salt?
are your outer eyebrows sparse?

Any blows to the head prior to things going wrong?


#5

Working on getting body temps done, my urologist isnt treating me for TRT, called today and asked if they would be willing to test, his assistant put orders in. Thing is she put in a Quest Estrogen, Total order. Is that going to be helpful or should I call back and ask her to change that to e2? She also ordered cbc with Hematocrit. PCP appt next week and Ill address the AST/ALT levels as well as asking for a thyroid panel with A1C. Urologist wants to wait on the T levels.


#6

You should specifically ask for "estradiol’. Doctors are probably unfamiliar with internet abbreviations (E2).


#7

@KSman PCP feels its a fatty liver with minimal alcohol use, and little use of NSAIDs. Also liver levels were normal as of 2.5 years ago. Meds: lisinopril for elevated bp 140/85, started in Nov. I feel its from the weight gain in last year or so, as bp not much of issue before. Ambien for sleep, which used to be once in a while, but around the time my bp started getting jacked up, I cant sleep without it.(Estradiol the cause?) Epididymitis before Androgel started in Nov. No sore muscles before the BW. Read stickies, and body temps for 5 of the 6 days measured in AM were below 97.3 and all days I was below 98.2
Iodoral is coming tomorrow. Eyebrows not sparse, iodized salt not used …sea salt. IED exposure twice, maybe three times. Some DoD research linking connection of exposures to testicular issues. Below are my labs from last week. I really think the symptoms I described in the OP are related to these and I realize if I had waited until end of April like the endo said… Id probably stroke out. Was not able to get doc to run A1C TT FT CRP or thyroid panel.

2/7/2017-

ABSOLUTE NEUTROPHILS 4058 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 2220 850-3900 cells/uL
ABSOLUTE MONOCYTES 915 200-950 cells/uL
ABSOLUTE EOSINOPHILS 308 15-500 cells/uL
ABSOLUTE BASOPHILS 0 0-200 cells/uL
NEUTROPHILS 54.1 %
LYMPHOCYTES 29.6 %
MONOCYTES 12.2 %
EOSINOPHILS 4.1 %
BASOPHILS 0 %
CBC (INCLUDES DIFF/PLT) WITH SMEAR REVIEW NL1
WHITE BLOOD CELL COUNT 7.5 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.89 H 4.20-5.80 Million/uL
HEMOGLOBIN 17.8 H 13.2-17.1 g/dL
HEMATOCRIT 52.9 H 38.5-50.0 %
MCV 89.5 80.0-100.0 fL
MCH 30.3 27.0-33.0 pg
MCHC 33.8 32.0-36.0 g/dL
RDW 13.1 11.0-15.0 %
PLATELET COUNT 244 140-400 Thousand/uL
MPV 8.1 7.5-12.5 fL
ESTROGEN, TOTAL, SERUM 292.9 H 60-190 pg/mL
ESTRADIOL 48 < or = 39 pg/mL

Today I had my appointment with urologist so that he could take over my TRT. The way he was talking at my first/last appointment with him, he portrayed himself to be very aggressive in treating for TRT. Today didnt appear to the case. He asked why I wanted to be on injections in the first place, then proceeded to tell me he is concerned about my H+H and red cell counts. I had to point out to him that my estradiol was up too. He told me to stop the injections immediately. I was due for one Sunday and felt like I should hold off until todays appointment. He said obviously its too much testosterone. He told he wants me to stop for 6 to 8 weeks so “he can see what my baseline is”. Does anyone else agree with this? Because my “baseline” is what got me on TRT in the first place!! My aggravation is growing each day with this. He said that after that try a pill, Clomid to kickstart me. After the appointment I tried donating blood, but they got me set up and as they went to stick me, they noticed a scratch near the vein and refused. I want this BP down now. I am totally lost feel kinda hopeless. Guide me.

My questions are …

Sudden insomnia likely from high E2?
How quickly will my blood levels come back down
How long will it take me to clear the estradiol/estrogens
Should I take something to assist with above question
How much of a world of hurt am I looking at stopping TRT
Clomid, is it a good idea or not
What should I be asking to have done
When guys say the get the “bloat” does that include your face and neck feeling its going to pop?
Was I better off with the Endo? (half joking)

Update: 2-15 Urologist gave me labs to be done in 6 to 8 weeks for FT TT E2 CBC


#8

200mg T EW is truely wrong.

Getting baseline is meaningless for multiple reasons.

Suggest:

self inject 50mg T twice a week
0.5mg anastrozole at time of injections
250iu hCG SC EOD if you want to preserve your testes.

Low magnesium can affect BP by messing with muscle tone of arterial muscles. If you get leg cramps or can make muscles lock up or cramp by contracting them, you are magnesium deficient. This site’s store has a product “ZMA” to consider if needed. Most are deficient if not supplementing. And that does not show up on lab work.

Your low body temps mean that there is a real problem. Most docs will not understand “because some people have lower temperatures”.

Estrogens are toxic to the endothelium, the one cell thick lining of the arteries. E2 needs to be balanced by T in men and progesterone in women and DHEA to some extent in both sexes. If E2 is high and T is low, one is very estrogen dominant. E2 in upper 30’s with high T creates problems too. If there is arterial damage happening, the artery specific inflammatory marker gets elevated and should be tested. If elevated, you need to take some specific steps re supplements and hormone health. One upon a time, inflammatory marker CRP was thought to be cardiovascular specific, which is not true, it is a generalized inflammatory marker. Chronic inflammation can damage your arteries, good example is gum disease.

It is starting to be recognized that head trauma can damage pituitary function and some advocate that all head injuries in males should include steroid hormone labs as part of follow-up. Shock waves might be damaging as well.

Your thyroid issues could easily be tied to having not used iodized salt. I have never heard of a doctor ever asking about iodine intake. The medical community has forgotten the lessons of 1922 when iodized salt was introduced which eliminated huge problems across the whole populations.

Supplements:

25mg DHEA if DHEA-S is < 300
EFA’s: fish oil, nuts, flax seed oil/mean
Vit-D3 5000iu, take 25,000iu first five days
Take above 3 with low fiber meals that have some fats/oils

High potency B-complex multi-vit that lists iodine+200mcg selenium[sufficient]
Supplements for males should not normally contain any listed iron
Males may also need to avoid iron fortified foods [pasta, cereals, bread etc]
1000mg Vit-C twice a day or 2000 at once, may help sleep if taken at night
Melatonin 5-6mg TIME RELEASE if needed to bring on sleep
Magnesium - helps with muscle tone, nerves and sleep
Extra iodine

Your doc asked why. This is enough:
FSH 4.6 1.6-8.0 mIU/mL NL1
LH 4.4 1.5-9.3 mIU/mL NL1
PROLACTIN 6.4 2.0-18.0 ng/mL NL1
TESTOSTERONE, TOTAL, MALES (ADULT), IA 252 250-827 ng/dL

There is a component of primary hypogonadism too.

Good luck with the docs. You need to manage your own health care, you cannot be passive as that fails.


#9

Wrote an email to the urologist last night, and today he had his assistant call and so he likes his plan better. Wants off anything for 2 months and then testing BW, then starting Clomid. Can someone explain to me what Clomid will do for me… and do they think its a worth a shot? Im also concerned about if I do that, how long itll take to get my E2 down. If its worth a shot… can I take something mean while to get the E2 down? Side effects are kicking my ass on top of feeling like my usual …ass-iness.


#10

There are two factors:
E2 creation rates FT–>E2
and E2 clearance rates in the liver

With very low TT, FT must be low, so FT–>E2 can be assumed to be low, so we need to suspect impaired liver E2 clearance.

Clomid will reduce E2 seen by the hypothalamus and the pituitary in turn will produce more LH and FSH. The testes will then create more T and FT–>E2 will increase and E2 will increase not go down. I don’t think that you doctor has thought this through or does not has enough knowledge to do that. SERMs increase E2, only aromatase inhibitors [AI] will reduce E2. SERM’s and AI’s should be used together.

Baseline seems insane, you had low T in 2013.


#12

Yes, but amount varies with T levels.

Suggest .3mg anastrozole per week in divided doses. You will need a liquid to dispense from.


#14

Where does one check to see if a research chem company is reliable on TNation? I dont know if its ok to mention a name on here or not.


#15

Not really okay. Because TRT is legitimate medication, you should be fine with anything doctor-provided or filled at a pharmacy. Finding “grey market” sources isn’t what the forum is for.


#16

Understood.


#17

Update: Urologist refuses to give any anti-estrogen. As of today I am 18 days from my last injection, I am starting to breakout in pimples all over my back, neck and arms. My head is greasy, all issues I have never had before, and I cried over an action movie. WTF is going on?!? All started about 4 days ago Getting increasingly emotional about stuff, it’s just not me. Called the endo Tues. and left a message…it’ll be 1 to 2 weeks before I hear from him. I have my Rx of testosterone the Endo originally gave me, enough for a year… but I feel like that would be apathetic and stupid to go back without anything else to support.

@KSman
As of 3 days ago taking all of the supps you suggested.


#18

liquid anastrazole research chemicals USA peptide. Your e2 is likely elevated past your optimal range.


#19

Let’s add gyno to the list. Fatty tissue on my chest started feeling sore today…after trimming up my chest hair, it would appear i may need a bra soon.


#20

See my post above and start looking for a new Dr as well. Yours like 95% of others don’t know very much about TRT or are bound by medical coding and insurance.


#21

Agreed, but often there is no other option. Doctors are the problem.
[Many guys also have to make up a solution of 1 mg/ml anastrozole in vodka to refine doing beyond what can be managed with pill cutting there prescribed anastrozole.]

Now OP reports symptoms of gyno. Will his doctor take action on that? The doctor may tell him to stop taking testosterone.


#22

I ended up ordering through extreme peptides. The urologist did tell me to stop taking T back on the 14th to “wash me out” so he can put me on clomid in 2 months. I called him and left a message about the gyno and told him do something about this now. Also called the endo and said the same… If anything the endo will want to continue T, that seems to be his thing. I hate that i have to “dr shop” but the dr who has no problem giving Rx’s (endo) is way too passive and doesnt seem to give advice for anything thats beyond normal.

Hope whats coming is legit. Im holding on to the walls.