T Nation

33, Exhausted, Looking for Advice

Hello,

I stumbled upon your forum a couple of weeks ago, trying to research low-T, ultimately trying to “fix” my life. I’m amazed at how much knowledge seems to exist here, super excited to have found the site!

I’m 33, 6’, 270 lbs. and exhausted 24/7. I have, for the past 6-7 years felt just drained and exhausted. It’s complicated so much of my life at this point that for the past year I’ve been on a mission to figure out what is going on. I’ve seen a few highly recommended doctors, the latest one suggested that we explore low-T based on my symptoms. We did the tests and her office said “everything is normal”. I’m headed back for a follow-up with her on Friday (it’s Tuesday now) and want to be prepared for the discussion.

I’ve explored plenty of things based on my symptoms, low vitamin B & D levels, Thyroid issues, sleep apnea, etc., have made some changes, haven’t been able to feel ANY better.

Based on everything I’ve read I feel like this could change my life…

Here are my stats per the “newb post”…

-age : 33
-height : 6’
-waist : 53"
-weight : 275
-describe body and facial hair : average, have lost head hair during the past 6-7 years, going bald, shaved my head as a result
-describe where you carry fat and how changed : where hasn’t changed, I’ve carried it around my waist and with moobs for years
-health conditions, symptoms [history] :
6-7 years ago I had a vasectomy. until that point I was healthy aside from being over weight (240 lbs.) Ever since (and I’m not saying this is related!) I have been getting more and more tired, I feel like I’ve become straight up dumb (memory loss, inability to think clearly, to form sentences when in a conversation), I’m always cold, I have so little motivation to do anything (work, play, sex, etc.) that I don’t feel like myself. I used to be the most laid back guy you’ve ever met… not so much anymore. I feel like I’m being a dick a lot.

I was diagnosed with mild sleep apnea (the tech said "you probably don’t even need CPAP), however they did set me up with CPAP, they say it is working, I don’t feel ANY different when using it. I have always slept through the night, I fall asleep 30 seconds after I lay down and absolutely struggle to get out bed in the AM, regardless of using my CPAP (which I do… even though it doesn’t help!)

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever : tried rogaine for 3 months ~3 years ago, didn’t help, stopped it. otherwise no other meds, now or in the past. I have very much been anti-rx drugs up to this point.
-lab results with ranges : see below
-describe diet : I lean towards paleo whenever possible (heavy on red meats, fish, good fats (coconut oil, avacado, etc.) but I do eat more crap than I should (fried foods, bread).
-describe training : I cannot motivate myself to “train”. I used to in high school, haven’t been able to get off of my ass in the past 6-7 years… I pay a damn gym every month though. I do walk my dogs 1-2 hours per day religiously and have done so for 2+ years… it always makes me more tired. My dog had surgery, this is part of his long-term rehab, if not for it keeping him healthy, I would NOT exercise (but I would give anything to be motivated to be in the gym daily!)
-testes ache, ever, with a fever? only when I haven’t had sex for a while, one will ache until I do.
-how have morning wood and nocturnal erections changed : pretty much gone away past 5 years

lab results (suggested by my doc, I had her add the Thyroid, B and D to compare with previous attempts to diagnose):

my #s first, lab range in parenthesis (all from Arup labs), test was done at 8:30 AM

SHBG: 28 nmol/L (11-80)
T Free Calc: 65 pg/mL (47-244)
T % Free: 2.0 (1.6 - 2.9)
T Total: 329 ng/dL (300-1080)

Thyroid tests:
TPO: 2.9 IU/mL (0.0-9.0)
T3 Total: 0.97 ng/mL (0.6 - 1.81)
TSH: 1.674 uIU/ml (0.550 - 4.780)
T4 Free: 1.45 ng/dL (0.89 - 1.76)

Requested tests:
V B12: 1267 pg/mL (220-1100) Note: I supplement 5000 / day (looks like it is working!)
V D25 OH: 31 ng/mL (30-100) Note: I supplement 1000 / day (looks like I need to up this!)

Basic metabolic panel:
Sodium: 141 (135-145)
Potassium: 4.0 (3.5 - 5.1)
Chloride: 105 (98 - 107)
CO2: 31 (21 - 32)
Anion Gap: 5 (5 - 15)
Glucose: 94 (75 - 99)
BUN: 13 (8 - 20)
Creatinine: 1.08 (0.70 - 1.40)
GFR: 84 (>60)
Calcium: 9.0 (8.4 - 10.2)

So based on your collective expertise… is it worth me pursuing TRT or am I barking up the wrong tree? Based on all of the reading that I’ve done, it seems like my symptoms align to low-T remarkably and I haven’t been this excited about finding help in a long, long time. Should I push my doc to retest, start TRT, add other tests (E2?) to confirm it isn’t some other root cause? If she says “sorry, can’t help” should I pursue TRT with another doc?

Is my total T at 329 as low as it seems to me for a 33 year old? Shouldn’t I be at like 800? Is this number not really accurate? Does the % free make me more “normal?”

If you were me… how would you proceed?

Sorry for the rambling post, tried to clean it up!

Thanks in advance for any help!!

There’s definitely room for improvement. You should find a good doc that will look at adrenal, thyroid and hormone imbalances. Maybe someone here can recommend and good doc in your area. They can be tough to find.

Given your symptoms, I would recommend a 4x saliva cortisol test at a minimum. Read some of the stickies for other testing you should request. Post back with results.

If I were you, I would absolutely pursue TRT. Were you ever tested for celiac disease? Have you tried any dietary changes? Regardless of how you answer those two questions, your story indicates to me that you would experience relief from your symptoms on TRT.

second dhickey.
pregnenolone for adrenal fatigue? http://vimeo.com/3818805

[quote]celiac wrote:
If I were you, I would absolutely pursue TRT. Were you ever tested for celiac disease? Have you tried any dietary changes? Regardless of how you answer those two questions, your story indicates to me that you would experience relief from your symptoms on TRT.[/quote]

I have not been tested for celiac disease but… my wife is pretty gluten sensitive so we’ve eaten gluten-free for long stretches (I still try to avoid it as much as possible) and it doesn’t seem to help. I do see a difference in congestion and a few aches here and there when eating gluten but not a huge difference for me to believe that I could have Celiac’s (I definitely considered it a possibility early on). I’ll mention it to my doctor Friday.

Diet-wise, I’ve tried everything that made any logical sense to me over the past 5+ years. Any time I eat “better” I feel a little bit better overal but have never had any substantial change in my energy. Starting with Atkins, I’ve tried many low-carb eating styles. I’ve tried vegetarian (I am 100% certain I am on this planet to eat meat after that), gluten-free and over the past two years paleo “diets”, most recently focusing on high fat, medium protein, medium carb (potatoes, sweet potatoes and green vegies mostly). I’ve lost as much as 40 lbs. but was shocked at how little it impacted how I felt.

re: finding a good doc in the area, I’ll be pursing that immediately after my appointment in a few days if my current doctor can’t or won’t help. If anyone has any suggestions in the NW Chicago 'burbs please PM me, otherwise I’ll dig into the stickies I’ve seen on the subject if need-be.

Thanks guys!

[quote]Danny880 wrote:
second dhickey.
pregnenolone for adrenal fatigue? http://vimeo.com/3818805[/quote]

Thanks both for the pointers!

I had my follow-up today.

After talking with my doc, I had blood drawn for a cortisol test and a kit on the way for the 4x saliva test to see if this is a more systemic problem. I’ve read a ton on pregnenolone and the whole adrenal/hormone system since you posted this. Sounds more and more like I have bigger issues.

My doc is up for trying TRT and has prescribed androgel and is willing to help if we see issues with the cortisol levels as well (digging further into why, supplementing, etc.)

I’ll report back after I’ve got my cortisol results and have had some time with the gel to see if it helps at all.