T Nation

33 Y/O, Low T - Should I Get TRT


#1

In December 17 I went to the doctor because I had every symptom of Low T, and felt very beat up. Total Test comes back at 230 on scale 280-800 So I tell the doctor what next because I probably need trt? He is TOTALLY against it, goes on tirade about how TRT is only popular now because it makes the companies a lot of money and how hes hesistant to give it to me because im so young, I tell him “I think I SHOULD be on it BECAUSE I am so young, I want to feel my age, not 20-30 years older” Hes still against it but says he will do an “expanded” blood panel and if that is low then refer me to a endo.
I have read many cases on this forum and… everywhere, of people getting the run around for TRT people going to gp then endo then uro then MRI then nowhere…
My question is this:
With the limited “expanded” blood panel that my doctor provided do I need TRT? I feel that I do as I want to feel my age and my main hobby is lifting weights and I have definitely been feeling the effects of low t (I think). The VA pays all my insurance so IF I could get it from there I would rather get it for free but it sounds like it could be a 6 month to year long process IF they will even give it to me.
Should I go to a men’s health or low t clinic as opposed to jumping through countless hoops with the VA only to get nowhere (only benefit would be that its free)?

-age 33
-height 5 foot 8 inches
-waist 40 inches
-weight 216
-describe body and facial hair: hair on my head started to thin 2 years ago. Hair everywhere, started to get hairy at like 9 years old, started shaving at 12. Thick eyebrow hair all the way.
-describe where you carry fat and how changed: I carry a majority of my fat on my love handles (40 inch waist), stomach and chest. Hourglass shaped with very big chest, like a bodybuilder
-health conditions, symptoms [history]
Dysthymia (depression most of my life)
PTSD started 2009 (Afgh)
Lower back arthritis
Right foot missing cartlidge 3-4th metatarsal , right knee pain
Vasectomy at age 30
At about age 30 I started to feel beat, run down, low energy, lethargic, takes longer and longer to recover from weight training. Used to always be able to rerack weight on the bench, but at 30-31 started not to feel that ability to push out that last rep.
Low vitamin D
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
After 2009-2016 took just about every anti depressant under the sun (as prescribed) some pills would work for a year or two then stop working
Currently prescribed buproprion, ambien, prazosin, though im trying to get off of them.
I take normal vitamin daily and fish oil. On workout days (weights) I take 1x Animal Pak (lot of vitamins)
-lab results with ranges
Initially thought I had Low T because I felt I had all of the symptoms so doctor did very simple initial test.
12/26/17 blood test at 730am
Vit D 24.75 30-100
Testosterone T 2.3 2.8-8
After that Test I persisted and my doctor told me he would do an “expanded blood test for testosterone”
1/28/18
Albumin 4.9 3.5 - 5.2
PSA 0.6 0 – 4.0
WBC 5.9 4.3 – 10.
HCT 44.5 38.0 – 50.0
PLT 186 150 - 400
SHBG 23 10 - 80
Testosterone T 2.7 2.8 - 8
Testosterone Free 59 34 - 194
Test . wk 157 84 - 402
-describe diet
I aim for 180+ grams of protein, lot of chicken, some ground beef, some protein shakes after workout. About 180 carbs, avocado, almonds, for fats. Maybe once a week I eat candy, water or water with bcaa is my main drink, mostly water.
-describe training
Don’t think I have missed more than 2 days in like 4 years of working out.2 days on 1 day off weight training, maybe every other day ill do 15-25 min on bike. Day 1 chest day 2 bi tri day 3 OFF (sometimes on off days do smaller muscle groups traps, shoulders, forearm) day 4 back day 5 legs
-testes ache, ever, with a fever? No
-how have morning wood and nocturnal erections changed
In past few years I don’t have morning wood anymore, occasionally when im about to fall asleep (during day) I will get wood. Over past year I have had several instances of wife wanting sex but I don’t feel the want myself (not aroused) but she will so we will attempt but its just not there, I don’t feel aroused or excited which has never happened.
-get cold easily? a change?No, Hardly ever wear a coat, feel hot most of the time but don’t sweat much. At night wife says I feel like a furnace. My hands are the first thing to get cold.
dry skin, brittle nails? No
use iodized salt? Occasionally table salt, pretty sure its iodized.
eat much sea food? maybe 2x a week, canned tuna, fish oil pills.
exposure to chemicals? I don’t think so. Had many shots and injections that the military (army) gave me, whatever all of those are.
general energy levels low
difficulty gaining muscle / recent muscle loss Difficulty gaining muscle, been weight lifting past 4 years with 2 days on 1 day off never really missed a day but seem to be stuck with muscle gain
weight gain (difficulty losing weight) yes difficulty losing weight. Won weight loss competition last year, 230-213 in 24 days but very tough time getting below 213 even though im very active at the gym.
chest size/gyno?/chest sensitivity 46 inch chest, no gyno, have crystallization of cartilage in my rib cage (from boot camp injury I think) so there is some chest pain from that occasionally
trouble urinating or awareness of prostate No
normal sleep patterns 8 hours of sleep, wake up once or twice during night

Information is greatly appreciated.


#2

Im not familiar with those lab values, are you out of the US? Anyway, if its lower then 250 (total test) I think, the VA is obligated to treat you. You will probably have to go to an endo, and have an MRI to rule out tumor on pituitary, possibly have ultrasound done on balls.

I was lucky and I got my pcp to order it for me without seeing endo, but I see an endo on the outside. You probably wont be as lucky and will have to go through the ENDO process through the VA, and I probably will too at some point actually. Getting your test paid for is nice though, we’ve earned it. Use it.

As far as protocol, the VA is pretty retarded. I have heard some people say their endo actually RX them an AI through the VA! that is unheard of here where im at. Usually guys end up on the 200mg every 2 weeks, or worse, every 3 weeks. It causes guys to go high in their RBC/HGB and then they get yanked, or their e2 spikes and their PSA does and it gets yanked.

You will probably get the option to self inject at home, if you do, just do it twice a week and don’t tell them otherwise. Also be aware that the VA cut off in the upper limit is 870.


#3

The VA doctors are stupid, stupid, they have no idea how to do TRT and some doctors are perfectly happy if you’re barely above 350 ng/dL or as long as your within range they will not optimise you. The VA doesn’t even have access to E2 sensitive testing so what are you going to do when you get side effects? What’s your game plan?

There was a guy that was given TRT for a 319 ng/dL score and VA doctors were happy to see him at 352 ng/dL when he had labs done months later and the poor guy still has symptoms but because he was in the “normal range” they didn’t care, they shut his HPTA down for 33 ng/dL increase. Forget about the VA, pay for it out of pocket or in the end you end up paying for it in other ways.

The stories that come out of the VA are the worst of the worst! This is what you can expect from state healthcare systems because if these doctors were the best of the best you couldn’t afford them as they would be cash pay only running their own practice.

Insurance doctors always equal substandard care.


#4

You may be overweight in part because of low thyroid function. You can eval this on your own, see “oral body temperature” below.

Do not guess about iodized salt. In USA iodized and non-iodized salt are on the same shelf with near identical packaging.

Do your vitamins deliver 150mcg iodine and 200mcg selenium?

Any thyroid problems in your family or home. Iodine deficiency can affect whole family and women are more prone to resulting problems.

Steady diet of tuna can lead to mercury problems.

Perception of warmth can be misleading.

Diabetes? Labs: fasting glucose, A1C

Blows/blast to the head can damage the pituitary.

You have low T, now you need these labs to learn about why:
LS/FSH - both
prolactin
AM cortisol - do at 8AM or one hour after waking up
And while at it: TSH, fT3, fT4 [rT3 would also be helpful given your history of stress and injury]
[please not T3, T4 or other indexes etc.]

Heavy training with low T, low thyroid function can lead to adrenal problems.

Note the second reference below.


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

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#5

Thank you all for your time in replying to my post.
So as of right now I should probably go the longer route in getting TRT and go to an endo etc to look into if I have a thyroid problem first? I thought the weight problem and extra fat would go away once my T levels went up. Didn’t really want to wait another 6-12 months, but if it’s a thyroid problem.
Thank you all for your time in replying to my post.
Yes, I am located in the United States.
I looked at my vitamins, Centrum has 150mcg Iodine and 55mcg selenium and Animal pak 75mcg iodine and 25mcg Selenium
Blows/blast to the head? Got hit in the head with a football in my eye socket really hard in 2009, didn’t go to the ER or anything for the hit, didn’t give me a black eye. but it did cut my eye which healed over time, saw an eye doctor about it.
I will take my temps as per stickie. and after I go to endo ill post labs.


#6

Body temperatures are directly correlated to fT3 thyroid hormone which is the only active free thyroid hormone, testing using a glass thermometer upon waking and 12 noon will either show hypothyroidism or a slight iodine deficiency which supplementing iodine and selenium can often solve.


#7

I received a letter from my doctor regarding these past results… from a non-visit endocrine doctor:
“Recommendations: Testosterone replacement therapy not indicated given that his bioactive form of testosterone, the free testosterone levels are within normal limits. The mildy low total testosterone level can be explained by the low sex hormone binding globulin (SHBG as this will cause a low reading on the laboratory analysis. The free testosterone level is more reflective or his actual bioactive testosterone. Low SHBG can be from obesity given BMI of 34.7. Recommend assessing and optimizing co-morbidities, as able, including weight management and OSA, we can see him on a once time routine visit.”
Does total testosterone not matter like the “doctor” says? Doctor told me this over the phone then I received the letter in the mail the next day. When I was on the phone he said I was “very obese”. As I said in the first post Im far from obese, I workout 4-6 days a week weight lifting and biking and never miss a day, I even look like a body builder, big chest big shoulders, no stomach overhang or anything. I never remember them taking my BMI. I do however have fat on my stomach and chest, it doesn’t hang out like a gut at all. Having stupid doctors calling me “very obese” is driving me crazy, no one has ever said that about me. (5 foot 8, 216 pounds V taper shape but I do have big love handles like I said in first post)
Looks like I’m going to call the Endo on Monday or Tuesday when they get the consult then I’m going to request to be seen “in the community” (not at a VA facility) which is better.


#8

Doctor is wrong about low SHBG having anything to do with low TT. To many doctors get male hormones wrong, has everything to do with no medical school education on the subject.

Lots of guys with low SHBG have very high free T above the normal ranges, while free T is important so to is TT. This doctor is struggling with TRT, time for a new doctor.

It’s the VA what did you expect?


#9

Whats the recommendation here?
Here are my temperatures, as I said above I take a multivitamin Centrum has 150mcg iodine and 55mcg selenium. Animal pak has 25 mcg selenium and 75mcg iodine (because I only take 1 pak, recommended 2 pak a day but that’s like 20 pills! Been taking these for 3 years roughly.
2/9/2018
AM X PM 98.1
2/10/2018
AM 97.5 PM 97.9
2/11/2018
AM 96.9 PM 97.4
2/12/2018
AM 97.2 PM 97.8
2/13/2018
AM X(forgot to take) PM 97.8

Thank you for your input.


#10

If taking temps at night time is wrong, take temps upon waking and 12 noon. Temps drop at night, otherwise you wouldn’t fall asleep.


#11

Taken at just before 8am and 3pm, so noon is better? ok


#12

Temps drops as the day goes on, take pm temps at 12 noon.


#13

new temps
2/13/18
AM X PM 98.1
2/14/18
AM 96.6 PM 97.4
2/15/18
AM 97.4 PM 98.1
2/16/18
AM 96.1 pm 97.2
2/17/18
AM 97.2 PM 97.1

Also, I will get to schedule a endo appt in like a week when they call me, pretty sure ill have to go to outside clinic when I want to do TRT because it seems next to impossible to get TRT any other way.


#14

Temperatures are low.
In a case like this it is good to see if someone else can get 98.6F on the thermometer to have confidence in it.

Did you confirm tables salt is iodized?

Waist is 40".
Sorry, but you do have a weight problem and then thyroid is a critical factor. Low thyroid is also depressing.

Did PTSD involve injury or blast damage?

  • foot and knee?

Surgeries?

These things are high stress and rT3 might be elevated which blocks some fT3 at T3 receptors. To resolve this you should do TSH, fT3, fT4 and rT3 labs and may need to pay out of pocket. You can order via WWW in most USA States. As this also then would involve adrenal function you would also need to test AM Cortisol, done at 8AM or 1 hour after waking.

Training when your body is compromised and natural energy or stamina that is impaired often involves adrenalin and that makes things worse. Starvation diets also are a problem.

Please read all of the thyroid basics sticky. These issues are complex.

FT is released in pulses with a short half-life. So one should not read much into any single FT result. SHBG seems reasonably healthy to me. Need context of E2.

To me, your hormones are low and we also lack the context of E2.

Labs:
LH/FSH
prolactin
TSH
fT3
fT4 [Not T3, T4]
rT3
CBC
hematocrit
fasting cholesterol
fasting glucose
A1C
AM cortisol

Fish oil and 5000iu Vit-D3 would help with metabolic rate and inflammation. You might try Rx 15mg Meloxicam once a day for lower back arthritis. 90 doses at Walmart for $10. If script written properly you can get 360 doses at once, after you determine that it is helpful. Nothing OTC worked for me.


#15

Thank you for your time and input.

  1. My table salt isn’t iodized but I do take a multi vitamin daily that has 150 mcg iodine
  2. No surgeries, PTSD didn’t involve injury or blast damage but, I Got hit in the head with a football in my eye socket really hard in 2009, didn’t go to the ER or anything for the hit, didn’t give me a black eye. but it did cut my eye which healed over time, saw an eye doctor about it.

Looks like my next step is an expanded blood test. Thank you for your help.