Firstly, thanks to everyone who applies their time and interest to this forum. Imagine if everyone in society could become an expert in their interests and be rewarded for helping others...
My Case: I am 34 years old and have always experienced ED with partners and low-libido (I have never had penetrative sex, I have only been hard enough for fellatio 2X in my life, I donÃ¢??t really want to have sex, I rarely have erections with partners, but I can masturbate completely hard with online imagery and did so almost daily since age ?16 until I stopped 4 days ago), along with general fatigue and poor quality sleep, below-range T levelsÃ¢?Â¦ and IÃ¢??m looking for answers. Testicles always hang close to body, I recently have had dry skin and restless legs, and I have always had a sort of a "blah" feeling in day-to-day life.
Though I am the hardest-gainer I know, I am reasonably good-looking (I have no trouble going to a bar and going home with someone), as well as well-educated, gainfully-employed yet not willing to pull the trigger to take the next career step, and affable yet somewhat introverted and nerdy.
My current goals are to:
(1) Be able to have consistently strong copulatory erections that would allow me to receive fellatio and perform penetrative sex to orgasm
(2) Reduce my fatigue
(3) More easily fall asleep and sleep better
(4) Comparatively it's so insignificant, but: build more muscle
I recently had lots of labs done, motivated by suggestions on this forum, and was prescribed a 3-month trial of Androgel, but I am wondering what I really should be doing.
The DevilÃ¢??s Advocate inside me says my lab values are leading me astray and I just need to (1) consistently practice sex with someone while abstaining from artificial sexual stimulation, (2) eat better and (3) improve sleep hygiene.
I would simply ignore my lower-than-range testosterone values and concentrate on eliminating sexual stimulation from my computer - given that, when I go to www.yourbrainonporn.com, almost everything there resonates with me - but I then recall that, even before using online stimulation, I never had a strong desire to have sex. PDE5 inhibitors (e.g. Viagra, Cialis) are not really effective and anyway don't affect libido.
My current plan, though, is (critique requested - please help me here!):
(1) To use the Androgel (1.62%, 2 pumps per day) and see how I feel, getting labs done at 1 and 3 months. I will continue my supplements of Vitamin D3 15,000, Zinc 50mg, B-Complex,and multi-vitamin. Does this sound reasonable?
(2) To do my best to stop using my computer as sexual stimulation, and see if this helps.
(3) To try to improve sleep hygiene through more consistent bed times and no screens on the bed, and keep it up in the gym with compound lifts.
When looking at my labs (below), I note the following salient aspects:
(1) My testosterone is often, but not always, below or at the bottom of the "range"
(2) My TSH has been going up every year
(3) I have an above-range thyroglobulin antibody result, but the lab note says it might be insignificant. I have an appointment with an endocrinologist in 2.5 weeks, since my GP didn't know how to interpret the result.
(3) My bad cholesterol and triglycerides are high and have been high since I first had them checked in 2007.
I realize this is probably an incredible story to anyone reading this, but I assure you it is true and I am here asking for any additional guidance you might provide as regards possible TRT in the context of my above story and my below labs. If you think my issues are "psychological", go ahead and say it. But if you see something else in all this info that might help me, please respond. THANK YOU!!!
-Describe body and facial hair:
Head: Scalp is full of hair, though somewhat thinner compared to 10 years ago, <10 gray hairs total; face is full and I could easily grow a beard; chest quite hairy everywhere, as are legs; I have hair on the small of my back and in the last ?2 years I've developed some on the sides of my back and a little on my shoulders, too.
-Describe where you carry fat and how changed:
Always been skinny or skinny fat: 80% fat on belly, 20% on shoulders and love handles.
-Health conditions, symptoms [history]:
Life-long low libido and copulatory ED
Poor sleep quality - hard to fall asleep, and I wake up often
Never feel refreshed upon waking
Fatigue during the day - sometimes I nap at work after lunch and often just feel exhausted. My younger brother also has always felt fatigued. Uncle was put on thyroid meds at age 50?
Used to get a severe cough/bronchitis at the change of fall to winter and winter to spring (people thought I was a heavy smoker, and I don't smoke). Have not experienced this in 2 years.
Ears often itch (may be food allergy)
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever:
RX: 3 days ago I started Androgel, 2 pumps 1.62% QD
OTC: Vitamin D3 15000 units QD
Zinc 50mg QD
Multivitamin QD (Includes 110mcg Selenium, 2mg Copper)
I consumed 1.5g of Potassium Iodide over by taking 46 tablets of 32.5mg KI over 30 days, ending about 01/12/2015, and did a half-hearted job of tracking the temps (below)
Have never taken hair loss / prostate drugs.
Only other drugs in past are: oral antibiotics for previously-yearly ear infections (caused by food?), and inhalers/antibiotics for bronchitis which I used to get every change of season but which I haven't experienced in 2 years now.
-Describe diet some create substantial damage with starvation diets:
I have never had much appetite. Typical day is coffee for breakfast, lunch at a cafeteria, and Chipotle for dinner.
-Describe training [some ruin there hormones by over training]:
I have always been very weak - the weakest male I know - and I always feel fatigued when training. I stopped training 2 months ago after 4+ years of little gaining, and I re-started last week: 2X per week, upper body one day (bench and front press) and lower body / back the other (squats and chin-ups). My best squat ever was 115lbs, 5X5 - after ~2 years of training, which I am working back up to.
-Testes ache, ever, with a fever?
Maybe 2-3X a year I will feel an ache in the right testicle. No fever, no known trauma.
-How have morning wood and nocturnal erections changed
I gets semis, I think more so when I haven't used porn. Hasn't ever changed.
-Lab results with ranges:
TESTOSTERONE (all before beginning Androgel this week):
01/17/2015: 304 (348-1197); Free Testosterone (Direct) 9.4 (8.7-25.1)
10/17/2014: 337 (220-1000); Free Testosterone 76.1 (40-240); Free Testosterone % 2.3% (0.5-3.2)
4:14 PM: 262 (348-1197); Free Testosterone (Direct) 10.6 (8.7-25.1)
9:33 AM: 266 (348-1197); Free Testosterone (Direct) 10.7 (8.7-25.1)
10/09/2014: 288 (348-1197); Free Testosterone (Direct) 9.3 (8.7-25.1)
04/25/2014: 480 (300-1080); Free Testosterone 120 (47-244); Free Testosterone 2.5% (1.6-2.9)
10/11/2013: 408 (348-1197); 2.5% Free (1.6-2.9)
11/29/2012: 440 (348-1197)
04/25/2014: 17 (11-80)
10/17/2014: 4.5 (1.4-18.1)
10/17/2014: 3.9 (1.5-9.3)
10/17/2014: 7.2 (2.1-17.7)
01/17/2015: 14.3 (7.6-42.6) (Roche ECLIA methodology)
01/17/2015: 44 (<151)
01/17/2015: 11.8 (6.2-19.4)
01/17/2015: 290.2 (138.5-475.2)
VITAMIN D, 25 HYDROXY
04/25/2014: 20.6 (30.0-100.0) I HAVE BEEN TAKING VITAMIN D3 15,000 UNITS QD SINCE 01/2015
01/17/2015: 0.8 (0.0-4.0) (Roche ECLIA methodology)
10/17/2014: 1.1 (0.0-4.0) (Siemens Vista Chemiluminescence)
01/17/2015: 4.270 (0.450-2.500) NOTE: THIS WAS A FEW DAYS AFTER COMPLETING 46 TABLETS OF 32.5MG POTASSIUM IODIDE, 2 PER DAY, = 1.495 GRAMS IODIDE.
04/24/2014: 3.923 (0.500-5.000)
10/11/2013: 2.790 (0.450-4.500)
THYROID PANEL COMPLETE (01/17/2015):
Thyroxine (T4) 5.9 (4.5-12.0)
T3 Uptake 32% (24-39%)
Free Thyroxine Index 1.9 (1.2-4.9)
Thyroid Peroxidase (TPO) Ab <6 (0-34)
Thyroglobulin, Antibody 2.4 (0.0-0.9) Please Note: Low positive Thyroglobulin antibodies are seen in a portion of the asymptomatic populations.
T4,Free(Direct) 1.00 (0.82-1.77)
Reverse T3, Serum 10.6 (9.2-24.1)
Triiodothyronine (T3) 123 (71-180)
Triiodothyronine,Free,Serum 3.8 (2.0-4.4)
04/25/2014: 474 (211-911)
ASPARTATE AMINOTRANSFERASE (SGOT)
10/11/2013: 22 (0-40)
ALANINE AMINOTRANSFERASE (SGPT)
10/11/2013: 26 (0-44)
HIV, SYPHILIS, CHLAMYDIA, GONORRHEA:
02/2015: ALL NEGATIVE
Glucose, Serum 98 mg/dL 65 - 99
Uric Acid, Serum 6.5 mg/dL 3.7 - 8.6 (Please Note: Therapeutic target for gout patients: <6.0)
BUN 14 mg/dL 6 - 20
Creatinine, Serum 0.92 mg/dL 0.76 - 1.27
eGFR If NonAfricn Am 108 mL/min/1.73 >59
BUN/Creatinine Ratio 15 8 - 19
Sodium, Serum 139 mmol/L 134 - 144
Potassium, Serum 4.0 mmol/L 3.5 - 5.2
Chloride, Serum 100 mmol/L 97 - 108
Carbon Dioxide, Total 21 mmol/L 18 - 29
Calcium, Serum 9.8 mg/dL 8.7 - 10.2
Phosphorus, Serum 3.5 mg/dL 2.5 - 4.5
Protein, Total, Serum 6.7 g/dL 6.0 - 8.5
Albumin, Serum 4.6 g/dL 3.5 - 5.5
Globulin, Total 2.1 g/dL 1.5 - 4.5
A/G Ratio 2.2 1.1 - 2.5
Bilirubin, Total 0.5 mg/dL 0.0 - 1.2
Bilirubin, Direct 0.11 mg/dL 0.00 - 0.40
Alkaline Phosphatase, S 88 IU/L 39 - 117
LDH 173 IU/L 121 - 224
AST (SGOT) 27 IU/L 0 - 40
ALT (SGPT) 33 IU/L 0 - 44
GGT 37 IU/L 0 - 65
Iron, Serum 144 ug/dL 40 - 155
LIPIDS(01/17/2015) - NOTE, MY CHOLESTEROL AND TRIGLYCERIDES HAVE BEEN ABOVE RANGE SINCE AT LEAST 2007.
Cholesterol, Total 257 High mg/dL 100 - 199
Triglycerides 265 High mg/dL 0 - 149
HDL Cholesterol 34 Low mg/dL >39 (According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a negative risk factor for CHD.)
VLDL Cholesterol Cal 53 High mg/dL 5 - 40
LDL Cholesterol Calc 170 High mg/dL 0 - 99
T. Chol/HDL Ratio 7.6 High ratio units 0.0 - 5.0
Estimated CHD Risk 1.6 High times avg. 0.0 - 1.0
WBC 4.1 x10E3/uL 3.4 - 10.8
RBC 5.11 x10E6/uL 4.14 - 5.80
Hemoglobin 14.5 g/dL 12.6 - 17.7
Hematocrit 42.6 % 37.5 - 51.0
MCV 83 fL 79 - 97
MCH 28.4 pg 26.6 - 33.0
MCHC 34.0 g/dL 31.5 - 35.7
RDW 13.6 % 12.3 - 15.4
Platelets 213 x10E3/uL 150 - 379
Neutrophils 39 % (NO RANGE PROVIDED)
Lymphs 52 % (NO RANGE PROVIDED)
Monocytes 7 % (NO RANGE PROVIDED)
Eos 2 % (NO RANGE PROVIDED)
Basos 0 % (NO RANGE PROVIDED)
Neutrophils (Absolute) 1.6 x10E3/uL 1.4 - 7.0
Lymphs (Absolute) 2.1 x10E3/uL 0.7 - 3.1
Monocytes(Absolute) 0.3 x10E3/uL 0.1 - 0.9
Eos (Absolute) 0.1 x10E3/uL 0.0 - 0.4
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2
Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1
TEMPERATURES FROM DOCTORÃ¢??S VISITS: