T Nation

35 Y/O M, Stuck in a Cloud and Lacking Motivation. Low T


#1

Good evening everyone,

Here is my story. For the past nine years I have felt a loss of focus, motivation, sex drive, and desire to do anything. I love my wife, and am happy with where I am at in my career but I feel like I am in a fog daily. I wake up everyday at 5 am and train before work, I get adequate sleep and my diet is solid. I recently had a wellness panel and as far as the ref ranges go, everything was good. I know the ref ranges aren’t the end all be all so I wanted to go further into the testing. I requested a testosterone blood test, as well as a PSA, and TSH test. When the test numbers came back, both the free and total test results were low ( I will post numbers below). My doc suggested trt and is starting me on 200 mg a month, with test cyponate. They aren’t breaking the injections down weekly, I am scheduled to get one shot and then return a month later for another 200 mg. I picked up my vial from the pharmacy but before I get my shot I wanted to do some more research, and of course I stumbled upon this forum. My doctor is actually a good friend of mine, a urologist at the hospital I work for. I respect him, but I need to learn more about this myself. I want to get better, and want to feel better. I am still young, and have young children that I want to play with and a wife that I want to have a healthy sex life with. Please let me know what there info you need/want from me for any suggestion you can make.

I am 6’2 275 lbs, at one point I was 410 and dropped the weight in a slow steady pace.

My current supplementation

4,000 mg vitamin C
Nordic Naturals Fish oil
2,000 iu Vitamin D
B-Complex 1x a day
K2 100 mcg

Prescription RX. None currently

In the past I took 350 mg of norco for a neck injury. That was about one year ago. Nothing else.

Here are my labs, all were fasted except for the TSH and PSA.

Component Standard Range Your Value Flag

Testosterone,Total 250 - 1100 ng/dL 231

Testosterone Free 35.0 - 155.0 pg/mL 41.4

TSH 0.36 - 3.74 uIU/mL 1.83

WBC 4.8 - 10.8 K/uL 6.6
RBC 4.70 - 6.10 M/uL 5.71
Hemoglobin 14.0 - 18.0 g/dL 16.5
Hematocrit 42.0 - 52.0 % 50.0
MCV 80.0 - 94.0 fL 87.6
MCH 28.7 - 33.1 pg 28.9
MCHC 33.0 - 37.0 g/dL 33.0
RDW 11.5 - 14.5 % 15.4 H
Platelet Count 130 - 400 K/uL 330
MPV 7.4 - 10.4 fL 7.6
Sodium 136 - 145 mmol/L 140
Potassium 3.5 - 5.1 mmol/L 4.7
Chloride 98 - 107 mmol/L 105
Co2 20 - 29 mmol/L 26
Anion Gap 10 - 18 mmol/L 14
Glucose 70 - 100 mg/dL 90
Bun 9 - 25 mg/dL 14
Creatinine 0.7 - 1.3 mg/dL 1.1
Please note: New reference range as of 10-21-2015.

Calcium 8.5 - 10.1 mg/dL 9.0
AST(SGOT) 5 - 37 U/L 17
ALT(SGPT) 12 - 78 U/L 29
Alkaline Phosphatase 46 - 116 U/L 67
Total Bilirubin 0.1 - 1.2 mg/dL 0.7
Albumin 3.5 - 5.0 g/dL 4.1
Total Protein 6.4 - 8.3 g/dL 7.2
A-G Ratio 1.3
Cholesterol,Tot 0 - 200 mg/dL 149
Triglycerides 35 - 150 mg/dL 80
LDL <100 mg/dL 103 H
HDL 40 - 150 mg/dL 39


#2

Your testosterone is without question low, but there is typically a cause. Some concerns at the start. You need more labs before injections begin to get a baseline; most importantly e2(estradiol), t4, t3, rt3.

The more fat men carry, usually correlates to higher aromatization/conversion of T (testosterone) to e (estrogen). Estrogen getting too high will negate all effects of T and will make matters worse.

T to e2 can be reduced by reducing T spikes/peaks which is done by more frequent injections of smaller doses of T. Once per month injections is idiotic. Minimum is once per week due to half-life of most T esters. I like injecting EOD or every other day.

If e2 is still high after the above then you either need to reduce T dose or use an aromatase inhibitor. The most common is anastrazole/arimidex. Typical arimidex dose is 1mg/100 mg test.

Are you done having kids? Your testicles will atrophy without hCG.

Your Dr needs to keep your hematocrit heavily monitored. Your above number is already high pre trt. TRT can make this number go even higher. If it gets too high it makes our blood viscous and thick which increases our risk of stroke, blood clots etc.

Hematocrit is reduced by reducing T dose but in your case you’ll likely have to donate blood, typically the double red blood cell donation is most effective.

Also at home you can test your thyroid function by testing your body temps both upon waking before getting out of bed. No talking, drinking before etc. and also around 3 pm as well.

Waking should be 97.4 or above. Afternoon you should hit 98.6. Write these down for a few days for us and your Dr.

Its good that you’re friends with your urologist but he doesn’t know what he’s doing from the sound of it. He appears to be operating on antiquated methods and isn’t up to date with modern HRT (hormone replacement therapy) treatments. Youre going to need to educate him, go along on a rollercoaster ride while he learns if he wont listen to you or find a new Dr.

Report back and good luck.


#3

I’m relatively new to TRT. Hostile and KSman will be the best resources for you. I just wanted to say congrats on the weight loss! That’s an impressive achievement.

Also need to think about supplements. Most guys here take the following:

DHEA 25mg
Vit D 5,000 iu
CoQ10 the ubiquinol form 50-100mg
High Quality Omega 3 Fish Oil 750-1,000mg
High Potency B complex with iodine and selenium but NO iron


#4

KSman will be a better resource than myself.


#5

Thank you very much for the feedback. I am taking most of the supplements you mentioned, and will add them to my original post now. Again, thank you


#6

If I were you, I would spend your time and resources finding a Dr who will allow self injection, is open to use an AI if your E2 becomes too high and also hCG to preserve the function and form of your testes.

You can start by using google maps, identifying pharmacies and compounding pharmacies, call them and ask them to suggest a Dr that prescribes T, arimidex/anastrazole and hCG.

When/if you get to the point of self injection, you can use smaller syringes and inject subcutaneously, no need for intramuscular to avoid scar tissue on your muscles over the years.


#7

KSman is gonna ask about prescription meds. Both current and past, so might as we’ll add those to your original post. It’ll save time…


#8

Please follow these links in the 2nd post of the 1st forum topic:

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

Labs:
TT
FT
E2
LH/FSH - before any TRT starts!
TSH
fT3
fT4

TSH should be closer to 1.0
Are you feeling cold easier now? Wife too?
Stopped using iodized salt?
Check oral body temperatures as per the thyroid basics sticky.

Your doctor does not know how to manage the diagnostics or the treatment.
Show him the linked material above.

Neck injury?
A blow to the head can damage the pituitary gland.


#9

Thanks KSman,

I did find a TRT doc, I have an appointment on the 7th, and they will do blood work, a body scan, and a consult with the physician. The Physician himself is currently on TRT so I am going to see him about my issue.

As for your questions:

I don’t get very cold, but I did stop using iodized salt. I use pink salt and sea salt. I will begin checking my body temperature. Thank you.

No blows to the head recently, I did have a severe blow to the head fifteen years ago during football, but not much since then. My neck injury happened in the gym, during presses.


#10

You need iodized salt to avoid iodine deficiency.

You are probably iodine deficient and anyone else in your home.


#11

I had my first visit with my TRT doc today. He himself is currently on TRT and we discussed treatment option. He is has order more blood work to be done, to get a better understanding of what my body is doing. Once I get the blood work done, they will do a dexa scan as well. The one thing I was a little put off by was his suggestion of going on the HCG diet with daily HCG shots. He wasn’t pushy about it but he did sound like he wanted me to go in that direction. I am going to research it a bit more, but it doesn’t seem like something I want to do on top of the TRT.