T Nation

38 Y/O Blood Test = 238 Total T


38 -age
73"-height
39"-waist(measured directly under naval)
210-weight

-describe body and facial hair- decent, but lower legs have lost some hair over last 5 years. Started balding in late twenties at a somewhat quick rate.

-describe where you carry fat and how changed - all in waist/chest and is very stubborn. I remember feeling nipple pain during puberty…always had bigger nips and fatter chest, even as skinny teenager. Still have this problem as an adult.

-health conditions, symptoms [history] - mild HT, seems more genetic…GI issues when eating dairy/gluten. Overall in decent health.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - Took propecia approx. 10 years ago. Stopped because boobs felt like they were getting bigger, didn’t notice anything else as far as side effects. I take Accupril 20mg ED, high grade fish oil, Zinc, magnesium, multi) No steriods… Try to stay away from NSAIDS…

-lab results with ranges (see attached)

-describe diet. I eat fairly clean, paleo/gluten free type diet. I eat some grassfed meats, but it’s hard to have a total true organic diet. I try to eat every few hours…eggs, meats, fish, nuts, almond milk w/ high quality protein, veggies and lots of water. I have always eaten fairly clean…but do drink socially, usually have 2-5 drinks night after I come off shift(I’m a firefighter). I’ve cut way back recently though…with no difference in the way I feel.

-describe training Been doing 5X5 barbell type workouts for awhile…and mix in some Crossfit during the week. I do not feel like I overtrain…one of the reasons I got my T tested was because my energy/recovery has been horrible.

-testes ache, ever, with a fever? NEVER

-how have morning wood and nocturnal erections changed? Still good wood…with strong sex drive. I asked to get my T tested approx 3 years ago during a Firefighter physical but the Dr. said if I still got hard-ons and had a strong sex drive there was no need for a test! A-hole.

My deal:

I have been feeling more and more run down, anxious and generally crappy for the past 5+ years. I’ve been trying to kick up training to get rid of stubborn belly/chest fat but recovery/joints have been really poor. I’ve been a firefighter/paramedic for approximately 7 years…so sleep, stress is definitely an issue. Sex and hard-ons have been an non-issue…so far. I can go on the drop of a hat…twice a day when the wife is wiling. So I went to my Primary Dr. and she agreed to do a more comprehensive test…I thought my Estrogen/Test was out of whack and perhaps a thyroid issue. My Dr.'s nurse called back and said blood looked good except fasting glucose was a tad high…she said I needed to cut back on sugars/pop/etc and I said I didn’t really eat that except for a few drinks here and there. She then said my test was low and Dr. wanted me to start Androgel. I asked for the blood results because I needed to see what’s going. I did start Androgel (2 pumps)…it’s been about 7 days and I do feel better, but I know this is not the solution. Since then I’ve been reading non-stop to see what to do next. My Dr. wants me back in for a follow up at one month.

Next, I went and saw a TRT specialist by my house a few days ago that I found online…he looked my results over and said Firefighters/shift workers are generally 150-200 points lower because of sleep patterns/stress/etc. He said my labs/physical exam looked like I was healthy and just suffering from low T. He said he’d start me on weekly test injections with an Arimidex and HCG worked into the cycle. I don’t remember the exact dosages/injection cycle. He seemed knowledgeable and said he’d studied under/with Dr. Crisler…is that good? I thanked him and said I needed more information before moving on.

Lastly, I made an appointment for middle September to see my Urologist to make sure everything looks good with the testes. I saw him 5 years prior because I was going to get my tubes tied…I have two young crazy boys which adds to my daily stress level. I want to see what his opinion is.

So any advice? After I meet with my urologist in a few weeks I’ll have gone to three doctors and hopefully have all the necessary tests done. I know I could lose a few lbs… even though I have a fairly lean athletic build I do have a bit of softness around the belly…but compared to most people I eat and train well. I’m sorry if I left anything out that would be pertinent…


Here’s a pic of what i look like…not sure if this is necessary. But I just wanted to show I’m neither a steroid guy or a big fat guy who never trains.

I do not understand why there were no responses here. A very good opening post.

I did some work with a fire fighter where the whole district had metal contamination from having to wear fire retardant cotton pants underneath the fire suits, so they were wearing those garments all of the time they were on duty. Many in the district had hormone and other significant problems.

What time of day for the labs? [cortisol]
Need TT, FT, E2, LH, FSH as a set.

Do not do anything before you get LH/FSH!!!

Read the protocol for injections sticky. T+AI+hCG

What supplements?
fish oil
vit-D3 -you do not appear to get much sun exposure
vitamins?
iodine in salt or vitamins?

[quote]KSman wrote:
I do not understand why there were no responses here. A very good opening post.

I did some work with a fire fighter where the whole district had metal contamination from having to wear fire retardant cotton pants underneath the fire suits, so they were wearing those garments all of the time they were on duty. Many in the district had hormone and other significant problems.

What time of day for the labs? [cortisol]
Need TT, FT, E2, LH, FSH as a set.

Do not do anything before you get LH/FSH!!!

Read the protocol for injections sticky. T+AI+hCG

What supplements?
fish oil
vit-D3 -you do not appear to get much sun exposure
vitamins?
iodine in salt or vitamins?[/quote]

Thanks for the response KSman, I thought my opening post wasn’t too bad either and was hoping for more feedback!

I did the blood test above around 8:30am after I came off shift at the firehouse and didn’t sleep much. I’m going to my urologist this week and will get him to test the whole set including FH/LSH. I’ll re-read the protocols for the injections again.

I take high grade liquid fish oil (Carlsons), ZMA at night, Zinc in the morning, mult-vitamin(not ED tho), and occasionally Vit D. I was taking these BEFORE I even knew I had low T. Despite the picture, I do get quite a bit of sun…but live in Chicago area so not year round. I’ll get this tested as well. Iodine…not sure, need to look into this. Doesn’t my thyroid look ok?

Since this all went down a few weeks back…I’ve stayed on Androgel 2 pumps a day until I meet with my primary again. Since I was diagnosed I’ve cut way back on canned Tuna (was eating several cans a week), booze and been eating even cleaner. With all these changes I’ve been feeling better/happier/stronger and have noticed better recovery. But over the past 72 hours I’ve noticed some old symptoms creeping back in…so the Androgel may have already ran it’s course.

I’ll post results from my Urologist…but one last question, do I ask for a heavy metal poisoning test??

Thanks,

DM

Quick question. Ive been on androgel 2 pumps daily for two weeks. I didn’t initially get lh/fsh tested along with some other recommended labs…and I panicked and started taking the androgel right away. So
when I go to a different dr this week will my labs(especially lh/fsh) be way off my baseline? If I
Stop cold turkey today(Sunday) and have my tests this Friday what could
I expect after taking androgel for 2 weeks? I’m sort of lost right now…

My recommendation is not to panic and get a round of testing done, wait another couple weeks and get another test so you can establish a pattern. My uro told me T levels can double in hours depending on environmental factors so I wish going back I hadn’t just trusted the first test before starting TRT. I’d say TRT should be a last resort. TRT caused me to lose my sex drive which to me, is worse than the symptoms I had before.

I have a similar situation as you, and jumped on T-cyp shots before I had a better understanding of things and complete labs. This is a major mistake, but many of us do it because frankly, we feel like shit and do not know any better…

Others on here will have better advice than I can give, but I would suggest postponing your tests, getting off the gel and waiting two to four weeks and then getting the labs done - start fresh. TRT without all the right labs upfront is like trying to put a puzzle together without a picture. It really sucks.

That being said, TRT is completely worth it. Just take the time to do it right. It is essential to understand the root cause of your problems before treating (and I am guilty of this too).

Lastly, most get the tests done in the morning since that is when we wake up. You may consider getting your tests done when you awake from whenever you get your most sleep. Someone on here will probably be able to lead you to the best time to get labs based on your job and sleep patterns…

See points re iodine and thyroid in the advice for new guys sticky.

A 8AM cortisol test is for someone who was sleeping at night. Your test is not an AM test.

Jdeck: Sounds like your E2 got out of control.

[quote]Jdeck wrote:
My recommendation is not to panic and get a round of testing done, wait another couple weeks and get another test so you can establish a pattern. My uro told me T levels can double in hours depending on environmental factors so I wish going back I hadn’t just trusted the first test before starting TRT. I’d say TRT should be a last resort. TRT caused me to lose my sex drive which to me, is worse than the symptoms I had before.[/quote]

Not to discount everything you are saying, as TRT should be approached with caution and due diligence, but you drove your E2 level down to 5 with too much Arimidex, and that is most likely why you lost your sex drive. Getting your E2 dialed in correctly most likely would have had you feeling great with a good sex drive. Most people, assuming they actually need TRT, get a much improved sex drive when it is properly administered and monitored.

UPDATE

During the past month I had two appointsments, one with an urologist and a follow up with my primary.

First, the urologist was exactly like everyone said here…no help, he wanted to do no further tests and said he would keep me on androgel and get periodic blood tests (test only) to see how I’m doing. he did examine my testes and drew blood to check prolactin levels.

I followed up with my primary last week and told her I was feeling better on Androgel but wanted further tests done. I asked her what were next steps and she said I should look for other treatment options because she doesn’t really do much beyond Androgel. she did another blood test to include a few other things. After 3.5 weeks on Androgel here are my numbers.

Test = 337 (348-1197) LOW
Free T4 = 1.44 (.82-1.77)
Estradiol = 18.9 (7.6-42.6)
Free T3 = 2.8 (2.0-4.4)
LH = 2.2 (1.7-8.6)
FSH = 1.4 (1.5-12.4) LOW
Vit D = 53.4 (30-100)
Prolactin 5.2 (4-15)

So my test went up a touch…but not much and still way too low. My LH,FSH and Prolactin are low/low normal. My primary is going to recommend me to an endo…but I’m wondering, did Androgel lower my LH, FSH and prolactin? Could being on Androgel for only 3.5 weeks and having test go up only 100 points still cause the low numbers with LH,FSH and prolactin. I believe high prolactin is a cause for concern…correct?

Any feedback here? Do I need a MRI on pituary? I’ve made several changes this past month…eating better, no booze, sleeping good and exercising, taking Vit D/Zinc,fish oil…all while taking Androgel and my T still sucks. I’ve felt better…but not good enough.

The Androgel is suppressing your LH/FSH to some extent. Soon it will suppress them to zero and your endogenous test production will completely shut down. If your Androgel dose doesn’t increase that means your Test will only drop from here on the Androgel. Also, absorption of transdermals can fluctuate and the long term trends that I’ve seen all indicate the transdermals to lose effectiveness over time.

I’m sure some people maintain good test levels on transdermals over time but I don’t think they are the majority. My Test went up a whopping 2 points on Testim. After the initial boost I felt the first few days I actually felt worse after a month. My nuts were shriveled up and hurting and I was a mess emotionally after that first month.

If you can try to find a doctor that will prescribe injections and will look at the whole picture of your thyroid and adrenals along with the sex hormones. For me getting my thyroid treated and going to twice a week injections has made a massive difference in my health.

I used androgel for a year (really never felt all that different), only cost me $10 with the discount card. After 12 refills, the card (even a new one) won’t work anymore and my co-pay went to $50 which I didn’t want to pay based on not ever feeling all that better. I called my uro and said that my insurance won’t cover androgel any longer, and that I need to switch to injections. He tried to tell me that he would give me another discount card, and I had to tell him that the drug he’s pushing has a 12 transaction limit per person period. Maybe you can use that tactic down the road.

I did talk to a Dr. that runs a mens health clinic today…I saw him when I was initially diagnosed in August. I told him my latest labs and asked if he thought there could be any other underlying causes and what his treatment would be.

He stated he did not see any obvious underlying causes…pituitary/thyroid look ok so he would recommend 100mg T shots x1 a week along with HCG and arimdex as needed.

I’m trying to really think back to when I started feeling crappy…and I think my initial run of Propecia in my late 20’s is when I noticed more fatigue, harder gains and more belly/chest fat. I never had any ED tho…thank god. This Dr. also thinks my job/sleep schedule is knocking me down some…so it’s possible that propecia knocked me down…then getting the job as firefighter in my early 30’s caused me to drop to low levels. Just a theory of course…

I’m really thinking of giving this guy the go-ahead and starting his treatment protocol…he said the HCG will keep the testes working so if I decided to stop for some reason I would go back down to my “normal” levels.

Can anybody confirm that my thyroid levels are good/bad? They appear normal…

It’s been awhile since I’ve updated…I thought I’d give a quick review and I am seeking some new advice.

I found a men’s health clinic in 9/2012 and have been going weekly until last week. I was on 250mg of test cyp every 6-8 days…arimedex and hcg as needed. I actually only did one cycle of hcg in the early stages of trt…testicular atrophy went away and has stayed away. My labs looked good…I feel pretty good and with hard training and “paleo” type diet I’ve changed my body comp. quite a bit. Sexual desire and mood are great. The problem is I felt trapped with this clinic…it is a pain the ass to go in every week and spend $. Plus I think my dose was high and my levels were going over norm during the week. I was doing crossfit type training before trt with periods of heavy Oly and powerlifting…but now it’s much easier to put on size and strength… I think it’s because my levels are possibly too high? I’ve been searching for other options and found an urologist who will let me inject at home. He wants me to back down to 200mg weekly. He is not very favorable to an AI at this moment…which I’m also fine with. My questions/concerns are:

How can break injections up to 2x a week? What syringe/needle should I use? I had to demonstrate at the office I could do it…it was a 21 - 1.5" in my thigh and it’s still sore! This is what they RX for me. My old clinic did it in the flutes and I’d usually be sore for a few days.