T Nation

39 and Looking for Advice


#1

I’m a 39 yr old male from the US. I have spent the last 7 years dealing with some health issues that my doctors keep down-playing. The more I read here, the more hopeful I’m becoming. At this point I’ve probably had 30 gallons of blood drawn to be given the same diagnosis of “you’re fine.” I know I’m not fine because I feel like crap.

Here’s a what I have going on:
Insomnia
Mood swings
Irritability
Decreased libido but all the hardware works
Low energy
Difficulty concentrating
Highly anxious
Depression
EXCESSIVE sweating (all caps because it’s beyond excessive)
No strength/Weakness
No drive or desire
Constipation

I had blood work done 7 years ago that really only found that I had high cholesterol. I had quit smoking about 2 years prior thinking the sweating was related to years of smoking. My first doctor just handed me some Lexapro to help out with anxiety and told me to clean up my diet and get more exercise. I had just started a business and she thought that may have been affecting me. They refused to give me any cholesterol meds because they didn’t want me dependent on a pill for the rest of my life. The lexapro had me feeling good and it was great for keeping me from ejaculating. I eventually gave up on the lexapro after a year and found a new doctor. She immediately put me on atorvastatin and fenofibrate. Cholesterol was now in check. As time went on, my moods worsened. She put me back on lexapro and added welbutrin to help with delayed ejaculation. We also tested T and some thryroid at that time to look into sweating and my fatigue issues. Tests results all landed in the “normal” range. I recall the T was around 348 (scale 300-1100). I was then sent to see a shrink. She had me on 450 mg welbutrin and 10 mg lexapro, and believed that I was showing signs of ADHD and put me on 10 mg of Adderall XR. That eventually got moved up to 50 mg of XR per day. I had tons of energy, that’s for sure. I stopped seeing her and started over with a new doctor. She listened, and ran the same thyroid and T tests with the same results. She did order a test where I had to piss in a bucket for 24 hours as well. I believe that was something for adrenals. Apparently that was ok or within range as well. Sent me to a dermatologist for sweating. They were no help either. After doing some reading, to me, it was becoming more apparent that the T was looking low, although it was in the clinical range. Ended up going back to one of the previous doctors and I kept pushing the issue. Summer of 2016, finally given referral to see a urologist. He listened, examined, did things no other man (or woman) have ever done to me lol, ordered blood work. Tested prolactin, SBGH, Total test, free test. My numbers were “ok” per the doctor. My total T was 459. At that time, I had been taking a T-booster for about 4 months and was actually feeling better, sleeping better, waking better, but still sweating. My moods were somewhat better but nothing to write home about… I use the Adderal like it’s a Red Bull when I’m dragging ass. The XR’s only seem to last 2-3 hours for me anymore.

I just had (very limited) blood work done December 29th 2016. here are the results of what was actually tested.

Testosterone- 317 ng/dL (262-1593)

Chol- 169 mg/dL (114-210)
Trig- 153 mg/dL (36-152)
Hdl- 50 mg/dL (>40)
Chol/Hdl Ratio- 3.4 (<6)
Ldl- 88.4 mg/dL (49-125)
non Hdl Chol- 119 mg/dL (<160)

Hepatic
AST- 26 U/L (6-52)
ALT- 35 U/L (13-86)
ALK PHOS- 107 U/L (22-136)
D. BILI- .20 mg/dL (.10-.26)
T. BILI- .7 mg/dL (.1-1.5)
T. PROTEIN- 7.6 g/dL (6.1-8.4)
ALBUMIN- 4.2 g/dL (3.2-4.9)
GLOBULIN- 3.4 g/dL (1.0-5.1)

TSH- 1.520 uIU/mL (0.35-4.010)
T3 UPTAKE- 31% (29.1-37.9)
T4- 10.2 ug/dL (5.0-11.8)
Reverse T3 Serum- 20.1 ng/dL (9.2-24.1)

Prolactin- 7.6 ng/dL (2.5-17.0)

LH- 2.9 mIU/mL (.8-7.6)

I’m currently 39 yrs old, 5’10, 205 lbs. I’m moderately active. I do commercial HVAC service/repair. I climb ladders, carry heavy motors, do a lot of walking, and sometimes a lot of sitting. I try to maintain a good consistent diet. I avoid all fast food, fried foods, processed foods, and sweets. I do not drink soda or juices. I drink fresh/home brewed tea that is lightly sweetened with sugar. While weight training I eat around 2500 calories, 250 grams Protein, 250 grams Carbs, 80 grams fat. I supplement with whey protein, Omega 3 and CLA. I use a pre and post workout and drink a BCAA drink throughout the day. When not training, I’m cut the protein back, and enjoy a little more sweets. I typically don’t crave sweets, though lately that’s all I want to eat- i.e. soda and donuts.

I workout like a mad man for very small (if any) gains. My abdomen carries all my fat and no matter what I do I can’t shed any of it. I measure close to 40 inches around at my belly button. I’m hard-pressed to grow facial hair. I can go 2-3 weeks without the need to shave. I’ve never had a “beard”, hair doesn’t grow on my cheeks or jaw line. Hair on back and chest though I used Nair on both before vacationing at an indoor water park last month and there’s very little regrowth. Testicles are a good size (per urologist last year), with not pain currently. I did have a period back in 2006 where they hurt like hell but was ruled as a groin strain/pull and treated with some sort of anti-inflammatory/muscle relaxer. I have three kids with my wife. All three did take 3-6 months to make, lol… I don’t know if that’s normal or something to do with me or her. I used to love getting up at 5 am to go fishing or golfing. Hate going to bed and getting out of bed. I become frustrated very easily whereas I used to be the complete opposite.

I plan to find a new doctor and schedule a visit this week. I will request more blood work and look for recommendations from you guys on what to have checked. I’m tired of feeling tired and weak. I’m tired of getting out of the shower only to get sweaty while getting dressed. I truly feel that if I could fix the sweating, that’d fix half of my problems. I will check my body temps and post them tomorrow.

A BIG thanks in advance to everyone. I look forward to ALL feedback and suggestions.


#2

Your T levels are definitly low even if they are in clinical range. Most doctors assume lower range levels as correct . Your excessive sweating could be due to low T levels . Anxiety depression are also due to low T . Thyroid seems to be okay . You should find a good endo for treatment and you can get valuable advice from experts here also. Hang on someone with more knowledge will chime in.


#3

Thanks for the reply. It was also mentioned to me by a hormone doc or specialist that’s part of a fitness group I follow on FB that I sound like I’m high estradiol and may have elevated cortisol levels. I don’t believe I’ve ever had those levels tested.


#4

Please ask ksman he is expert here on these complex matters.
Cortisol do effect T levels but to what extent I have doubt. Are you under constant stress??? If yes then you can check morning cortisol levels. It will be better to do HPTA restart by following expert advice. You seems to be secondary hypogonadal if you are not primary then HPTA restart could work but chances are low since I have not seen anyone here for whom HPTA restart worked.


#5

If you havnt, read these “stickies” they have a ton of needed info.

You can also get your own lab test done. I go to Private MD Labs http://www.privatemdlabs.com/

They accept FSA and HRA payments. Gotta know your E2 and other levels so you can be informed.

Also, be prepared to take matters into your own hands if necessary (i.e. self administration of TRT)


#6

If E2 is elevated and/or SHBG is elevated, TT is inflated and FT could then be easily below range.

Labs: - fill in the blanks
TT
FT
CBC
hematocrit
TSH
fT4
fT3 [ not T3, T4]
AM cortisol - at 8 AM please or 1hour after waking up
fasting glucose

Training with low T and/or low thyroid function is highly stressful as it is not natural energy, but adrenalin overcoming fatigue.

Do not do thyroid indexes and uptake work. Those are obsolete now that fT3 and fT4 labs are available. Only the free hormones are active. T4 is a reservoir to make T3 and fT3 is the active hormone.
TSH should be closer to 1.0
T3, T4, fT3, fT4 should be midrange or a bit higher.

rT3 is too high. You lab company has a high upper range that might be an problem. rT3 interferes with fT3 and slows down your metabolism.

Stress is hard on the adrenals and Aderall could have made this worse. You already have a major stress profile. The end result can be adrenal fatigue.

See the thyroid basics sticky and note references to stress, adrenal fatigue and Wilson’s Book.

The bottom line for the balance of all of these thyroid hormones and other things is body temperature which provides a good measure of thyroid function. See last paragraph in this post.

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

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

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.


#7

My temp at 1130 pm last night was 97.5. I had been laying relaxed in bed for 20 minutes. 630 this morning I was at 97.5. At 1 pm today, I was at 97.7.

I will push new doctor this week to have the above tested.

Thanks for the responses.


#8

Get some Iodoral and also Selenium. I had the low temps for years, until I supp’d both those. Once you get your temps up you will feel a lot better.

Also, my cortisol is high, which drives up my RT3. This creates a hypothyroid(low) and a host of other issues, such as low DHEA (Precursor to Test). I sweated like a bandit before TRT. My sweating was likely due to low E2 though, because all my hormones were low. It really does take a lot of blood testing to find the issues, if one thing is off it can throw off a lot of other things.


#9

Thank you for the response Jdeck. I wonder sometimes if half my anxiety and depression is because I sweat so bad. Its embarrassing and debilitating. Im trying to find a new doc that will hopefully wanna help.

Were you able to fix the sweating? Will the iodine and selenium help the sweating too?

And to update my temps, I was 97.2 this morning, 97.6 after lunch.

Should I get blood tested before starting iodine replacement?


#10

No

Read about IR in the sticky. Selenium is mission critical!

Have you explained your history of using iodized salt and/or vitamins that list iodine+selenium?

If you do not feel any changes or temperatures do not change, do lab then to see what problems look like. But note that TSH is high during IR and TSH then has very little diagnostic value.


#11

@KSman , how long should someone wait after stopping IR so that they get a true TSH value?


#12

“how long should someone wait after stopping IR so that they get a true TSH value?”

I have no idea how long that takes and there may be individual variations as well. If body temps have improved along with energy and mood etc, there is no need to rush to lab work.


#13

I tend to follow the trend of avoiding salt. I do use sea salt though. Frankly not a big salt guy anyway. Im already always thirsty on a regular basis.

My temps only made it to or above above 98 ONCE this week. That was after doing some work and lugging a 50 lb tool pack. It was 98.7 to be exact. Otherwise, 97.1 usually at wake. 97.5 mid day.

What dosages should i use for iodoral and selenium. Will be getting this weekend. Dont wanna deal with stomach issues along the way either… lol


#14

Have you read the thyroid basics sticky?


#15

Yes, i have read them quite a few times. I started taking a thyroid supp that contains iodine and selenium. The iodine amounts are kind of low. Im considering getting the iodoral or some drops to add on to the thyroid supp. I havent check my temps again since i lost my thermometer. Last time i check, i was still in the mid 97’s at midday and low 97-s in the morning.

I have an appointment set up for next week. Is there any other blood tests you recommend besides the ones you listed previously?


#16

Got my blood tests back. Of course the doctor didn’t want to check all the shit we’ve discussed but, I’m extremely confused by the results. I’ll post the full results when I get a chance but, for now, can someone explain why there is such large change in only 3 months? Test went up to 552 total test (range 250-1100 ng/dL) and 92.2 on free test (range 35-155 pg/mL). How can my test be up one day and down the next like that?

Also, my TSH went up to 2.17 (0.40-4.50 mIU/L)
Free T4 1.1 (0.8-1.8 ng/dL)

First AM cortisol 16.3 (4.0-22.0 mcg/dL)

Says I should do a sleep study since I’m always tired and sleep poorly.

Started taking Iodoral on Monday. Starting at 12.5 mg per day. Will up it every 5 days or so just to make sure it doesn’t make me sick or something weird.

Any advice, scenarios? Probably gonna do sleep study and look for good endo.

Thanks in advanced.


#17

Iodoral is expected to increase TSH. That is normal. But TSH labs may be alarming.

Iodine might contribute to improved T as low thyroid function slows down every cell, tissue and organ system in the body. T levels can change.

Have you checked body temps of others in your home? Anyone else with low energy?


#18

Thanks for the reply. Everyone else (wife and 3 school aged daughters) have normal temps, and no issues with energy or fatigue.

I just started iodoral so it should not have affected bloodwork. Im just amazed at how things can fluctuate so drastically. Maybe my issues are due to sleep deprivation.

Thanks so much for the advice. I will continue IR amd check temps weekly to see if theres any changes.


#19

Sleep:

I have issues sleeping.

Trazodone is a very inexpensive Rx drug in USA, $40 per year at Walmart and Sam’s for example. Comes in 150mg tabs that are scored for 50, 75mg. Try 25mg to start, may need more over time. Does not have the problems and costs of other sleep aids. Does not drag over to next day. Not habit forming.

5-6mg of time release melatonin. Find in with vitamins in USA. Must be time-release and that can be hard to find on the labeling. Do not use non time release as it wears off in 4-5 hours and you wake up because falling melatonin levels are the mechanism of waking up. Exposure to light inhibits your own melatonin release and exposure to light wakes you up by causing a fall in melatonin. Dark room required.

I have found that 2 grams of vit-C help me sleep as well. But might be specific to the product I am using.

Sleep clinics: Are they focused on snoring issues? TRT makes snoring worse for some reason.


#20

Thanks again for your reply. I will see an ENT on monday, and do a home sleep study next week. Because my latest T level was in the 500’s, that whole notion is out the window. Not sure what else can be done or checked. Havent had the chance to set up with endo. I guess im just anticipating being told my blood tests say I’m the picture of health. I started taking 25 mg of iodoral per day. Been taking about 9 days now. No difference noticed.