T Nation

40 and on the Journey


#1

This site and the info I have picked has been stressful and life changing at the same time. So lets start with thanks to all who have assisted everyone on this trek.

Age 40
Height 5'10
Weight 280

Have been working nights for the better part of 16 yrs and needless to say it has taken a toll on my body. Eating too much junk and not working out I just took the side effects as normal getting old and lazy. After my annual my Doc put me on Axiron as my T was 148 and everything was normal for a few days. About a week later came the tenderness in my chest. At this point I had just found this site and started to study up. I found a local PA that had a more experience than my Primary so we did new labs and he added 1 mg apex 2 a week. Those labs (Lab Corp) came back with T=537 FT=9.9 but E2=65.5. I figured I would man up and go to the shots. So I am currently doing 30 units of test-c ETD, 1mg adex ETD and 250 iu HCG EOD. New labs done and I am thinking I should make a tweak and could use another opinion. Thanks guys

Test 9/9/14
LabCorp
CBC With Diff/Platelet
WBC 7.9 x 10E3/uL 3.4-10.8
RBC 5.45 x 10E6/uL 4.14-5.80
Hemoglobin 16.7 g/dL 12.6-17.7
Hematocrit 48.6% 37.5-51.0
MCV 89fL 79-97
MCH 30.6 pg 26.6-33.0
MCHC 34.4 g/dL 31.5-35.7
RDW 14.8% 12.3-15.4
Platelets 269 x10E3/uL 150-379
Neutrophils 59% 40-74
Lymphs 33% 14-46
Monocytes 6% 4-12
Eos 2% 0-5
Basos 0% 0-3

Testosterone 1342 ng/dL 348-1197
Free Test 39.6 pg/mL 6.8-21.5
Pregnenolone <10 ng/dL <151
Dihydrotest. 56 ng/dL 30-85

DHEA-S 308.2 ug/dL 102.6-416.3
Cortisol 6.2 ug/dL 2.3-19.4
Estradiol 20.3 pg/mL 7.6-42.6
Prolactin 41.3 ng/mL 4.0-15.2
PSA 0.6 ng/mL 0.0-4.0
Vit D25 44.0 ng/mL 30.0-100.0

I'm planning on dropping down to 25u of test ETD and .5 adex ETD also as E2 is down.


#2

There is more going on here other that hypogonadism.

You should have had LH/FSH tested to determine what was going on BEFORE TRT. It is now too late.

What T levels did you get from Axiron, if that was tested. If low, poor absorption and perhaps thyroid problems need to be considered.

Prolactin 41.3 ng/mL 4.0-15.2
- This is a real problem. Please note comments re prolactin in the advice for new guys sticky. Would also contribute to gyno.
- see action items
- can lead to or contribute to depression and low energy

Pregnenolone is low, DHEA-S is not. Are you taking DHEA?
- try oral 50 or 100 mg [hard to absorb, take with meal that has fats/oils
- if not taking DHEA, this is odd as pregnenolone is the precursor for DHEA which is not low
- pregnenolone is the basis for all subsequent steroid hormone production
- also leads to progesterone which is upstream of cortisol and progesterone cream might improve cortisol

Cortisol 6.2 ug/dL 2.3-19.4
- this is very low if AM Cortisol that should be done around 8AM. Repeat if needed. Otherwise, read in the advice for new guys about stress, rT3, Wilson's book.
- might be a good idea to do a 4 sample saliva test

Thyroid problems can contribute to hormone problems, low energy and weight gain. The symptoms of functional hypothyroidism are largely the same as hypogonadism. We see these two problems together here very often. Please read the thyroid basics sticky and check your body temperatures and think about your long term intake or lack of intake of iodine from iodized salt or vitamins that list iodine.

You need TSH at least, TSH, fT3, fT4 would be very useful. You could reduce anastrozole by 10%. However, your anastrozole dose needs to track your T levels. So a further decrease of 25/30 is required which yields .9*25/30

What are your fasting glucose and cholesterol numbers?

Estradiol 20.3 pg/mL 7.6-42.6 is almost idea. We suggest E2=22pg.ml as a target. To fine tune anastrozole dose, you need a liquid product and you can make your own 1mg/ml with vodka, shake before use and dispense by the drop after you determine the drops per ml.

Do labs 1/2 way between injections and be consistent so changes are not due to timing effects.

Action items:
- read two stickies
- check body temperatures and eval long term iodine sources <== important
- change anastrozole dosing and method
- retest AM cortisol if need, otherwise confirm timing
- report fasting cholesterol and glucose
- retest prolactin, if still high, get a MRI looking for a prolactin secreting pituitary adinoma, treat with cabergoline
- prolactin can be controlled in any case with 0.5mg/week cabergoline in divided doses
- report blood pressure and pulse
- screen for diabetes risk with A1C lab test
- test LH/FSH just once, should be near zero on TRT. Otherwise if FSH is not, screen for testicular cancer, if clear, suspect pituitary.

Supplements:
- high potency B-complex multi vit with trace elements and iodine
- natural source vitamin E
- EFA's: fish oil, nuts, flax seed meal/oil
- DHEA - NOT NEEDED
- Ubiquinol form of Co-Q10 IF there are any blood pressure problems
- vit-C and other anti-oxidants
- healthy fats in diet

So the above is a lot of material to deal with. This will take time. Please return to this post to see what you have dealt with and what you have missed. Print this for your PA.

To loose fat, you need high T levels, E2 near 22pg/ml, fT3 mid range or higher, sufficient iodine stores, good cortisol levels. [Testosterone, thyroid function and cortisol.] Pregnenolone is made in the mitochondrial bodies in your cells. Thyroid levels control body temperature via fT3 effects on the mitochondria. So thyroid function can affect pregnenolone levels.


#3

Thanks for the response. My Doc put me on Axiron before I found this board. I was on that for only 2 wks and started feeling a gyno response. Axiron had me up to Total T=537 FT=9.9 but E2=65.5. Since this was my Primary Doc and this is not his thing I started to look for a different one to work with. I will go thru your input and do my homework.