T Nation

43 Year Old Moose on T Replacement


#1

Alright, here's my story as a first time poster and long-time reader that started T-replacement this summer.

43 year old male at 6'3 and usually 210-220 lbs.
Chest 44 inches and waist 36 inches
Hair on head still, but a little thin on top, but no real change in it in about 15 years from looking back at old pictures.
Plenty of hair on chest and belly. Minimal on back and legs.
Bodyfat is about 15% currently with a little extra fat around the waist. Could never really lose that last little belly fat even at 190 so never had really cut abs.

former ice hockey and rugby player in college and then switched over to endurance sports (running, cycling and triathlons including 6 Ironman distance ones). When I was racing Ironman distance, would drop to 190 and probably 8-9% BF right before a race. Any lower BW and I would get sick and feel like crap. Stopped triathlons about 4-5 years ago due to increased work schedule, but would still cycle and started trying to hit the gym for weights

Main symptoms started about 4-5 years ago with the increased stress of running a struggling business. Insomnia, decreased libido, fatigue through the day, weight gain (got up to over 235 lbs and looked crappy according to friends. Looking back, probably borderline depressed - was definitely the angry guy and stopped doing a lot of the things I enjoyed. Would need about 5 cups of coffee to get through the day. Panic attacks, brain fog, no morning erections, irritable.

Also noticed problems recovering from workouts - even easier ones and a big drop off in speed and power.

Last two years were ridiculously stressful. Had a business collapse, which led to wife filing for divorce (served on our anniversary) and going through a business bankruptcy. She, of course got the house, but at least I got the dog (and no kids to fight over custody)

Realized that a good part of these symptoms were just due to the BS of the divorce and a failing business, but have been moving forward and back on my feet financially, having fun dating and getting back into working out, but still was noticing difficulty recovering from workouts and the libido and erections were really not there as well as still with â??brain fogâ?? and difficulty concentrating

Medical Stuff

Did had hyperthyroidism as a teenager - found out on a trip to the ER for stitches and my BP and pulse were sky-high. Was treated with PTU and inderal (beta-blocker) for about 2 years where I was tapered off. Have had the thyroid checked periodically and TSH has always been in the "normal" range

One testicular injury from hockey - checked from behind and guy landed on top of me. Protective cup caught the right testicle and pushed it up into the canal. Worse type of pain you can imagine. Had to go to the ER and had ultrasound (no rupture) and they were able to get the testicle to come back down without surgery. However it still can slide up into the canal sometimes (but always easily reducible back down). I do get an ache in the right testicle every once in a while for a day or so after hard workouts or runs. HAve seen a few docs through the years and no one has really strongly recommended repair since there is no hernia there.

Did have a health scare this spring during a interval running workout with pretty severe episode of palpitations. Saw a cardiologist, had a normal stress echo test, but found that thyroid and testosterone levels were off. This was the episode that finally got me moving on taking care of myself and have followed up with a local doc that does TRT. Had one minor episode since then, but otherwise feeling ok regarding the heart

DIET-

Diet could be better, but probably still better than 99% of the U.S

Was a vegetarian for about 13 years during this time (except for fish), but now on more of a modified Paleo diet for the past 2 years

Breakfast is eggs (organic) usually omelet. Whey protein drinks after workouts.
Lunch is toughest meal due to work issues, but try to grab healthy mexican or a chicken wrap without sauce or a salad.
Meat intake now is still mostly fish, but with 2 days a week of organic or grass-fed beef or buffalo or pasture raised chicken with minimal carbs 6 days of the week. Minimal rice and bread. If I have grains, its quinoa. I do have 2 glasses of red wine at night with dinner.

MEDICATIONS

Vit D - 2000 IU daily - 2 years
Viagra 25 mg PRN - stated about 1 year ago
Fish Oil 2000 mg daily - 3 years
No 5HT reductase medications

Initial labs - MAY 2011

Complete Blood Count
WBC 7.5 (4.0-10.5 x 10E3/uL)
RBC 5.38 (4.10-5.60 x 10E3/uL)
Hemoglobin 16.4 g/dL (12.5-17.0)
Hematocrit 47.7% (36.0-50.0)
Platelets 276 (140-415x10E3/uL)

Iron Binding Cap (TIBC) - 293 ug/dL (250-450)
UIBC - 232 ug/dL (150-375)
Iron, Serum - 61 ug/dL (40-155)
Iron Saturation 21% (15-55)

Total Testosterone 263 ng/dL (249-836)
free Testosterone 7.5 pg/mL (6.8 - 21.5)
SBHG, serum - 26.4 nmol/L (14.5 - 48.4)
Estradiol 41.7 pg/mL (7.6 - 42.6)
DHEA-S - 173.0 ug/dL (88.9 - 427)
DHT - not tested
LH, serum - 3.0 mIU/mL (1.7-8.6)
FSH, serum - 5.9 mIU/mL (1.5 - 12.4)

TSH 4.210 uIU/mL (0.450-4.50)
free T4 - 1.24 ng/dL (0.82-1.77)
free T3 - 2.5 pg/mL (2.0-4.4)

Vit D-25OH 43.5 (32.0 - 100.0 ng/mL)
Vit B12 - 675 pg/mL (211-946)

Total Cholesterol - 275 mg/dL (< 200) HIGH
HDL - 66 mg/dL (>=40)
LDL - 195 mg/dL (<130) HIGH
LDL Density Pattern A (A = Large Buoyant LDL)
Triglycerides - 63 mg/dL (<150)

Saw the TRT doc who had some good info and thoughts
Was started on:

Testosterone Cy 200 mg weekly with 1000 mcg of Vitamin B12 IM
Arimedex 0.5 mg twice a week
NatureThyroid 65 mg daily

Increased Vitamin D from 2000 IU to 5000 IU daily
Viagra 25 mg prn

Continued Fish Oil 2000 mg daily

Interval Symptoms - slightly improved libido, but still only with morning erections about 2xweek and diminished erections but when I take Viagra, I now notice that it seems to continue to work into the next morning.

Sleep pattern is a little better, but still with morning fatigue and some brain fog. Usually have a crash at work around 3pm that needs a cup of coffee or two to get through

Strength seems better during workouts (now just weights) but still seems to take a while to recover from muscle soreness etc -3+ days. A little bit of weight gain - now up to 222 lbs - some muscle (but some fat since the pants are a little snug).

Testicles a little smaller than normal, but not to where Iâ??ve been concerned about.

Only weird side effect I could report to the Doc was isolated â??hot flashesâ?? on the palms of my hands. Would come on randomly once or twice a day and last for about 5 minutes. HAvenâ??t been able to correlate to T or Arimidex dosing. Doc thought it may be a sign that the estradiol levels were dropping, but labs below show different.

AUGUST 2011 LABS
WBC 6.4 (4.0-10.5 x 10E3/uL)
RBC 5.41 (4.10-5.60 x 10E3/uL)
Hemoglobin 16.5 g/dL (12.5-17.0)
Hematocrit 47.6% (36.0-50.0)
Platelets 247 (140-415x10E3/uL)

Iron Binding Cap (TIBC) - 302 ug/dL (250-450)
UIBC - 201 ug/dL (150-375)
Iron, Serum - 101 ug/dL (40-155)
Iron Saturation 33% (15-55)
Ferritin 26 ng/mL (30-400) - LOW

Total Testosterone 901 ng/dL (249-836) - HIGH
free Testosterone 34.1 pg/mL (6.8 - 21.5) - HIGH
Estradiol 45.5 pg/mL (7.6 - 42.6) - HIGH
DHEA-S - 150.5 ug/dL (88.9 - 427)
DHT - 96 ng/dL (30-85) - HIGH

TSH 3.620 uIU/mL (0.450-4.50)
free T4 - 1.09 ng/dL (0.82-1.77)
free T3 - 3.5 pg/mL (2.0-4.4)
reverse T3 223 pg/mL (90-350)
Thyroid Peroxide Ab 145 IU/mL (0-34) - HIGH
Antithyroidglobin Ab 110 IU/mL (0-40) - HIGH

PSA - 0.3 ng/mL (0.0-4.0)

Vit D-25OH 48.0 (32.0 - 100.0 ng/mL)

Total Cholesterol - 261 mg/dL (< 200) HIGH
HDL - 65 mg/dL (>=40)
LDL - 176 mg/dL (<130) HIGH
LDL Density Pattern A (A = Large Buoyant LDL)
Triglycerides - 87 mg/dL (<150)

So estradiol is high, but that is probably due to running out of the Arimidex 3 weeks ago and still on the TRT.

DHT is also a little high and Doc is recommending Adovart twice a month to block the Testosterone -> DHT conversion.

Thoughts on Adovart? I know that Finasteride (Propecia) has some side effects in some guys and Avodart is similar chemially.

the thyroid labs have improved a little bit, but the TSH is still on the higher end and reverse T3 is on the upper end of normal. Also, ferritin is low (donâ??t have an original one - since lab forgot to run it) and Doc wants to increase the NatureThyroid - probably to 2-3 pills (65mg) a day. I would guess that this continues to also help drop cholesterol levels as the thyroid balances out, correct?

Also looking at switching the testosterone to 100mg twice a week instead of the 200 mg once a week to try to keep the testosterone levels more stable.

Any comments on how guys schedule their testosterone injections around particular workouts as far as helping with recover? I haven't really thought about scheduling the T and the workouts together.

He also has me doing a salivary cortisol test since we didnâ??t get that initially and recommending IsoCort for the adrenals if I feel that Iâ??m getting an afternoon crash.

Would like to know peopleâ??s thoughts/experineces on IsoCort and/or hydrocortisone for adrenals.


#2

ummm dude you have a thyroid disease...those antibodies are sky high, and represent some sort of thyroid disorder such as Hashimotos...you need treatment for that ASAP

Your doctor's idea of taking a 5ARI to reduce DHT is stupid since your Test is higher than normal...you need to lower your test dose, or accept that DHT is higher...injecting twice a week would be much better, but probably only need 150 mg/week total.

Your Arimidex doesn't appear to be doing shit...is it a research chem or the real deal from a pharmacy?

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Your Vit D3 doesn't seem to be absorbed well as your numbers barely changed...you need to find a better, more bioavailable brand

When were these labs taken in relation to your last test dose?


#3

what VTBalla said and your FT3 to RT3 ratio is a bit low @ 15.7. Should be above 20 to feel good. Sounds like you may also want to look at cortisol levels for signs of adrenal fatigue. This is brought on by prolonged stress, which ultimately causes low cortisol levels which leads to elevated RT3 due to your bodies inability to properly convert T4 to T3 or something like that. Anyhow, looks like there is an adrenal/thyroid issue of some type to work out. Good luck.


#4

^^^Any possible cortisol issue is most likely explained by the thyroid disease...that has to be treated first and needs to be done ASAP...


#5

You definitely need a higher dose of thyroid meds with your immune system attacking the thyroid.

If you are concerned about testicle shrinkage mention hcg or clomid to the doctor.

My guess would be you do not need hydrocortisone. I think once you get your thyroid fixed you will feel better. getting a cortisol test would be good though since you need cortisol to help support thyroid hormones however since reverse t3 is normal and you seem to be a good converter of t4--->t3 you most likely have pretty normal cortisol levels. Best thing to do is to take a b-complex, supplement with vitamin c, meditate.


#6

Looks like Hashimoto's is a strong possibility. Get that sorted ASAP, as others have said. Also have your doc do a celiac blood screen, as celiac is strongly associated with Hashi's as well as other, harder-to-fix autoimmune disorders that you don't want to be learning about firsthand (lupus, MS, Addison's, etc). If you do have celiac, fixing your diet now will a) leave you feeling a lot better and b) help you avoid worse stuff later. (And if you don't, the blood screen is cheap as tests go, so no harm done.)


#7

Good thing about Hashi's is you get treated the same way---thyroid hormone. The OP just needs more thyroid hormone.


#8

This is true.

But.

Bad thing about Hashi's is that people who have it often end up getting other autoimmune stuff later on. Hence the cue to look for celiac now before the OP ends up with something less simple to treat.


#9

You were hyperthyroid in the past and are now hypo, which concurs with the antibody tests that you have Hashi's. I am perplexed as to why your doctor would test for thyroid antibodies then not say anything to you when they came back high. WTF?

Get on some dessicated thyroid or t3-only ASAP. Your thyroid is probably mostly destroyed at this point.

How long ago was your hockey accident?