T Nation

45, Educate Me On TRT


#1

Hello Everyone.

45 Years old
5’ 8"
360 pounds, down 20 from 380
Body/ Facial hair Hairy like a Bear
Carry fat around middle and love handles
Health conditions None, healthy as a Horse and same size as one
No hair loss or prostate drugs ever
RX Levothyroxine 75 MCG _ 1 tablet daily
Vitamin D3 5000 IU 1 softgel daily
Testes never ache
How have morning wood and nocturnal erections changed – non existant
although I am sexually active 2-3 times per week
Smoking – Just quit smoking on Fathers day, was smoking 3 packs per day
I am physically active, I work outside in the Florida sun 12-16 hour days.
Most of my day is spent walking, kneeling or with a shovel in hand.
I average walking 7 miles per day.

9/15/2016
Diagnosed with LAZY thyroid
11/15/2016
Follow up blood work after starting Levothyroxine and Vit D
5/24/17
More blood work, New Idiot Doctor
I asked Doctor to schedule LOW T test, His response was " You don’t need that, and besides, you’re insurance will not cover the test.

Blood work 9/15/2016
Cbc/ diff Ambiguous Default
Test Name …Result…Reference Range
Wbc 6.8(x10E3/uL) 3.4-10.8
Rbc 4.46 (x10E6/uL) 4.14-5.80
Hemoglobin 14.2 (g/dL) 12.6-17.7
Hematocrit 42.7 (%) 37.5-51.0
Mcv 96 (fL) 79-97
Mch 31.8(pg) 26.6-33.0
Mchc 33.3(g/dl) 31.5-35.7
Rdw 13.4% 12.3-15.4
Platelets 146 (x10E3/ul) 150-379
Neutrophils 59% 40-74
Lymphs 31% 14-46
Monocytes 6% 4-12
Eos 4% 0-5
Basos 0% 0-3
Neutrophils (absolute) 3.9(x10E3/uL) 1.4-7.0
Lymphs (absolute) 2.1(x10E3/uL) 0.7-3.1
Monocytes(absolute) 0.4(x10E3/uL) 0.1-0.9
Eos (Absolute) 0.2(x10E3/uL) 0.0-0.4
Easo(absolute) 0.0(x10E3/uL) 0.0-0.2

METABOLIC Panel (14)
Glucose, Serum H 108 (mg/dL) 65-99
BUN 18 (mg/dL) 6-24
Creatine, Serum 0.87 (mg/dL) 0.76-1.27
eGFR 105 (mL/min/1.73) >59
BUN/ Creatinine Ratio H 21 9-20
Sodium, Serum 140 (mmol/L) 134-144
Potassium Serum 4.6 (mmol/L) 3.5-5.2
Chloride, Serum 101(mmol/L) 97-108
Carbon Dioxide, Total 21 (mmol/L) 18-29
Calcium,Serum 8.8(mg/dL) 8.7-10.2
Protein, Total, Serum 6.8(g/dL) 6.0-8.5
Albumin, Serum 4.1(g/dL) 3.5-5.5
Globulin, Total 2.7(g/gL) 1.5-4.5
A/G Ratio 1.5 1.1-2.5
Bilirubin, Total 0.2 (mg/dL) 0.0-1.2
Alkaline Phosphatase, S H 126 (IU/L) 39-117
AST (SGOT) 16 0-40
ALT (SGPT) 26 0-44

Lipid Panel
Cholesterol, Total 134 (mg/dL) 100-199
Triglycerides H 242 (mg/dL) 0-149
Hdl Cholesterol 41(mg/dL) >39
Vldl Cholesterol Cal H 48(mg/dL) 5-40
Ldl Cholesterol Calc 41(mg/dL) 0-99
THYROXINE (T4) FREE,Direct, S
T4, Free (direct) 1.00 (ng/dL) 0.82-1.77
TSH H 4.590 (ulU/mL) 0.450-4.500
Prostate-Specific Ag serum 0.3 (ng/mL) 0.0-4.0

Vitamin D, 25- Hydroxy L 18.6(ng/mL) 30.0-100.0
Triiodothyronine, Free, Serum 3.7(ng/mL) 2.0-4.4

BLOOD WORK 11 / 15 / 2016
METABOLIC Panel (14)
Glucose, Serum H 104 (mg/dL) 65-99
BUN 13 (mg/dL) 6-24
Creatine, Serum 0.89 (mg/dL) 0.76-1.27
eGFR 104 (mL/min/1.73) >59
BUN/ Creatinine Ratio 15 9-20
Sodium, Serum 137 (mmol/L) 134-144
Potassium Serum 4.7 (mmol/L) 3.5-5.2
Chloride, Serum 100 (mmol/L) 97-108
Carbon Dioxide, Total 21 (mmol/L) 18-29
Calcium,Serum 9.2 (mg/dL) 8.7-10.2
Protein, Total, Serum 6.8 (g/dL) 6.0-8.5
Albumin, Serum 4.2(g/dL) 3.5-5.5
Globulin, Total 2.6(g/gL) 1.5-4.5
A/G Ratio 1.6 1.1-2.5
Bilirubin, Total 0.2 (mg/dL) 0.0-1.2
Alkaline Phosphatase, S 113 (IU/L) 39-117
AST (SGOT) 21 0-40
ALT (SGPT) 33 0-44
THYROXINE (T4) FREE,Direct, S
T4, Free (direct) 1.11 (ng/dL) 0.82-1.77
TSH 1.770 (ulU/mL) 0.450-4.500
Calcitriol (1,25 di-OH Vit D) 92.3 HIGH Pg/mL 19.9-79.3
I reduced Vitamin D3 1000 IU to only 3 days per week
Triiodothyronine, Free, Serum 3.8 pg/mL 2.0-4.4

Blood work 5/24/2017
Wbc 7.2(x10E3/uL) 3.4-10.8
Rbc 4.48 (x10E6/uL) 4.14-5.80
Hemoglobin 14.6 (g/dL) 12.6-17.7
Hematocrit 42.1 (%) 37.5-51.0
Mcv 94 (fL) 79-97
Mch 32.6(pg) 26.6-33.0
Mchc 34.7(g/dl) 31.5-35.7
Rdw 13.4% 12.3-15.4
Platelets 153 (x10E3/ul) 150-379
Neutrophils 65% 40-74
Lymphs 27% 14-46
Monocytes 6% 4-12
Eos 2% 0-5
Basos 0% 0-3
Neutrophils (absolute) 4.7(x10E3/uL) 1.4-7.0
Lymphs (absolute) 1.9(x10E3/uL) 0.7-3.1
Monocytes(absolute) 0.4(x10E3/uL) 0.1-0.9
Eos (Absolute) 0.2(x10E3/uL) 0.0-0.4
Easo(absolute) 0.0(x10E3/uL) 0.0-0.2

METABOLIC Panel (14)
Glucose, Serum H 106 (mg/dL) 65-99
BUN 15 (mg/dL) 6-24
Creatine, Serum 0.93 (mg/dL) 0.76-1.27
eGFR 99(mL/min/1.73) >59
BUN/ Creatinine Ratio 16 9-20
Sodium, Serum 141 (mmol/L) 134-144
Potassium Serum 4.6 (mmol/L) 3.5-5.2
Chloride, Serum 103 (mmol/L) 97-108
Carbon Dioxide, Total 21 (mmol/L) 18-29
Calcium,Serum 9.1 (mg/dL) 8.7-10.2
Protein, Total, Serum 6.4 (g/dL) 6.0-8.5
Albumin, Serum 4.1 (g/dL) 3.5-5.5
Globulin, Total 2.3 (g/gL) 1.5-4.5
A/G Ratio 1.8 1.1-2.5
Bilirubin, Total 0.3 (mg/dL) 0.0-1.2
Alkaline Phosphatase, S 107 (IU/L) 39-117
AST (SGOT) 17 0-40
ALT (SGPT) 23 0-44
TSH 2.4 (ulU/mL) 0.450-4.500
Cholesterol, Total 121 (mg/dL) 100-199
Triglycerides 70 (mg/dL) 0-149
Hdl Cholesterol 43(mg/dL) >39
Vldl Cholesterol Cal 14 (mg/dL) 5-40
Ldl Cholesterol Calc 64 (mg/dL) 0-99
NON-HDL Cholesterol 78 (mg/dL) 0-129
Prostate Specific AG, Serum 0.3 0.0-4.0
Vitamin D, 25-Hydroxy 42.9 NG/ML 30.0-100

(Doctor) Idiot , stated I did not need this test, it was unnecessary and that my insurance would not pay for it. I insisted he order the test.
I now have a new Doctor / Idiot.
5 /24 /2017
Testosterone, Free, Bio and Total
Albumin 4.2 NG/DL 3.5-5.5
Testosterone, Serum Total 131 NG/DL 348-1197
% Free Testosterone(Dialysis) 2.1% 1.5-3.2
Free Testosterone, Serum 28 PG/ML 52-280
Bioavailable Testosterone 50 NG/DL 95-350
Sex Hormone Binding Globulin 22.1 NMOL/L 19.3-76.4
Test from new Doctor 6 / 1 / 2017
Estradiol 20.84 MALE 7.6-42.6 ng/mL
Female
Follicular Phase 12.5-166.0 ng/mL
Ovulation Phase 85.8-498.0 ng/mL
Luteal Phase 43.8-211 ng/mL
Postmenopause <6.0-54.7 ng/mL
Testosterone, Total 103 L 240-950 ng/dL
TPO Antibody 10.54 0-34 IU/mL
ANTI-TG Ab 12.29 0-115IU/mL


#2

I recently discovered what GMO means. I’ve also developed a hatred for Monsanto and their roundup ready crops.
Over the last 2 months I have been changing my diet to non-gmo and more organic.
My thought process initially was to detoxify my body. Clean my gutt, detox my liver,endocrine system, thyroid, ect
I had hopes of naturally bringing my thyroid back to normal.

Diet
Here is my morning routine.

1 organic lemon
I grind a whole lemon, peel and all in nutribullet
Add tsp apple cyder vinegar amd a little raw honey
Add to full glass of water.

I drink a 2nd glass of water with tsp of Diatomaceous Earth.
Next I take 1000mg curacumin & bioperine
Naturespurest.com

I do 3-5 drops Atomidine every morning
1 tablet of Milk thistle also made by
Naturespurest.com

All this followed by a nutriblast, here is one of my favorites:
1-2 cups spinach or spring greens
Avocado
Organic blueberries
Some mango
Orange slice(s) or apple or both
Watercress
Ginger
Some days I also add coconut oil
Black seed oil - from black cumin seed.
Excellent, but tastes like shi* so I add it to smoothie to hide bad taste.

And finally I eat 5 times per day
Breakfest, snack,lunch,snack, dinner
All healthy,organic
I drink at least 1 gal water, most days it’s closer to 2 gallons
No soda or beer

Still brand new to the site, I will stop rambling now and go read more stickies so KSMAN does not scold me :slight_smile:


#3

Could you be Vit-B12 deficient?

Vit-D25 got a bit too low, try for 60
Levels changing with sun exposure, sun screens etc.

You are dancing with insulin resistance - diabetes. Diet changes needed. TRT is going to help.

Cholesterol should be up near 180, yours it too low and undermining your body’s ability to run the whole steroid hormone cascade.

You need to inject T, transdermal will not work sweating outside.

Thyroid: What has been your lifetime history of using iodized salt?
Please report as per last paragraph.
Body temps can be your thyroid med dosing guide.
TSH should be nearer to 1.0, lab ranges are stupid.
Test: TSH, fT3, fT4 - not T3, T4

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

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

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.

KSman is simply a regular member on this site. Nothing more other than highly active.


#4

Good Morning,

I never considered B12 Deficiency, will check into that.
Iodized salt - I have always been heavy handed with Salt / Pepper, more so as a child.
On occasion I will still reach for the salt shaker.

I do 3-5 drops Atomidine every morning. Have been taking about 1 month.

Body temp late yesterday afternoon 97.9
Body temp this morning 6/26/17 96.5 Afternoon 97.9
Blood sugar this morning 105

Bought a bottle of B12 1000mcg this morning, have followup apt with doctor on July 7th. Will see if they can test for B12.


#5

Hi Skinflute.

Sorry to hear about your situation.

The good:
You quit smoking.
You are very physically active because of your work and walking. This is very good and probably the only thing keeping you from having a massive heart attack or stroke.

The bad:
Your are 54+ on the BMI scale. That means you are in the category super-morbidly obese. You should literally weigh less than half of what you weigh now. The underlying problem with your testosterone is your extreme obesity. See these 5 links on the effect of obesity on testosterone and aromatization:
https://www.nebido.com/obesity-is-strongly-linked-to-low-testosterone-levels-in-men
http://www.webmd.com/men/what-low-testosterone-can-mean-your-health#1
https://www.ncbi.nlm.nih.gov/pmc/articles/
https://www.ncbi.nlm.nih.gov/pubmed/8626841PMC3955331/

Forget testosterone treatment. You are a prime candidate for gastric-bypass surgery and similar serious weight loss surgeries. It is almost guaranteed that you will see a very positive effect on your bloodwork if you lose about 200 pounds of unnecessary body weight.


#6

Look for sublingual B-12. this type: https://en.wikipedia.org/wiki/Methylcobalamin
If you take that, really not point in te$ting B-12 then as you will not be detecting low levels.

Low body temperatures with FT=3.8 strongly suggests elevated rT3 as part of a spectrum of adrenal fatigue. Please read all of the thyroid basics sticky noting references to adrenal fatigue, wilson’s book, rT3 and stress.

Your thyroid function is low and that contributes to weight issues and you seem to have metabolic disorder aka syndrome X.

Supplements:
high potency B-complex multi-vits with trace elements including 150mcg iodine and 200mcg selenium. Consider 2-per-day at lef.org
fish oil
25mg DHEA
vit-C
natural source Vit-E

Selenium is very important for thyroid health and supplemental iodine without selenium is dangerous.

Is there something about your diet causing low cholesterol? <160 is associated with increased all-cause mortality. Your low cholesterol may be lulling you into a feeling that you have no cardio risks. Do these labs: CRP, homocysteine. What is your resting BP?


#7

+icedog198
Thank you for the information, I will spend some time this evening
reviewing each link.
I am in agreement with you, if I were to lose about 200 pounds of unnecessary body weight. It would have a positive effect not only on my bloodwork but also my outlook.

Thanks again,


#8

+KSman

Last couple visits to doctors office resting BP was / is normal
120 / 80
BP has always been in normal range, have never had high or low BP.

Diet causing low cholesterol?
Not sure, I will work on increasing this number, maybe by adding additional avocado’s or additional coconut oil, Something…

I am reading every sticky I can.
I even purchased Wilson’s book on adrenal fatigue, came in mail on Saturday. Have only read first 2 chapters. Been reading stickies :slight_smile:

CRP
Not certain that I have inflammation.
I have been detoxing my body for the past couple of months

(Tumeric) Curcumin & Bioperine
Curcumin & Bioperine(pepper)

Tumeric is anti inflammatory, anti oxident, many great benefits
Milk thistle
DE or Diatomaceous Earth

I picked up a gym membership the other day. Woohooo for me
Worked 14 hours today, heading to gym now to do 60 minutes on treadmill, fast pace walking.
Will read more stickies when I get home this evening.
Thanks again…


#9

Hello Everyone.

Has been a delightful week, I spent it in the hospital with kidney stones. All I can say is worse pain ever imaginable. For anyone who doesn’t know, they go up your peckerhole with a little claw on the end of a wire, grab the stone and yank it out. To make matters worse, yep , they get worse. After they rip this stone out thru your urethral, they go back in and leave a plastic tube which will need to be removed 3-5 days later while your AWAKE. Once again they go in thru the peckerhole to remove tube (Stent) they left in their on purpose the first time.

I have gained an average of 7 pounds per year over the last 20 years, regardless of how lazy or how physical I have been. Question: is the weight gain caused by lazy thyroid and LOW T
OR is the lazy thyroid and LOW T caused by the weight gain???

I have a followup appt with my Integrative Medicine doctor on Tuesday. To discuss my blood work from beginning of June. Blood work shows lazy thyroid and Low T.
According to their site, they specialize in BHRT.

MEDICAL TREATMENT

Bio-identical Hormone Replacement Therapy must be administered by a well-trained physician who will first evaluate your existing medical condition and run a variety of tests to determine your hormone levels. Hormone levels should also be monitored during and after your treatment to ensure optimal health results and minimize side effects.
HOLISTIC APPROACH

BHRT combined with lifestyle modifications, changes in diet, and increased levels of exercise can have a positive impact on your health, improve your quality of life, and help you look better and feel younger. A comprehensive medical approach is needed to optimize your health, renew your energy levels, and restore your body to feeling years younger. Hormone replacement therapy requires a holistic approach, if you want to slow down the aging process, stay healthy, and live longer.

I am not certain what their procedures are or how the conversation may go. I also don’t fully understand the difference between BHRT vs TRT.

KSman,
How would I make the argument to my doctor to do things your way?


#10

Thank you, MUCH


#11

Doctor prescribed Test Cyp 200 MG/ML
Inject 1 ML IM weekly

200mg is double what KSman recommends. When I questioned my doctor, his response was that I had the lowest Test levels he had ever seen. Then jokingly stated I had less testosterone than a 4 year old …

He also prescribed me BD 3 ML Syringe 25g x 1- 1/2

My thought is to inject twice per week 1/2ML on Wed and Saturday

no HCG or Arimidex / anastrozole
Docs suggestion was to wait until I lost some weight??

I have bloodwork and followup appt in 6 weeks.
Do I wait 6 weeks or try and push for HCG / anastrozole now??
Thoughts / suggestions
+KSman


#12

Did first injection this morning. 1/2 ML
Actually I chickened out and had wife poke me in the butt.


#13

@KSman
I know your a busy man and your experience / knowledge on this topic is invaluable.
Please chime in when you get a free moment and offer some more of your wisdom.
Thanks,


#14

Morning temps for the week range from 96.5-97.7
Afternoon temps for the week range from 97.4-98.5
If I do not give myself about 30 minutes to cool down in the afternoon my
temps are 98.9-99.9


#15

200mg a week is a lot, but after my forth blood test, that ended up being what I need. As fat as you are your Estradiol levels are going to shoot up. Anastrozole is really needed. It takes me 1mg of anastrozole a week stay in line. When you start to show symptoms do not wait. HCG can wait if you must. But you probably will want to be on it. I doubt you will be making it 6 weeks nor should you.

The good news with your dietary changes and hormone changes, your weight should start dropping easily. Its all interconnected. Which came first really doesn’t matter so long as you fix them all. As tough as you obviously are, doing what you do at your size and age. You are going to be a new man


#16

Losing weight has no effect on HCG that is just to keep your testicles working. Weight can effect your need for anastrozole. If you cut your body fat in half you might need less maybe even a lot less. But you probably will need anastrozole more now than you ever will. All this is an educated guess until the tests confirm things. Not sure why your doc would think it was a good idea to wait. I doubt thinking has anything to do with it


#17

Initially I did not press the doctor. I accepted his nonsense response about losing weight first before starting HCG.
Two days later I contacted him and requested he write me a script for HCG Plus Anastrozole.
Doctor got pissed off and and gave me the speech:
I am the doctor, YOU are the patient, YOU do not tell me what to prescribe, blah blah blah.
Doctor then referred me to another Doctor- Dr. Justin Saya with Defy medical in Tampa florida.

My doctor’s concern was that he did not want to prescribe me such a HIGH dose of HCG. I did not realize 250iu hCG EOD was considered HIGH DOSAGE.

After speaking with Defy medical, they normally start their TRT patients on 400-500 hCG EOD.
which is double the dosage I was trying to request from my doctor…

One question or concern that I have. Testosterone injections without hCG.
Testicular shrinkage or atrophy.

How long does it take for shrinkage to occur? 24-48 hours? a week? or several months?
So far I have only done 2 injections of Test Cyp 200 MG/ML
1/2mL on Wednesday and 1/2mL on Saturday 7/15


#18

Your doctor did not know what he’s talking about. 250 mg twice a week. That is the smallest dosage for any use hCG ever has. Some protocols give shots of four thousand milligrams more than once a week. Losing that dr. is a good thing.
From what I’ve read is long as your dosages is not over 500 mg. you don’t really need to worry too much about it. You’re not likely to have adverse effects at those dosages. For what we’re doing, we are taking very low dosages. As I understand it more is not better and hCG is not cheap. 250 mg twice a week is enough. Though personally I see no reason to argue with the folks at Defy. They have a sterling reputation. Some protocols actually take four weeks off from hCG after 8 weeks on at 1000mg a week. I’ve never heard anyone say that has adverse effects. So I would say your testicles could handle a month without any problem. I am not saying I particularly like the sounds of that protocol. but I’ve heard of no problems with it ether.


#19

T dose has nothing to do with how low you were.
Body weight does.

Higher T levels create more risks of high HTC and RBC, need to monitor that.

TRT, BHRT?
The bio-identical T talk is mostly self-serving hype. Injected T is T with an ester group to create solubility in the oil. As absorbed, ester groups are stripped off and you have a bio-identical time release delivery system.

Tell doc that you want 250iu hCG subq EOD.
Someone has hCG and hGH confused?
250iu hCG is low dose, you do not want more and more =$$$+problems
When diluted to 1000iu/ml, you inject 0.25ml which is “25iu” on an insulin syringe. Does someone have insulin volume IU’s confused with actual drug dose?

200mg T per week and not anastrozole… your case is not been managed properly. You were close to target E2=22pg/ml before TRT, it can only go up. E2 management is critical for weight loss and fat patterns. Elevated E2 also creates risk of gyno.


#20

About the stent: Those are used when the ureter gets damaged by hardware or another cause. The stent can hold a corner tear down while it heals. Not very comfortable. In my case I don’t know if the doctor created the tear or it was from a painful forced stretching maneuver that I was subjected too. I started to get blood in my urine right after that. The radiology sees a small stone that may not have been been the source of the bleed. I will never know, the urologist seemed to be indicating that he did not know where the damage came from… First they did Lithotripsy that was not successful and the pieces of stone were very painful and second procedure to go up with the hardware to get the pieces.