T Nation

47 YO, New to TRT, a Lot to Learn


#1


47
6'6"
44w
382# today
shave face every other day grow a beard in 2 weeks crown balding in past 6 years moderate chest hair little back hair
thorax and belly fat
MI at 24yo from breathing paint fumes at auto body shop no ongoing problems
wt gain to 350# liquid diet lost 100# in just over 1 year Dr supervised "Medifast"
got heavy into weight trainging at 270# looked awesome
torn rotator cuff, surgery fixed gained up to 400#
ED for the past 15 years
another liquid diet lost 100#
gained wt the minute the fast stopped
tries trt 12 years ago to help ed Andogel max dose, didn't help quit after 6 months
weight gain to 424#
just suffered for years
body aches, fatique, depression, Ed, weak, dry skin,leg cramps, high blood pressure started about 4 years ago
Diagnosed with sleep apnea 3 years ago, treated with cpap,

starts weight lifting again as I had on and off all my life
lost 87# down to 345 weight (Crack the fat code diet) labs looked good but
little low T said the Dr. and could not keep weight off
back up to 400# but training hard very active
but ED at the worst ever, fatigue, depression, skin issues, low libido,
But strong in the gym, bench over 400 pretty easy, considered a monster in the gym not a fat slob
went to Dr. in June. said lets do blood work
diagnosis Low T and borderline Hypothyroid
started me on T injections 200mg IM every other week re test in 6 weeks deal with thyroid if T doesn't help
----T will give lab results just finishing time line---

TT was 279 before trt
6 weeks later TT was 260
DR said go to 200mg IM every week re test in 6 weeks
This is when I knew I better figure this out because my Dr. are limited in knowledge
This site has been an eye opener and I've read a load or your info Awesome gathering of invaluable info
I type slower than I produce T so this will come in several posts
This picture is what I have today another symptom of low self esteem don't do pics often


#2

Where to start:
Weight gain can easily be made worse with thyroid issues. Please read the thyroid basics sticky and post waking AND mid afternoon body temperatures. Report your long term use of iodized salt or vitamins that list iodine.

Need thyroid labs:
TSH at bare minimum
TSH, fT3, fT4 would be good. Do not want T3, T4

Please read the advice for new guys sticky.

Post all lab work with ranges.

Inability to absorb transdermal T is a symptom if hypothyroidism, so is dry skin!!!

Borderline hypothyroidism is a major problem!

Please read the protocol for injections sticky:
- Inject T twice a week, 200mg total per week
- might be too much, but given your body weight, lets see what the results are

Labs:
PSA - should be before and after starting TRT
CBC
TSH
fT3
fT4
TT in 3-4 weeks
FT in 3-4 weeks
DHEA-S
IGF-1
E2 <-- important in 3-4 weeks
CRP
Homocysteine
fasting cholesterol
fasting glucose
A1C

Did you get a DRE? [Digital Rectal Exam for prostate health]

Leg cramps: probably a magnesium deficiency. Get a good magnesium supplement.

Please read the three stickies and report body temperatures. Provide lab data and ranges for what you have now.

Tag me in the KSman is here thread if I don't pick up on your posts fast enough.


#3

I have read the stickys and a bunch more on here before I send post
I might not remember all but pretty teachable
I've taken temp 4 days in a row (9/17-9/20) since reading thyroid post twice

am before getting out of bed digital thermo. sub lingual
1 6am 96.4 high at 2pm 97.7
2 6am 96.6 high at 1pm 97.9
3 630am 96.3 @ 9am 200 mg 1cc T IM high 3pm 97.7
4 6am 96.4 high 98.0 1pm

First trip to Dr. she ordered blood work 7/2/14
I'm sending in pieces because this is my third attempt at this and lost my work 2x

Testosterone
T 279 205-781.0 ng/dL

vit D-25- hydroxyl 27.9 30-100.0 mg/mL

CBC/NO DIDD (W/PLT)
WBC 5.0 3.8-12.8 K/uL
RBC 4.86 4.20-5.70 M/mm3
HGB 15.6 14.0-18.0 gm/dl
HCT 46.0 40.4-52.4 %
MCV 94.6 81.0-102.0 fL
MCH 32.0 26.9-35.0 pg
MCHC 33.8 32.4-35.4 g/dL
RDW 13.7 12.3-15.9 %
platelet count 210 137-397 K/cumm
COMPREHENSIVE METABOLIC PANEL
sodium 139 135-145 mEq/L
potassium 4.3 3.4-5.4 mEq/L
chloride 103 97-109 mEq/L
co2 26 mEq/L
glucose 87 65-105 mg/dL
creatinine 1.1 0.5-1.5 mg/dL
calcium 9.7 8.5-10.3 mg/dL
protein 7.5 6.3-8.3 g/dL
albumin 4.4 3.7-5.2 g/dL
alkaline phosphatase 60 38-126 IU/L
alt (SGPT) 68 7-52 IU/L
ast (SGOT) 32 13-39 IU/L
bilirubin total 0.6 .2-1.5 mg/dL
A/G ratio 1.4 1.1-2.5
Lipid panel
cholesterol 166 75-200
triglycerides 72 11-150 mg/dl
hdl 58 40-131 mg/dl
hdl ratio 2.86 0.00-4.99 ratio
VLDL calculation 14 5-40 mg/dl
non hdl 108 0-129 mg/dl
ldl 94 <101 mg/dl
ldl/hdl ratio 1.6 <3.3
Vit B12 404 180-914 pg/ml
TSH 2.79 0.34-4.00 mU/L
T4 free
thryoxine free (free T4) 0.83 0.58-1.64 ng/dl

start TRT 200m 1cc IM every 2 weeks
possible thyroid rx in 6 weeks if TRT doesn't help symptoms
dr inject every other fri. no charge for injections... ($80 10cc via)

no improvement after 6 weeks... so sent for more blood test


#4

second blood work after 6 weeks on TRT 200mg 1cc IM every 2 weeks
8/29/14
CBC with platelet no differential
wbc 7.6 3.8-12.8 K/ul
hgb 4.92 4.20-5.70 M/mm3
hct 46.0 40.4-52.4 %
mcv 93.7 81.0-102 fl
mch 32.0 26.9-35.0 pg
mchc 34.2 32.4-35.4 g/dl
rdw 13.3 12.3-15.9 %
platlet ct. 199 137-397 K/cumm

comprehensive metabolic panel
sodium 139 134-145 K/ul
potassium 4.1 3.4-5.4 mEq/l
chloride 104 97-109 mEq/l
co2 24 22-32 nEq/l
glucose 94 65-105 mg/dl
bun 26 5-36
creatinine 1.2 0.5-1.5 mg/dl
calcium 8.7 8.5-10.3 mg/dl
protein 7.2 6.3-8.3 g/dl
albumin 4.2 3.7-5.2
alkaline phosphatase 59 38-126 iu/l
alt (SGPT) 26 7-52 iu/l
ast (SGOT) 20 13-39 iu/l
bilirubin total 0.5 0.2-1.5 mg/dl
a/g ratio 1.4 1.1-2.5 mg/dl
estimated glomerular filtration rate
GFR/black >60 >60 ml/min/1.73m2
GFR/white >60 >60 ml/min/1.73m2
testosterone 260 205.00-781.00
tanner stage IV 165-854 ng/dl
tanner stage V 184-783 ng/dl
Went in for regular 2 week injection saw Dr quickly and she said we will up TRT to 200mg 1cc IM every week and re test in 6 weeks
THIS IS WHEN I BECAME PROACTIVE and found this site as well as a ton of other research
I do feel a bit more energy 2nd-3rd day after injection but not much else no help with ED fatigue etc.
Morning wood 2-3 times a week as always
when Dr 15 years ago (Urologist)put me on TRT it was after Viagra use,
a doplar study on penis (Inject with rx caused a stiff erection and did ultrasound image checking blood flow) and sent home with a device to wear for 2 nights to measure sleep erections the conclusion was good blood flow plenty of nocturnal wood try TRT

I talked to my current Dr. yesterday and told her we need a consult to discuss the TRT not effective, possible Hypothyroid Tx and to make sure we do the proper blood work in 2 weeks. She is very interested in all my research, she loves endocrinology and loves a patient that does his research. That's a good sign.

I can understand the (aromatization) T into e2 estrodile issues now
the hypothyroid rT3 possible issues
all the Possible reason why TRT not effective yet
I hope no typo's in my post but possible due to typing not my forte
That being said I'm confident these hormone issues can be fixed and my Dr. has not killed me yet :slight_smile:


#5

wanted to list diet and training
was training 3 days on 1 day off for 4 months
possible over training so for the past 6 weeks training 4 days a week with 20 min cardio on off days, bike or treadmill max speed 3.0 mph 2% grade
back/bis
chest/tris
shoulders/calves/abs
legs
diet was clean (crack the fat code diet) carb up days, carb down days, baseline days etc.
past 6 week diet is an attempt to boost metabolism
7 meals on training days
5-6 meals on off days
1 8 eggs unlimited greens
2 8oz protein (chicken,fish,beef)greens 2 tbs olive oil
3 8oz protein 11/2 cup brown rice +++ greens
4 pre wo meal 1/4 cup cream of rice 1 scoop iso whey
5 Intra wo meal Gatorade 2 scoop iso whey
6 8oz protein 2 cups brown rice
7 1 cup egg white (pasteurized) 1 scoop casein protein 2tbs olive oil

can sub 8 oz potato for 11/2 cup rice 10 oz potato for 2 cup rice
2 scoop iso with 2tbs Peanut butter for non carb meal not more than 2x
cut carb down by 1/2 cup rice on off days
no intra wo meal on off day
no pwo meal on off days
I've kept detailed journal of food been perfect will intro cheat meal soon
also journal TRT, body pain, mood, energy, libido etc and body temp now too.


#6

never allow hunger to set in eat every 2-2.5 hrs if hungry eat another protein meal
cardio before first meal
This has all been easy for me 20 years ago I trained with a group of pro and semi pro body builder/power lifters very similar diet and training

That's where I'm at now....


#7

-----INPORTANT PIECE OF PUZZLE MISSING-----
Wife reminded this am that I forgot about blood work I had done 5 days after my initial labs on 7/2/14
I do not have those in my possession and will get from the Dr tomorrow
They were after Dr saw first test and low T, she ordered Pituitary study to determine primary or secondary hypogonadism......
Dr said that was working as shood so it's primary
---start TRT---
I know how important that blood work is since most Dr's are idiots
The forgetful problem is recent just in the past year and highly unusual too me MAJOR concern to me
I DON"T THINK IT'S OLD AGE AS I'VE BEEN TOLD I've always had a remarkable brain function especially math figures etc.... it's gone !! and happened fast!!


#8

also initial blood labs were after fasting
BP runs in the 124/74 -135/79 range


#9

Don't let your cholesterol get lower. 180 is a good target. Your diet might be low fat extreme.

You need to consider that you might be iodine deficient before you get started on a life time of Rx thyroid meds.

TSH 2.79 0.34-4.00 mU/L
T4 free
thryoxine free (free T4) 0.83 0.58-1.64 ng/dl

TSH is high
fT4 should be near mid range which is 1.11
So your fT4 is very low.

TRT cannot fix your thyroid problem.

What has been your long term intake of iodized salt. Looking to see if you are at obvious risk for iodine deficiency.

When you were injecting every two weeks, when did you do the lab work? Your levels changed so much that your levels would be mostly determined by the lab timing. Please inject twice per week and do labs always 1/2 way between injections. You want to reduce the noise from lab timing artifacts.


#10

when I was injecting every 2 weeks labs were done the morning before my injection
I assumed my system shut down and 200mg every 2weeks was not enough to boost above my natural production? that would be why the dose every week 200mg was ordered?
If I go to 2x a week IM 100mg (.5cc) would I still inject in the glute with the .23 pin x 1.5" IM ? every 3rd day? so t on mon. then t on Thur. then T on sun. then T on Wed etc? if yes then test T on what day?

Sorry I'm struggling with understanding.
Iodized salt most of my life but at times possible low salt during diets. have suffered from lower leg swelling for years so I may have lowered salt to try and fix that as well. I never thought much about it till now
How long does it take for IR to notice results in labs?
the low fat diet has changed in the past 5 weeks... with 8 eggs, the 6 tbs olive oil and 4 tbs natural peanut butter every day that might help the low cholesterol from the first lab


#11

also the Dr. was referring more to my symptoms of fatigue, depression, weak, Ed etc
when she was saying see if TRT helps she feals the thyroid in borderline low. I disagree with her. I want to show her body temps as evidence of hyperthyroid being a more significant problem. But her fix will defiantly be Thyroid meds. I'd rather fix without lifetime of Rx.

I was never thrilled with TRT but truly tired if years of feeling so poorly. It's pretty bad when my wife tells my dr. (her's too) I'm not the man I used to be!! and she means that as a loving friend that doesn't know what happened to her unstoppable, hard working bas ass no fear man.
If TRT will help me lower belly fat, gain more lean muscle, increase strength and maybe make the Levitra work good enough to have sex.... I'm all for it.


#12

THE MISSIND LAB RESULTS
7/11/14 1 week after the initial lab work
TRT started after this lab
Hepatitis (HCV) IGG nonreactive
FSH 6.41 1.27-19.26 mlU/mL
Luteinizing hormone 3.16 1.24-8.62 miU/mL
prolactin 7.64 2.64-13.13 ng/mL


#13

Please read the protocol for injections sticky: *********************

You will be injecting under the skin on the top of your upper leg, or into belly fat. Whatever is most comfortable for you. You can also inject large muscles on top of upper leg. If you inject it, it works equally well.

Use 0.5ml #29 1/2" insulin needles. Slow to load, injection time is OK.

Based on labs above, you seem to have a degree of primary hypogonadism.

If you want to take Rx thyroid meds and not correct a possible iodine deficiency, that is your choice.


#14

I'd rather not go with thyroid drugs.. as I said the Dr. would prescribe that approach but if I can fix the thyroid issue with a IR supplement that is the way to go. I have follow up labs in 3 weeks, if I begin IR will that be enough time to see results in TSH and T4 or like most therapy it will take a while. and as I'm paying for the labs out of pocket I can wait longer.
I plan to have a consult wit her before labs to explain my concerns and ask her to order the specific tests that will be more conclusive with both the hypothyroid and hypogonadism.
I understand the importance of the
TT
FT
E2
Also the
rT3
fT3
fT4
TSH
Also need to encourage the digital prostate exam
PSA
what all am I missing here?

I don't want to screw around with screwing up for a hole lot longer, I'm now aware of the importance of all the above.
And until we determine that there is an E2 issue(very possible at 47 and near 400lb and 200mg TRT 1x a week hasn't done much yet) there is no sense mentioning the AI ? I mentioned the drug "Clomid" once before TRT approach and Dr. was very hesitant to talk about off label approach to low T issue.


#15

I certainly don't know how Arimidex would be perceived by the Dr if I need that to limit aromatization


#16

There is a finding a TRT doc sticky that you can read.

With IR, you may feel better without lab results to tell you that things are getting better. Watch your body temperatures, you may find that your vitality improves with body temperature. Track waking and mid-afternoon temps.

With IR, you can think that is really does not matter what the lab values are during your iodine deficiency and do labs after to see what your body is doing when it has ample iodine stores. You may have a sense of when it is time to do the thyroid labs.

Review labs in my post of 9/19.


#17

Sounds great... will do
So in your opinion i don't need to add any other orders to the lab work from the 9/19 mentioned ones.
Thanks again
I will post results from IR and blood labs once preformed


#18

10 weeks on TRT lost 10 lb FROM 390#. but the last 2 weeks noticed lower leg swelling and gained 4 lb back no changes to my diet ? E2 high I'm suspect blood work in 2 weeks


#19

Might be the E2. Most with high E2 do not experience such fluid imbalances. I do not understand the mechanism but know of the association.


#20

Note that muscle gain can offset fat loss. For many whose weight seems good, they can loose inches from their waist and gain muscle with no change in weight. So now you know that there are some competing processes that affect your weight.

In my case I went from 34" waist to 32" rapidly and then to 31". No change in weight.