T Nation

48 and Just Starting, Could Use Your Thoughts


#1

Hi-

My name is John. I'm now 4 weeks into TRT. For the past 5 years I've been losing energy and gaining weight like crazy, especially in the past 2 years. Lots of aches and pains. For all my life I've been a competitive athlete, despite carrying too much weight. Played Div I college baseball at 30 lbs overweight. I continue to play today, although its getting tougher. I'm a lawyer so I spend a lot of time at my desk and traveling. I've read the tacked threads.

My PCP (from Northwestern Univ Hospital) tells me I eat too much and that I should have weight loss surgery. He initially refused to test for low T at my most recent physical 3 months ago. When it came back as 210 he told me "see that's normal". I then went to Dr. Bloom in Boca Raton, FL at the advice of a client. He ran a full panel and prescribed:

1 ml Test Cyp 200 mg once per week with .5 ml of Vit D in the same syringe. (IM)
0.5 ml HCG on 5th and 6th days after T injection (SubQ)
25 units Sermorelin GT 20.4mg nightly (SubQ)
1 mg Anastrozole 3 times per week
1 ml Glutathione (IM) per week.

I've switched to an every 3 day protocol with .25 HGC every other day. I've followed the same dosage of A. Since starting, the minor aches and pains have disappeared. I've lost a little weight, but my diet just started in earnest, this week.

Without further ado, here are my stats.

age: 48
-height: 5' 10"
-waist: 46
-weight: 325
-describe body and facial hair: went through puberty in 6th grade, shaving by 7th. Can grow a full beard in about 3 days. Moderate hair on chest and arms. Very little on legs. Full head of hair but started turning gray at 30 and I color it.

-describe where you carry fat and how changed: I carry fat in my stomach and love handles and face. I am barrel chested
-health conditions, symptoms: After standing or walking for 10 minutes or so, I get what feels like an adrenal response and sweat like crazy, no matter what the temp. Sweat comes from head and face Good results on stress tests, no blockages. Tired all the time. Used to be the life of the party and now don't feel like talking to people. Was a single guy on the hunt all the time, now I have no drive. Gaining weight like crazy. Low carb diet makes me feel good and lose weight, can't seem to stick to it , where it used to be no problem. Lots of little aches and pains. Used to drink a lot. For the past 10 years I drink a few drinks per month, at most.
-Rx and OTC drugs, any hair loss drugs or prostate drugs: Only OTC pain relievers, mostly Alleve.
-lab results with ranges: see below
-describe diet: Alternate between low carb (meat and veggies) to complete binge junk food. Love to cook, but just feel too lazy some times.
-describe training: Pitch 5 to 6 inning per week. (real baseball) couch potato otherwise
-testes ache, ever, with a fever?: never ache
-how have morning wood and nocturnal erections changed: occasional morning wood. Used to get nocturnal erections 2 or 3 times per night. Now very rare. Borderline ED.

COMPLETE BLOOD COUNT

WHITE BLOOD CELL 8.2 3.9 - 11.1 K/ul
RED BLOOD CELL 5.72 4.2 - 6.0 M/ul
HEMOGLOBIN 16.4 13.2 - 18.0 g/dl
HEMATOCRIT 47.8 38.5 - 54.0 %
MCV 84 80.0 - 100.0 fl
MCH 28.8 26.0 - 34.0 pg
MCHC 34.4 31.0 - 37.0 g/dl
RDW 15.0 11.0 - 15.5 %
PLATELET COUNT 199 140 - 400 k/ul
MPV 8.8 7.5 - 11.6 fl
DIFFERENTIAL
GR% 61.0 38 - 75 %
LY% 25.9 15 - 49 %
MO% 10.4 2.0 - 13.0 %
EO% 2.2 0 - 8 %
BA% 0.5 0 - 2 %
GR# 5.0 1.6 - 8.4 K/ul
LY# 2.1 1.0 - 3.6 K/ul
MO# 0.9 0.0 - 0.9 K/ul
EO# 0.2 0.0 - 0.6 K/ul
BA# 0.0 0.0 - 0.2 K/ul
GENERAL CHEMISTRY
GLUCOSE 105 H 65 - 100 mg/dl
BUN 21 H 6 - 20 mg/dl
CREATININE, SERUM 1.2 0.5 - 1.2 mg/dl
URIC ACID 9.9 H 3.4 - 7.0 mg/dl
SODIUM 141 133 - 145 mmol/L
POTASSIUM 3.9 3.3 - 5.1 mmol/L
CHLORIDE 102 96 - 108 mmol/L
CO2 24 22 - 32 mmol/L
CALCIUM 9.4 8.5 - 10.5 mg/dl
TOTAL PROTEIN 7.6 6.4 - 8.3 g/dl
ALBUMIN 4.8 3.2 - 4.8 g/dl
GLOBULIN 2.8 2.1 - 3.6 g/dl
BILIRUBIN, TOTAL 0.9 0.0 - 1.0 mg/dl
ALKALINE PHOSPHATASE 66 35 - 129 U/L
ALT 60 H <42 U/L
AST 40 H <39 U/L
Albumin/Globulin Ratio 1.7 0.8 - 2.0
BUN/CREAT RATIO 17.5 7.3 - 21.7
GFR, estimated 69 ml/min
HEMOGLOBIN A1C 5.5 < 5.7
INSULIN, Fasting 36.3 H 2.6 - 24.9 (was not fasting)
IRON/ANEMIA EVALUATION
FERRITIN 732.4 H 30 - 400 ng/ml ( HIGH)
VITAMIN B12 822 243 - 894 pg/ml
FOLATE, SERUM 13.0 9.1 - 30.9 ng/ml
CORONARY RISK
LIPID PANEL
CHOLESTEROL, TOTAL 214 H <200 mg/dl (High)
TRIGLYCERIDES 239 H <150 mg/dl (High)
HDL CHOLESTEROL 30 L >40 mg/dl
LDL CHOLESTEROL, calc. 136 H <100 mg/dl
CHOL/HDL RATIO 7.1 H <5.0
CRP, Cardio 5.7 H <3.0 mg/L
HOMOCYSTEINE 14.9 4.5 - 15.0 umol/L
LIPOPROTEIN (a) < 5.4 < 30.0 mg/dl
Vitamin D,25-OH,Total 10 L >30 ng/ml (LOW)
Reverse T3 28.4 H 8 - 25 ng/dL
T3, FREE 4.0 1.8 - 4.6 pg/ml
T4, FREE 1.19 0.9 - 1.7 ng/dl
TSH 2.880 0.27 - 4.2 uIU/ml
THYROID PEROXIDASE Abs 34.6 <35 IU/ml
THYROGLOBULIN Abs 36.0 <115 IU/ml
PSA, TOTAL 0.531 0.0 - 4.0 ng/ml
ENDOCRINE EVALUATION
FSH 3.5 1.5 - 12.4 mIU/ml
LH 5.7 1.7 - 8.6 mIU/ml
PROLACTIN 6.5 4.1 - 18.4 ng/ml
PROGESTERONE 0.43 0.2 - 1.4 ng/ml
ESTRONE (E1) 8.8 <60 pg/ml.
ESTRADIOL (E2) 38.1 7.6 - 42.6 pg/ml
DHEA-SULFATE 160.5 44.3 - 331.0 ug/dl
DIHYDROTESTOSTERONE 18.6 11.2 - 95.5 ng/dl
TESTOSTERONE, TOTAL 210 L 280 - 1100 ng/dl
SEX HORMONE BIND GLOBULIN 35 10 - 80 nmol/L
TESTOSTERONE, FREE 3.68 1.9 - 27 ng/dl
IGF-1 48.8 L 119 - 252 ng/ml
Results verified by repeat analysis.
CORTISOL 16.3 ug/dl 2.3 - 12.3 (Afternoon)

Any thoughts?


#2

One other thought- I'm not trying to use low T as an excuse for gaining weight. I know I need to change my lifestyle and this is the first step.


#3

Damn i get 150 week trt feel better going to ask about anti estrogens now, you need to lose weight, eat better i m in a glass house but making progress. Iam nor doc can only decifer some numbers got to go going to four times week workout


#4

Your rt3 is high. Your TSH is also somewhat high Are you under a lot of stress? I believe your AI dose is too high, at least to begin with and that your e2 is now possibly low which is why you're having ED.

I would suggest coming off of your AI for a week to see if your feel better as your e2 rises then taking 1mg with your twice per week injection of 100 mg/test. Better yet, get labs done to confirm low e2.


#5

No need to repeat info on lifestyle changes necessary.

That is a RIDICULOUS amount of anastrozole!

I'm assuming the labs are pre treatment? If so, I'd take 0.5mg of the Adex at the time of the injections. The only possible reason to take a little more than this is to bring your E2 from 38 to 22 faster, at most I might take 1.5mg/week in divided doses for a few weeks then go to the 0.5 mg at the time of the injections.


#6

Thank you for the responses. Some answers and other info:

  1. Stress - yes, my career is fairly stressful. I was recently named head of my national practice group which needs to be rebuilt from the bottom up. Stress will exist for a while. I typically don't let things bother me, too much, but I guess that doesn't mean that they won't take a toll on your body.

  2. The labs are "pre-treatment". I'll have another set in a couple weeks.

  3. I'm not sure how I'd split the AI pills into half doses. They are tiny. I'll probably follow my doc's prescription until my next labs/appointment in a couple weeks.

  4. I'm also taking Vit E, Fish Oil, and CoQ10 on a daily basis as well as a multi-vitamin. I take Magnesium before going to bed.

  5. I'll check my body temp. I probably don't eat as much Iodine as I used to as my table salt has been sea salt for the past few years. But my eyebrows are fine and I don't get gold easily. I'm always hot.


#7

Everyone cuts the Adex pills in half using a pill cutter that can be bought at any pharmacy. You may want to reconsider as others chime in. If you think moderately high E2 sucks, wait until your E2 totally crashes. Just remember I told you so...


#8

Pill cutters as Nashtide suggested. The 1 mg pills can easily be quartered. I can guarantee that you've lost your erections because your estrogen has become too low. Estrogen is required for proper blood flow, circulation and vasodilation. See the below links. I hate to break it to you that Dr's typically don't know what theyre doing. Many (including my own) usually over prescribe anastrazole/arimidex in the context of TRT if intelligent enough to prescribe at all. That being said, I think getting a view of what's going on is also intelligent, i.e. waiting until your next labs. It's just a shame that you'll have to suffer for another two weeks before you receive validation that your Dr's AI dose has bottomed out your e2.

I also wouldn't underplay the impact of stress on your quality of life. Your rt3 is going to block your good ft3 levels and your tsh makes you slightly subclinically hypothyroid. I'd suggest starting to meditate and make sure you're participating in something at least an hour per day that you find calming. I would also suggest taking a good iodine supplement but make certain you're also supplementing with Selenium to prevent the potential for hashimotos disease.


#9

Yeah, watch the E2 - 3Mg is a lot!!! When are you getting blood tests again? If it's short, say six weeks, you may want to follow the protocol but know, you may crash the E2. If it's long, I would NOT follow his protocol.

Typically, Adex (Anastrazole) is prescribed at 1mg per 100mg of Test, so if you are on 200mg per week, 2mg would be appropriate. Granted, at 38 you are already high, but 3mg seems aggressive. And, with Hcg thrown in, which can fuck things up as well by continuing endogenous test production, it gets to be a clusterfuck.

So, if I were you, I would try to get bloods done again after six weeks of treatment (in two weeks). If not, and you choose to follow the protocol, read up on the effects of crashing your E2 so you can recognize if it happens.

I'm on 150mg per week, no hcg, no AI, and my E2 is typically around ten (low). I take grapeseed extract instead of Adex (pretty mild AI). When I was on an AI, my E2 was <5, but I felt fine.

So, clear as mud, eh? Just be aware that these are things that can happen and have a plan.

Good luck!


#10

I want the be clear...I am not picking on the OP.

Every week a newbie comes on here and asks for advice. More often than not, the protocol they are about to start sucks. We try to help and are usually rebuked. Then 4 weeks later the poster reappears and is miserable. Talking about regretting ever starting TRT. We talk them off the ledge and they begin to accept that we know what we are talking about and start heeding the advice. Then, miraculously, they begin to feel good. Problem is they wasted 2 months of their lives. Makes me sad!


#11

Nashtide-

No need to explain. I didn't take it as picking on me I've been reading the forums for a couple weeks now. It's why I switched injection protocols.

Just to be clear, the borderline ED was there before I started, it's improved somewhat. I feel pretty decent. I need to get more sleep, though. Only getting 5 - 6 hours per night. I'm taking recommendations to heart, but I probably will stay on the current dosage until my next labs in 2 weeks. If I crash before then, I'll lay off.


#12

There's a good chance the ED was there before you began your protocol because your T was low with relatively high e2 by comparison.

Even with very high total T and free T levels, if e2 is too low, it will cause ED; so you may have flip flopped reasons as to why the ED was taking place.

I've found that it's less common in older men, but you don't by chance watch porn every day do you? Myth loves when I ask this question.


#13

LOL!

No I only watch porn every other day.


#14

Are you able to get erections while watching porn?

When you get your hormone profile in order, if you're still experiencing ED then hormones are no longer the suspect; you should start looking at neurotransmitters, specifically Dopamine.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0102419

https://www.theguardian.com/commentisfree/2013/sep/26/brain-scans-porn-addicts-sexual-tastes


#15

This study was focused on healthy individuals with Compulsive Sexual Behavior.

This one is Christian propaganda.

And the last is a salacious liberal British rag interested in titillation and sensationalism, which is why the referenced article refers to milfs and moneyshots so prominently.

Bro, really? Are you going to keep grinding this ax anytime someone has ED? You're a broken record.


#16

Yes. It speaks volumes if a man is able to get strong erections while watching porn but unable to achieve one any other time. That = Dopamine desensitization. You must love your porn. I bring this up frequently because I've witnessed men recover from their ED which was porn induced by giving it up. They even went through withdrawal like symptoms for up to a year depending on the severity of the addiction.

I also said that it MIGHT be worth looking into if the ED isn't gone AFTER he gets his hormones in order.


#17

Thyroid is a mess. Please read the thyroid basis sticky.
Check oral body temperatures as suggested.
fT3 is high because rT3 is blocking it.
Also note references to adrenal fatigue and Wilson's book.
Stress can be from every day stresses, illnesses, surgeries, infections etc.

Speaking of adrenal stress, low DHEA-S may be part of this.

CBC does not show a current infection, but CRP shows that you have a general inflammatory process somewhere. Might be liver related, AST/ALT are elevated any may relate to inability to clear E2. Unless you had some major muscle soreness from training increasing AST/ALT.

CRP is not cardio specific, that erroneous notion will not go away. Homocysteine is not good and that is cardio specific!

E2 comes from fT-->E2. As fT is very low, its clear that E2 clearance in liver is impaired.

THYROID PEROXIDASE tells us something about your thyroid that should not be ignored.

Your estrogen dominance has been damaging to your arteries. Your assumed current low E2 is damaging to your arteries.

There is nothing wrong with taking Vit-D3 5000-6000iu tiny oil caps orally.

  • Cholesterol, HDL and cardio:
  • EFA's: fish oil, nuts, flax seed oil/meal
  • TRT high normal TT, FT or higher
  • E2 near 22pg/ml
  • Vit-E3
  • 25iu DHEA from vitamin isle [in USA].
  • Natural source Vit-E
  • Ubiquinol form of CoQ10, 50-100mg note spelling carefully
  • 2000mg Vit-C per day
  • Magnesium/zinc supplement [ZMA available at this site's store]
  • IGF-1=200-300

  • Take Vit-D3, Vit-E, fish oil and Ubiquinol with a meal that has more fats and low fiber to avoid having these nutrients sequestered in you turds.

  • Take all/some magnesium and vit-E at bed time to improve sleep. If you have been having muscle cramps, magnesium can be expected to fix that.

Ensure that your vitamins:
1. do not have any iron
2. contain iodine+selenium

Your thyroid issues have been contributing to other hormone system problems, weight gain and low energy.

So how do you fix elevated/high rT3? You cannot take T4 medications as that simply leads to more T4-->rT3. You need time release T3 and that is only available at compounding pharmacies. If you improve your iodine status, you still get more rT3 problems. Read Wilson's book, available at Amazon.

Cortisol is way to high for afternoon. Could be part of developing adrenal fatigue and yes there are different stages.

Toss that sea salt and get common iodized salt or sea salt that has been iodized. Others in your home iodine deficient too?


#18

And what percentage of men with ED does that describe? Five? Ten? I don't think it's high enough to warrant asking every single poster with ED whether they watch porn - I think you're obsessed with it. I mean really, it's a T Replacement forum. If a guy is posting here, has Low T, well then it's likely he's going to have some type of libido issues. If it was a porn forum, and they had ED, well, then, you might have a point. But, it's not a porn forum, it's a Low T forum.

And, why do you have to ask the question instead of suggesting porn viewing habits might have an effect and just leave it at that? You ask the question because you are obsessed with others porn viewing habits, that's why.

Is that supposed to be an insult? I neither love nor revile it - it's just internet noise to me. The fact that you use this as an attempt to insult me reveals your Puritanical values. It's your shame Bro, not mine.

This sounds charismatic - like evangelical shit. Is that your problem? You're trying to redeem your porn induced shame by ministering to others?

Porn is possibly the cause of ED in a very small percentage of the population. It's probably a much smaller percentage of the population of men in a T Replacement forum. It is probably valid to present it as a possibility. But it's fucking obnoxious to ask every single poster with ED if they watch porn.

It makes you look sick. Just like editing your post after the discussion has begun. What are you hiding?


#19

Is your e2 high? You seem very emotional. I'm here to help by looking at all possible causes. Why are you here?


#20

My e2 is fine. Why don't you answer my question - what is your obsession with other's porn habits? I think you need to explain it so the OP can assess your motives - it is the OP's thread after all. Go ahead, explain to the OP, who has low T and high e2, why you want to know what gives him erections. Explain why you always ask posters about their erections.

Go ahead.