T Nation

58 Year Old - Low T Diagnosis


#1

Hi Guys, I’m new to the whole TRT thing and looking for some feedbacck.

I’m 58 years old and had suspected being low T for several years. I’ve always had very limited facial hair and virtually no hair north of my navel - not sure if this should have been an early indicator. No fertility issues earlier in life so I hadn’t thought much about low T.

I had labs done earlier this month which showed:
TT @222 (241-827)
TF @4.97 (4.25-30.37)
TB @11.64 (10.10-71.20)
DHT @223 (112-966)
E2 @28.7 (25.0-74.0).

All my other labs are okay and I don’t have any blood pressure or cholesterol issues.

I’m 6’-3" tall, 269 lbs. (looking to bring that down to 250 lbs. or so) and 20% bodyfat. I work out with weights 4x a week and do spinning 2x a week. Symptoms are low energy, weaker erections, feeling blah and lack of focus. I don’t feel horrible, but definitely am lacking “zest” for life. Not sure if I’ve had low T so long I’ve forgotten what “normal” feels like.

I discussed TRT with PCP and she referred me to an endochronologist. The endo suggested we start with clopine 25mg ED which began 5 days ago. I’ve got reservations with the clopine but didn’t want to jump into test and HCG right off the bat. I’m not sure my endo is up on the latest treatments for TRT. I’m hoping for some advice on whether Nolva would be a better option. If so, suggested dosage and at what point you make the determination to go to full TRT.


#2

Your E2 range is very unusual. typo?
typically range is <43 or similar

Please note that doctors typically do TRT wrong, endos seem to make huge mistakes and say things that are totally wrong. Urologists have a rather narrow view of male hormone health factors. Doctors are the biggest problem in TRT.

Clomid 25mg ED may be too much. If LH/FSH levels get high, then T–>E2 inside the testes can get out of control. Ask for labs at 3-4 weeks for TT, FT, E2, LH/FSH. Clomid 25mg EOD is often enough, but at your age and history, your LH/FSH may be less and 25mg ED may not create a problem.

Some guys feel terrible with Clomid and Nolvadex does not do that. Most docs have no idea about this, not in the literature and they lack a fundamental understanding that a SERM is SERM.

At your age, a SERM may not lead to decent LH/FSH levels and if so, then the testes may not be very responsive. There is age related decline in these things.

If SERM does not lead to decent LH/FSH or if does and T levels are mediocre, then you need to go to TRT.

Suggest:

  • self inject 50mg T cyp/eth twice a week with #29 1/2" 0.5ml insulin syringe, inject SC/SQ not IM
  • 0.5mg anastrozole at time of injections
  • 250iu hCG SC/SQ EOD to preserver testes, also many find good for mood

Inject SC/SQ over top of upper legs where you can see and avoid veins. Pinch up skin and inject into end of fold, needle parallel to tissue underneath. After injecting, press on injection site for 10-15 seconds to allow

You should have a known PSA history and a digital rectal prostate exam before and at 3-6 months… Watching for changes.

Best thing to do is to read the suggested stickies below.

AND

Self-eval over-thyroid function as per last paragraph is this post.
Most?many guys here have some thyroid issues. You cannot go on the thyroid lab ranges and many “normal” results involve serious quality of life issues.
Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • 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.


#3

Thank you for the prompt reply…

I verified the E2 value and reference range and it’s stated correctly.

My TSH in the same report was 4.292 (0.555-4.780), Free T4 was 1.03 (0.89-1.76) and Free T3 was 0.96 (0.60-1.81). LH was 2.2 (1.7-11.2), FSH was 3.1 (1.0-42.5).

Just under 2 years ago the TSH was 7.08 (0.40-4.50) and T4 was 1.3 (0.40-4.50).

PSA in this lab was 2.3. I have my annual physical with my PCP next week which will include an updated PSA. I was planning on asking for updated Testosterone numbers and LH and FSH to see if the Clomid is working or not. I have a follow up with my endo in another 4 weeks or so.


#4

Ask your doc to use a lab with sane reference ranges such as LabCorp or Quest Diagnostics. Most guys with E2=74 would be growing breasts.

TSH is way too high, should be closer to 1.0
Thyroid ranges are bogus and contain a lot of people who are suffering.

Both fT3 and fT4 should be mid-range or better.
fT3 is the active hormone that controls your energy levels, vitality and body temperatures.

Please get those oral body temps done ASAP.
Do you feel cold easily?
Are your outer eyebrows sparse?
Thyroid appears enlarged, feels lumpy, sore or asymmetric?

Tell me your history of using, or not, iodized salt or vitamins that list iodine+selenium. If not, others in your home also iodine deficient? - check their temperatures too.


#5

I don’t have sensitivity to cold or heat for that matter. Eyebrows appear good. My endo did a thyroid ultrasound about a year and a half ago - nothing remarkable. Another is planned on my followup visit in 4 weeks. He did mention that I should intake more selenium (Brazil Nuts)

My Anti TPO AB level was 1300 (<60) which apparently predisposes me to Hashimoto’s Disease.

I take occasional multi-vitamins and D3 along with a glucosimine type joint supplement. Usually have protein/spinich/berry shakes for breakfast which normally includes a creatine supplement. Usually use kosher salt at home which I don’t believe is iodized.

On medical issues I’ve had an appenedectomy when I was 32, a vasectomy, the only lingering condition is ongoing acne, nonstop from age 15 for which I take a low grade antibiotic. I’d always thought the acne might be from elevated testosterone - looks like I was wrong on that one.


#6

Doc is very concerned with your thyroid and he was right to suggest selenium as a deficiency leads to free radical damage of thyroid tissue and the immune system when cleaning up the wreckage can misinterpret the debris as foreign and there you are.

Get a high potency B-complex multi-vit with trace elements, including iodine 150-180mcg and 150-200mcg selenium. Do not take with spinach.

Get iodized salt. Others in your home will also be iodine deficient.
Selenium is very important if you want to avoid Hashi’s if not too late now.
Your problem is caused by not using iodized salt.
Do you have thyroid nodules as well?

Low T can lead to an adult form of acne from the skin getting incompetent from loss of collagen. TRT will fix that and resolve many aging aspects of your skin. But then T related pimples are possible, a small price to pay.

You are better off throwing out that kosher salt, or give it to someone you do not like.


#7

I appreciate your input…

I’ll pick up some high potency multi-vitamins and some Brazil nuts. I think we have iodized salt at home too so I’ll start using it. My endo checked for nodules and didn’t comment on anything. His ultrasound gal was out of the office so I’ll have that done next month.

I did a quick check online about low T and acne. It seemed to present with dry flaky skin. That’s not my issue at all, I produce generous amounts of sebum. I’d thought that TRT would likely kick that up a bit. Is it possible it could help?


#8

TRT can make some skin issues worse.
Do you have a high rate of skin turnover?

If you get multi-vits with 200mg selenium, there is no reason to also eat Brazil nuts to get selenium and you would want to avoid getting too much selenium.


#9

I’m not sure of the reference point for “skin turnover”. I generally heal pretty quickly and would guess it’s probably better than normal. I’m told I look more youthful than my age which I attribute to one of the positive effects of producing more skin oil than normal.

On a different note regarding side effects of Clomid. Within a two days of beginning 25 mg ED I noticed kind of a tightness in the back of my throat and mild unproductive cough. It’s like a thick film in the back of the throat and my voice deepened at bit and got more “nasalily”, kind of like when you get a cold. I don’t get sick often and don’t know if this is a coincidence or side effect. What would your thoughts be? I’m not sure whether I should discontine the Clomid for a few days to see if it will clear up or not.


#10

I would keep taking Clomid for a while more then decide that if it was a virus, that it should have been resolved by then. You could stop clomid at that time. How are you feeling otherwise? Vitality? Mood? Depressed? Some feel generally horrible with Clomid, but never seen your complaint with it.


#11

Skin turnover: My skin grows very fast. Sometimes I think I am shedding skin like a lizard. TRT made that somewhat worse.


#12

Thank you for your feedback. Overall I feel okay, a bit low on energy but overall no complaints. I think I’ve been low T for several years so my “normal” could be horrible and I just don’t know the difference.

I wouldn’t say I have a high turnover rate on the skin given your context.

Another general question for you regarding TRT… how does it affect joints and such. I don’t currently have any particular joint pain, I “creak” and “pop” all over the place - neck, hips, shoulder, elbow but no arthritis or anything. Will TRT likely affect this for better or worse?

Thank you again for doling out your wisdom on TRT and helping us newbies.


#13

I got results today for new labs done on 05/03/17 to see how the Clomid 25 mg ED was working.
My labs on 04/06/16 were:
LH 2.2 (1.7-11.2 miu/ml)
FSH 3.1 (10-42.5 miu/ml)
Testosterone 177 (241-827 ng/dl)
Free Test 4.9 (4.25-30.37 pg/mL)
Bio Test 11.64 (10.10-71.20 ng/mL)
After taking 25mg of Clomid ED for about 3 weeks my results were:
Labs on 05/03/17
LH 7.0 (1.7-11.2 miu/ml)
FSH 7.2 (10-42.5 miu/ml)
Testosterone 573 (241-827 ng/dl)
Free Test 8.66 (4.25-30.37 pg/mL)
Bio Test 20.29 (10.10-71.20 ng/mL)
Estradiol was requested by not included in these results.

I haven’t really felt much improvement mentally. About a week ago it seemed like my nipples were “fuller”, I’ve always carried some fat in the nipple area. Nothing too bad but makes me think I’m probably prone to gyno. The last few days I’ve noticed some changes in my eyesight on the peripheral vision so I stopped taking the Clomid.

I asked my Endo about trying Nolvadex for the E2 benefits. He says it would not increase testosterone production – contrary to much of the data posted here. I’d checked by body temp first thing in the morning and it was 97.2. Iodine supplements did bring it up to 98 or so in about a week but the doctor said I shouldn’t be mega dosing iodine at this point. I’ve been taking a selenium supplement also.

My TSH was elevated at 7557 and my Anti TPO AB was 1300. They did a thyroid ultrasound and that came back normal, symmetrical and no nodules or masses. He put me on the lowest dose of synthroid to see how that goes. His plan is to see how well my body maintains the testosterone levels without medication with another appointment in six weeks. PSA was 2.98, 2015 was 2.3 and 2014 was 2.2.

It seems I’m responding to the SERM. Assuming he comes around to prescribing Nolvadex and it produces similar results, is that a long term HRT plan or is it better to go to injections, HcG and an AI? I have good insurance so TRT would be covered. What are your thoughts?


#14

I need to clarify my tsh posting, damn decimal was missing. On 7/15 tsh was 4.200(0.550-4.780), ft4 was1.27 (0.89-1.75) and tt3 was 0.84 (0.60-1.81) on 4/17 tsh was 4.292 , ft4 was 1.03 and tt3 was 0.96 I started taking iodine selenium
supplements and on 5/17 tsh jumped to 7.557, ft4 was1.06 and tt3 was 0.99. I think the iodine pushed up the tsh and was told not to continue the extra iodine. Anti tpo sb was 1300 (max value) in each sample

What should ft4 and tt3 numbers be?


#15

Should focus on fT3 and fT4 which should be mid-range or a bit higher.

TSH is expected to get high on high dose iodine and that is OK. But docs do not know and panic.

The whole point of the labs on the SERM are to see if E2 is out of control. Some labs retain samples for a while to support followup work.

2nd labs with TT=573 and low FT suggest elevated SHBG lowering FT. LH/FSH getting high is also a problem and 25mg clomid ED was simply too much.

With more time, TT/FT may have increased. Thyroid perhaps a factor. Nolvadex really does not provide a different story for you, does increase LH/FSH and same things happen. Doctor is not speaking from experience and the issue is LH/FSH, not T levels which are a secondary outcome.

Try to get that E2 test done. If you want to run on a SERM, Nolvadex has no advantage unless clomid made you feel bad. You need to have lower LH/FSH and watch E2. T levels may be OK, but in your case will probably not get high-normal.

How have joints changed?


#16

Hi KSman, thank you for taking a look at the new labs.

I was disappointed that the E2 didn’t get run, I’d specifically requested it and saw the lab tech write it down on the labslip. I’ll ask about the sample being retained and ability to do a test at this point. I know elevated E2 is not a good thing but assuming the E2 was elevated what does that tell him other than I need something to bring it down. Does that aid him in prescribing injections, HCG and an AI?

My endo said it wasn’t his goal to have me on Clomid long term, maybe just confirming secondary hypogonadism? I’m thinking I might be in the market for a new endo that’s got more experience. He’s willing to work with me to some degree but he’s moving slowly.

I haven’t noticed any change in my joints. I’ve always “popped” a bunch - elbows, knees, neck and ankles. No pain - just noisy getting up out of a chair or streching the elbow out. If anything, it may have improved some. What’s to be expected?

I do seem to be feeling better, libido is up some, muscles seem “tighter”, still not much in the way of morning wood. What’s the half life of Clomid? I don’t see my endo for a month and only med I’m on is the 25 mcg of synthroid. I’m expecting that my T levels to be back to my pre-Clomid levels by that time. Is that likely? I had lost 6-8 lbs in the weeks prior to beginning Clomid. I’ve gained most of that back. I seem to be a bit hungrier or is it more likely water retention from higher E2? Thank you again for your input…


#17

Hi KSman, No luck with getting the E2 run on the last sample.

I’m trying to get a handle on the E2 thing. You said my LH was too high which would likely lead to conversion of testosterone to E2 inside the testes. Is it the combination of high LH and higher T that leads to the conversion to E2? If you’re naturally producing high normal T without meds, why isn’t there a problem with E2? Is it an age related thing that prevents the E2 conversion even though the T levels are high? Why don’t teenagers have issues with high E2?

So is the goal to take HCG at a level to not generate excessive T in the testes that would cause conversion to E2 and then take T injections to increase TT to the target number and use a AI to keep system E2 levels in check? Does the conversion of T to E2 happen both inside and outside the testes? If the T to E2 conversion happens inside the testes then you’re "stuck’ with that E2 until it diminishes through its half lifes?