T Nation

Ah, The Joys of Aging

Edited - added ranges

After bouncing through some crappy docs with some job relos, I decided to take back control of where my bodies heading. Not quite sure why I even let go in the first place. I hope the following will be helpful to some and would also greatly appreciate your thoughts on my labs below.

Went from my teens through my early 30’s in great shape, had some great strength, fitness, and nutrition coaches in college (played linebacker in D1 football in the USA) and kept it going. Then kids, job, travel, etc. led me to take care of everyone and everything else first - the same old story

Now at 44, spent the last 4 years trying to get hyperaldosteronism under control after first noticing some high BP readings and heavy muscle cramping. Started a regime of spironolactone, and whammo, massive fat (and weight) gains and gynocomastia. doc wasn’t really aware of the side effects.

This is when I decided it was time i started driving. First step was to stop the immediate train wreck, so changed to Inspra (which has same effect but a little better control of the side effects) and started pulling full labs to get an idea where things stand.

So a little net searching and here I am looking for your help and insight.

Test 1 - (from a panel including CMP12+ LP +6AC + CBC/D/plt + PSA + TSH + T4 + T3 + vit D + test, serum + hemo alc

  • TT 294 ng/dL 280-800
  • FT 9.6 pg/mL 6.8-21.5
  • Cholesterol 171 100-199
  • Triglycerides 171 0-149
  • HDL 33 >39
  • LDL calc 107 0-99
  • C/HDL ratio 5.3 0.0-5.0
  • E2 27.6 pg/mL 7.6-42.6
  • TSH 1.53 0.450-4.500
  • T4 9.5 4.5-12.0
  • triiodothyronine free 2.9 2.0-4.4
  • PSA 0.8 0.0-4.0
  • DRE: clear
  • Vit d (25-hydroxy) 21.7 32-100

Saliva around 10 days later
DHEA 8 3-10
Progesterone 27 5-95
Androstenedione 123 151-350
Estrone 26 30-58
Test 83 40-70
DHT 54 52-123

then a Test only blood panel 15 days later
T - 380 280-800
FT 14.9 6.8-21.5

and a saliva the same day and time
DHEA 9 3-10
Progesterone <8 5-95
Androstenedione 231 151-350
Estrone 15 30-58
Test 107 40-70
DHT 63 52-123

FSH 84 <125
LH 36 10-25

Man boobs
fat in female spots - sides of chest, thighs, under arm
morning on nightime wood - huh?
loosey goosey erection and ho hum finishes
high and tight sack
do i have to get out of bed?
why am i still tired?

that pretty much sums it up…

welcome onboard.

Can you edit your post and add the reference ranges to the tests (especially the saliva tests)? No idea what those numbers mean without the ranges.

Vit D is low - you need to start on 6,000iu minimum D3 (not just any old plain D)

Testosterone looks pretty low. E2 looks ok’ish, but symptoms say otherwise - might be the ratio between Free T and Estradiol messing you up.

Thyroid seems a bit stressed as well.

Have you read through the stickies and the recommendations?

Why are you on Inspra again? what were your original problems, symptoms, blood work, etc.

Also what supplements, medications, vitamins are you currently taking?

IMPORTANT: Use the [edit] function in your post above and add lab ranges.

You have estrogen dominance. Have you read the stickies? Possible prolactin issues, test that.

Are you using a statin drug?
Muscles hurt?
Slight persistent cough?

What other Rx and OTC drugs?

Fasting serum glucose?

What is your?
-waist size
-loss of hair on legs below the knees?

Take fish oil and 4000-6000iu vit-D3 per day or seven times that once a week.

You should do a saliva four sample cortisol test and rT3.

Appears to be secondary hypogonadism, verified by changes to scrotum.

High B-vit potency multi vits will improve HDL. Look for a good spectrum of trace minerals as well.

Do you use iodized salt or have iodine in a multi-vit?

Are you seeking TRT now? Lots to learn from reading other threads and experiences of others as well.


Have been through the stickies. Absolutely incredible information which led to me posting to start with. Been going through the posts and finding a list of things to talk to the new doc about as well as learn more.

Inspra looks like something i may have to take for a long time. Once i get the weight back off and nutrition/sups normalized, i plan to see if it can be dropped. Went down the spironolactone/inspra path because of high BP and suffering hypokalemia with traditional diuretics+limited results from traditional BP meds - and then primary and secondary screenings as well as adrenal glands scan ruling out an adenoma.

for these results, i stopped all sups roughly 8 weeks before testing.

fasting serum glucose 91 scale 65-99

waist - 43 1/4
hip - 47
height - 6’ 2"
weight - 253

hair on legs seems ok
almost no salt in diet with the conn’s problem above - cant handle much sodium well yet
no cough, statins, or aches/pains besides age - although i am more likely to cramp than before as my potassium now sits toward the low side 3.8 on 3.5-5.2 serum scale.

I was taking fish oil and a good multi prior to the reset and testing and will begin again as well as add in d3 and look at B, minerals, and iodine in what i usually would take.

looks like i’ve got more reading to do on estro dominance, prolactin, thyroid, etc. And i’ll look to add prolaction, saliva 4 samp cortisol and rT3 into next test panel.

TRT is definitely a consideration


Check waking body temps. If closer to 97 than 97.8, consider testing rT3

If no salt, that limits your iodine intake.

Second attempt:
Are you using a statin drug?
Muscles hurt?
Slight persistent cough?

Prolactin lab might be good.

thanks - will start checking waking body temps and have fasting labs + saliva scheduled again later this week.

no statin drugs
muscles dont hurt
no cough

started from post

fish oil from LEF.org
Pure+â?¢ Wild Fish Oil Concentrate
2000 mg
EPA (eicosapentaenoic acid) 700 mg
DHA (docosahexaenoic acid) 500 mg

5000 IU D3 daily

and multivitamin - LEF mix Tablet (which has high b vits as well as 150 mcg iodine

LEF is down the street so fairly easy to run by…

Appear to have t4 to t3 conversion in thyroid
Vitamin D is low - I recommend front loading 50,000 ius for 3 days then 10,000 ius retest in 6 weeks use biotics research vitamin D emulsion forte (most absorbable form)

I suspect metabolic syndrome or syndrome x from lipid panel with potential for insulin resistance.
Low testosterone has been pointed out.
at your age TRT would be first step then treat down the line (adrenals, thyroid, dhea, e2 issues)
No salt in diet is not good and can result in iodine deficiency and other health issues. One can use see salt with no issues like normal person.
SAliva are a waste for anything but cortisol and may be dhea (still debateable)

Hi all -

Many thanks for the responses and guidance!

After research and review, have started TRT (cream at this point due to heavy international travel - 10mg carbogel) and made some other adjustments including the d recommendation above and sea salt. Here are the 30 day updates.

Test 1 - fasting - morning within 2-3 hours of test cream application (from a panel including CMP12+ LP +6AC + CBC/D/plt + PSA + test, serum)

  • TT 225 ng/dL 280-800 - Down from before TRT
  • FT 6.3 pg/mL 6.8-21.5 - Down from before TRT
  • Cholesterol 137 100-199 - down 40
  • Triglycerides 119 0-149 - down 52
  • HDL 31 >39
  • LDL calc 77 0-99 - down 30
  • C/HDL ratio 4.3 0.0-5.0 - down 1
  • E2 27.7 pg/mL 7.6-42.6 - up 0.1
  • TSH untested 0.450-4.500 -
  • T4 untested 4.5-12.0
  • triiodothyronine free untested 2.0-4.4
  • PSA 0.6 0.0-4.0 - down 0.2
  • DRE: untested
  • Vit d (25-hydroxy) 50.3 32-100 - up 29.6

Saliva same morning
DHEA 7 3-10
Progesterone 33 5-95
Androstenedione 220 151-350
Estrone 15 30-58
Test >200 40-70
DHT >125 52-123
Estradol 3 1-3

FSH 36 <125 down from 84
LH 37 10-25 from 36

med change -
added daily test cream 10mg
added acarbose 50mg after each meal
added metaformin 500mg after heaviest 2 meals
dropped atenolol

lifestyle changes -
started RFL program (rapid fat loss)
3x weekly free weights (doing 5x5 for now)
2x weekly rowing clinic
1x weekly singles tennis league + related clinics/practices 2-3x weekly

30 days have dropped 15 lbs to 238
bp 124/72 avg

bench at 1x5 240 lbs (body weight)
squat at 1x5 325 lbs

more to come - and working on getting the other tests identified done.

Any new thoughts based on the updates or areas to focus and talk to the doc about?

WTF is 10mg carbogel? What is the percentage of T per ml, will typically be mg/ml. How much do you apply, how often and where? Your dose may be ineffective or you may be a non-absorber. Your T delivery system is not working.

One typically need to absorb 10mg T per day from a transdermal. That often requires the application of 70 to 100mg of T per day. 10% is absorbed at best. Some do not absorb because of thyroid problems and some do not absorb for reasons not understood. This basically means that one has to inject.

If you are applying 10mg to your skin, that is useless. If 10mg/ml, you would need to apply 10ml per day.

DHT response is good, if not prone to hair loss. This seems to be the only indication that you are doing TRT. If you increase your transdermal dose to the point that you get high normal T levels, I suspect that DHT might get very high.

Your E2 appears to be too high relative to T levels, making you still E dominant.

Now, tell us how you feel and what has changed.

How long on the T cream before the lab work? Days? weeks?

You should test before daily T application. When you tested 2-3 hours after application T levels should be peaking and FT should be strongly elevated.

Seafood is a good source of iodine and veges grown there might have more iodine than from other regions.

Its 10 mg/ml - carbogel is the carrier from the compounding pharm - my bad.

Have been doing 10ml per day applied to scrotum. Last blood test was 30 days from TRT start. Felt great for first few weeks until E must kicked in, but still better than before through remainder of first 30 days. doc wanted to test within a few hours of application to get idea of the spike, and based on results we’ve been discussing move to inject and something to adjust the E. is arimidex still at the top of the list?

I appreciate the responses as i’m trying to get this dialed in and get on top of it and helping point the doc in the right direction while also watching the various test results and phys/emotional results is challenging.

you guys make it easier to pick it up more quickly and this forum (with your responses) is really great!

That is insane, get 10% cream, 100mg/ml and apply 1ml.

10mg/ml is for women

thanks - talking to doc about that now. he agrees dosing needs to go up. Now to convince him how much so we don’t just keep going up in little steps.

after seeing the spread between my blood and saliva results, he also agrees saliva is worthless for most info.

its an education process for all.

The only known method that delivers T in a predictable manner is injections.

Also apply T cream to inner arms where absorption is good. You probably need more surface area.

Thanks for all the input and advice. Changed things up from the last set of labs and your input and am seeing the results in more areas than i expected! Switched to 100mg/ml cream at 1ml dosing daily, added AI (still in setting phase - arimidex .5mg x 2 weekly) and 5alpha RI (avodart 0.5mg daily), and from lef - 4000 iu vit d3 capsules daily, 1 lef one-per-day multivitamin, 2 super omega-3. all labs are in the around 9am, on a 10 hour fast, and prior to any trt or meds.

last lab

  • TT 225 ng/dL 280-800 - Down from before TRT
  • FT 6.3 pg/mL 6.8-21.5 - Down from before TRT
  • Cholesterol 137 100-199 - down 40
  • Triglycerides 119 0-149 - down 52
  • HDL 31 >39
  • LDL calc 77 0-99 - down 30
  • C/HDL ratio 4.3 0.0-5.0 - down 1
  • E2 27.7 pg/mL 7.6-42.6 - up 0.1
  • TSH untested 0.450-4.500 -
  • T4 untested 4.5-12.0
  • triiodothyronine free untested 2.0-4.4
  • PSA 0.6 0.0-4.0 - down 0.2
  • DRE: untested
  • Vit d (25-hydroxy) 50.3 32-100 - up 29.6

Latest lab

  • TT 210 ng/dL 280-800
  • FT 6.1 pg/mL 6.8-21.5
  • Cholesterol 145 100-199
  • Triglycerides 133 0-149
  • HDL 33 >39
  • LDL calc 85 0-99
  • C/HDL ratio 4.4 0.0-5.0
  • E2 18.9 pg/mL 7.6-42.6
  • DHT 76 ng/dl 30-85
  • TSH untested 0.450-4.500 -
  • T4 untested 4.5-12.0
  • triiodothyronine free untested 2.0-4.4
  • PSA 0.7 0.0-4.0
  • DRE: untested
  • Vit d (25-hydroxy) 33.3 32-100

i also had a TT from another lab that was 565 on a 350-850 scale done within a few hours of the latest lab? is it normal to see that much change prior to applying the gel?


In terms of your Vitamin D status whats the measurement? I’m guessing it’s ng/ml hopefully not Nmol/L, either way your Vitamin D status is borderline pathetic.

Its ng/dL - and you’re very right, it sucks. I’ve started 10,000 IU a day capsules (as i’ve got a few to finish off) and will go to liquid if i don’t see some improvements. I think its really holding me back.

I’ve been focused on the positives so far though - dropped a bunch of BF (almost 10%) by various caliper and tape checks, and feel a bit more like I used to in the gym and after hours (grin).

I’m thrilled i found this forum and you all are great helps. reading the other threads and your direct responses here really helps in making informed decisions.

The correct measurement is ng/ml as Deciliter = 100 ml which is a little much.

One of the most effective ways to your raise your D levels since your borderline Deficient (<32 ng/ml) is to bolus dose twice a week instead of on daily base. It would be wise to buy a 10K bottle as anything less will not allow for versatile dosing strategies unless you really like pills and feel the need to take 8-20 a day. With that being said Optimal D levels are between 50-80 ng/ml. Ideally you should shoot for 75-80 and nothing less.

Your probably wondering what happens if you overshoot 80 by accident…well simply put…you’ll be more then fine as at this point there are only three known reasons one would have a negative reaction to vitamin D3:

  1. They are vit D toxic - very rare (one is far from risk of toxicity, which does not present until levels of over 200 ng/mL)
  2. They have high blood calcium - rare
  3. They have cellular mag deficiency - epidemic (worldwide)

vitamin D can bring up symptoms of an underlying mag deficiency due to increased demand for mag by the enzymes that metabolize D. Simply put it would be a wise Idea to supplement with Magnesium with Vitamin D.

Personally the best place I’ve found to buy the two supplements is from iherb.com

Vitamin D 10k = Healthy Origins 360 caps (1 bottle = $ 24/ annually)
Magnesium 400 mg = Now Foods 180 caps (8 bottles = $ 64 / annually)

If you do end up deciding to buy these which I highly suggest you do effective dosing methods would be

Vitamin D
40k every 4 days (1 month) > 10k daily > 10k every two-days until you’ve reached 75-80 ng/ml

4 caps everyday(5-6 months)

Waiting on a new set of labs today and had a few questions based on last labs and overall feeling.

  1. I did tests on 12/3 and again on 12/10 at two different labs. total test on 12/3 was 210 ng/dL (280-800) and on 12/10 was 553 ng/dL (300-890). i’m using 10% gel/1 ml per day and had been for three weeks prior to 12/3. I did not apply the morning of the either test and took both tests around 10am and fasting.

Nothing else changed that i can think of (no supplement, sleep, diet, etc change). Thoughts on why they’d be so different? I;m not sure wether to be happy with the increase, ignore it or ?? I guess the new labs will offer some clues as to where i am 30 days later.

  1. I’ve hit a wall in terms of measurable BF% changes, LBM, etc. Weight, hip and waist measurements, gym volume, energy levels, and libido all have either stopped improving or returned to pre trt-levels (energy and libido).

Thyroid didn’t jump out at me based on thyroid handbook and stop the t madness site (morning temps (97.8-98.3), daytime temps all normal) with TSH 1.52 (0.45-4.5), T4 9.5 (4.5-12), and T3 2.9 (2.0-4.4). Estradol has dropped to 18.9 (7.6-42.6) with ai. D3 continues to be low so started dosing protocol above with magnesium. Where do I go from here?

  1. Starting to feel more and longer lasting post workout burn, sometimes enough to wake me up with pain in the middle of the night. Looking back through logs, i’ve been a pussy and haven’t been pushing it at all with the energy level down. Over the same period, my c-reactive protein climbed up from 2.61 to 3.42 (0.00 - 3.00).

Will keep looking for similar issues in the threads and looking forward to your thoughts.

Latest Labs and program

been roughly 8 months since the journey began and the at this point, I have to say I’m loving the results. Been trying to get off a plateau the last month or so (still working on it), but otherwise feeling so much better and also seeing the results directly has been amazing!

latest labs

Latest lab

  • TT 841 ng/dL 280-800
  • FT 25.1 pg/mL 6.8-21.5
  • Cholesterol 132 100-199
  • Triglycerides 119 0-149
  • HDL 35 >39
  • LDL calc 75 0-99
  • C/HDL ratio 4.3 0.0-5.0
  • E2 15.3 pg/mL 7.6-42.6
  • DHT untested ng/dl 30-85
  • TSH untested 0.450-4.500 -
  • T4 untested 4.5-12.0
  • triiodothyronine free untested 2.0-4.4
  • PSA 0.5 0.0-4.0
  • DRE: untested
  • Vit d (25-hydroxy) 34.6 32-100

Active TRT with 10% cream/ 1ml per day (labs above approx 2hrs after application)
avodart 0.5mg 1x day
arimidex 0.5 mg 2x per week
vit D3 10000 IU x day
metaformin 500mg 2x day - trying to drive fasting glucose sub 80, still in 78-85 range with high hemo a1c of 5.9 (4.8-5.6)

Feel great, waist dropped 6" since starting this, weight is down to 215lbs, body fat still way to high in upper 20’s all in torso (lots in chest from gynocomastia with Eplerenone side effect). no hair loss, thinning, or gonad issues at this point. very happy with bedroom performance anytime of day or night. feel a bit drowsy or tired at times and have high stress job, both of which I try to manage but i’m sure impacts my body and health.

Going to keep full speed ahead and continue to learn and change up program.

anything in particular i should be looking at? adding thyroid and 4 sample cortison in next set of labs.

No hcg?