I'm 24 years old, nearly 25, overweight at 210 pounds and 5' 11". For as long as I can remember I have lacked energy. In high school I used to wake up and play water polo / swim from 6am to 8:30am and then sleep through every class until school was over at 2pm. I was the fattest on my team, always with love handles, despite swimming / water polo year round and strength wise I never made any progress in the weight room during off-season. I didn't overeat either, just whatever homemade meal my mother cooked at the time. I have a baby face and have never been able to grow any facial or chest hair aside from 3 hairs protruding from a mole on my cheek and a nipple hair or two. My teammates' legs were covered in hair and mine were bare as a baby's bottom. My testicles have always been very small. In fact, when I was referred to a urologist he commented saying that they were abnormally small and I remarked that's how they had always been.
Recently, my PCP informed me that I have high cholesterol. My family has a history of cardiovascular issues and I was concerned. So for 6months, I ate a strictly ketogenic diet without cheating and went from 218 pounds to 196 pounds. I also made sure to get 8 hours of sleep each night, went to bed at roughly the same time every evening, and worked out at the gym consistently either 3 or 4 days / week. With my diet, sleep, and exercise in check I hoped to eliminate the chronic tiredness I had always lived with. I didn't. So I started googling and thought perhaps it was low testosterone. I asked the PCP to check my levels and it came back with the following:
DHEA Sulfate - 303 (85-690mcg/dL)
Progesterone - .5 (<1.4 ng/mL)
PSA - .3 (< OR = 4.0 ng/mL)
Estrogens, Total, Serum - 110.1 (60-190 pg/mL)
FSH - 24.7 (1.6-8.0 mIU/mL)
LH - 15.0 (1.5-9.3 mIU/mL)
Free Testosterone - 19.1 (35.0-155.0 pg/mL)
Testosterone, Total, LC/MS/MS - 126 (250-1100 ng/dL)
Thyroid Peroxidase Antibodies - 4 (<9 IU/mL)
TSH - 3.13 (.27-4.20 microIU/mL)
T4 Free - 1.20 (.93-1.70 ng/dL)
T3 Free - 2.9 (2.0-4.4 pg/mL)
hs-CRP - 5.9 (<5.0 mg/L)
LDL-C Direct - 121 (<100 mg/dL)
HDL-C - 37 (> OR = 40 mg/dL)
She wanted to put me on AndroGel which I refused because from my reading I believed it had low efficacy and wanted to "fix" the problem ASAP. I requested an injection and she offered 100mg E14D. I asked if I could inject 50mg E7D to maintain stable levels and she refused and referred me to a Urologist with a "Primary Hypogonadism" diagnosis.
The Urologist put me on 100mg Test Cyp E7D but each time following an injection between about 8 and 24 hours later I began to experience chest pains. After the 3rd injection I reported this to the Urologist and he asked me to stop TRT until I was cleared by a Cardiologist. Long story short, the Cardiologist ordered an echocardiogram, EKG, and a stress test and cleared me to continue. However, the Urologist no longer wanted to manage my care and referred me to an Endocrinologist. After a 4 week hiatus, I was back on TRT and (I forgot to mention earlier) I could again get through about the first 4 days of a week without feeling the need to nap a few hours after waking up. However, about 3 weeks later after a total of 8 or 9 injections total, I was beginning to feel tired again and where previously days 5, 6, and 7 were the worst, now all of the days were "the worst"--even after administering the weekly dose.
I re-read KSman's stickies and decided to try E3D as well as subcutaneous injections to even out the peaks and valleys. I also requested an E2 reading from the endocrinologist. Below are the updated lab results:
FSH - 7.7 (1.6-8.0 mIU/mL)
LH - 4.1 (1.5-9.3 mIU/mL)
Testosterone Total LC/MS/MS - 760 (250-1100 ng/dL)
Free Testosterone 177.3 (35.0-155.0 pg/mL)
Estradiol - 76 (< OR = 39 pg/mL) Quest
I requested Aromasin because I read on a TRT wiki over on Reddit that it has no negative effect on lipids, and, being that mine are high, this is preferable. However, the endocrinologist told me he prescribes neither Arimidex nor Aromasin because those are breast cancer drugs not intended for men.
Reading through more of KSman's stickies today, I think I might perhaps have subclinical hypothyroidism because I seem to match the criteria (feel cold easily, sparse hair at outer eyebrows), and my mother is diagnosed with hypothryroidism--perhaps it is genetic in my own case. I have not yet purchased an oral thermometer to check my morning and afternoon temps.
Going forward I am wondering if I am on the right track. Obviously I need to lower my Estradiol as well as check my oral temps and possibly begin IR. I intend also to check for adrenal fatigue at the next meeting with my doctor. But really my question is, do my labs indicate that TRT is a lifelong treatment for me and will fixing the above mentioned issues dispel the recent "tiredness" I've again been experiencing, primarily the Estradiol.
Finally, if anyone has any recommendations for procuring Aromasin through legitimate methods, I'm all ears. I've called several Low T clinics who all told me they would prescribe it but only if I would come off of TRT for a month so they could verify that my Total Testosterone is in fact below 400 ng/dL. The Endocrinologist, PCP, and Urologist all refused my request to be prescribed Aromasin. I think it's amazing that a male with abnormally high Estrogen receives no assistance from Doctors in managing it.
Thank you for your time and any help.