T Nation

Army Vet Looking for Answers

36yo Army Veteran. Been back and forth with the VA on reason for my sudden lack in sex drive and other things. Finally was able to get them to do some bloodwork and my results are below. First thing the doctor had me do was do a sleep study to ensure I don’t have sleep apnea. Dr. Stated sleep apnea could cause low T which I found strange until I did some research and found it to be quite common. Sleep test came back good, no sleep apnea. They think head trauma caused by multiple IEDs and Football could have damaged the pituitary gland which could be a cause for my low T. They are also ordering an MRI to ensure I don’t have a growth near my pituitary gland.

Had a follow up a couple weeks ago and they want to start me on TRT 200mg every 2 weeks. I am still waiting on my first delivery to be made (knowing the VA I may get it by thanksgiving smh). So the first thing I do is start researching and try to educate myself. Found this site and realized there is a lot of knowledge here. So after poking around this site and researching I have a few questions:

  1. I have no clue what my results are telling me and the VA doctors are quick to get you in and out.
  2. I have seen a lot of people that are recommended every 2wk injections split them up to help keep their levels consistent. Is it smart to start out that way or should I do the dr recommended way until after my next set of bloodwork results come back?
  3. To mix it up injections sites what are some areas that some use besides the ones I have found already? (glutes, thigh, and shoulder)

Test name Result units Ref. range
PROLACTIN 17.3 ng/mL 2.6 - 26.7
FSH 2.5 mIU/mL .9 – 15
TESTOSTERONE,TOT 3.8 ng/mL 1.75 - 7.81
METANEPHRINE <25 pg/mL 0 – 57
METANEPHRINES, TOT 68 pg/mL 0 – 205
NORMETANEPHRINE 68 pg/mL 0 – 148
GLUCOSE 85 MG/DL 70 – 105
CREATININE 1.1 MG/DL .9 - 1.3
SODIUM 138 MEQ/L 133 - 145
POTASSIUM 4.4 MEQ/L 3.3 - 5.1
CHLORIDE 106 MEQ/L 96 - 108
CO2 30 MEQ/L 22 - 32
CALCIUM 9.5 MG/DL 8.4 - 10.2
TSH 2.5
FT4 0.91
IGF-1 202

Any insight, recommendations, research site/docs/etc, encouragement is appreciated.

Thanks for your time.

If you haven’t already check out the Joe Rogan Experience podcast episode with Dr. Mark Gordon - they talk a lot about vets having low testosterone due to IED’s and head trauma. Very interesting. (episodes 574 and 700)

Did your doctor give you any indication as to your hypogonadism diagnosis? (i.e. primary or secondary). Sounds like he is saying you’re secondary if he thinks the cause is head trauma. Just curious because your LH lab value (3.9 iu/ml) is very similar to what mine were (4.1) and based on this value my doctor diagnosed me as primary hypogonadal, meaning my testes were not producing testosterone despite the signal from my pituitary (LH, FSH).

Good luck getting this all straightened out. I just started on testosterone replacement about 2.5 weeks ago. You’re lucky to have found this forum from the start - most guys seem to come here only after they’re having problems from bad protocol and/or shitty doctors.

You will not find success injecting every two weeks, you’ll feel like crap the latter half of the second week do to you T levels fluctuating wildly. You need a protocol to keep you hormones more stable so you don’t feel the dip as much, injection past 7 days is not recommended, even twice a week is becoming prefered.

Self inject subq, not IM, 50mg twice a week with #29 1/2" 0.5ml [not 1.0ml]. Inject over upper leg, pinching up skin to create a slight mound and inject laterally into end of mount with needle parallel to muscles below. Pull out needle and immediately press on injection site for 10-15 seconds to allow vessels to seal off preventing bleed bruises. Some will get lumps/knots in legs or belly fat, find what works best for you.

Insulin needles slow to load, injection time is OK. Some docs will object to this because they do not understand. Absorption is slower/smoother and 100%.

In many jurisdictions insulin syringes do not need an Rx. You may need a Rx. Box of 100 ~$15 at Walmart, ReLion house brand.

You will need to be testing estradiol [E2] and should control with anastrozole as needed to get near E2=22pg/ml.

TRT shuts off LH/FSH and testes will shrink and possible 24x7 dull ache. Good risk of infertility. 250iu hCG subq EOD prevents these issue and a nice boost of mood for some. hCG is water based peptide that acts like LH and needs to be refrigerated.

Many doctors do not understand the need to test for and control E2 or to preserve testes/fertility.

TSH=2.5 is bad. Thyroid lab ranges are useless, should be closer to TSH=1.0

fT4 is low and well below mid-range=1.3

This could easily be an iodine deficiency caused by not using iodized salt or vitamins listing 150mcg iodine and 200mcg selenium.

You may be more sensitive to cold and your outer eyebrows may be sparse. Evaluate overall thyroid function as directed below.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • 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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

Thanks for the feedback.

@pdxchef First off thanks for responding. I will definitely look into the Joe Rogan Experience. Have heard alot of good things about the podcast just never got around to listening.
Per my report : . Low testosterone, secondary hypogonadism

  • pituitary MRI to evaluate pituitary gland and start testerone injections 200mg

@systemlord Thanks for the response. To start out should I start with the Dr recommended dosage until they redo my bloodwork? I ask because I want to make sure they get my dosing correct before I start changing up my dosing plan. I prefer to dose every 3-4 days but I want to ensure my dosage is correct. The Dr stated 200mg is commonly prescribed as the starting point and they will adjust after the next round of bloodwork.

@KSman Thanks for responding. You are the man on this forum from all the reading I have been doing. I found this info after I made my post. Guess I should of researched the forum more. As far as the hCG how do I go about getting that prescribed? One of Dr. questions was do I plan on having more kids and with 4 already I said no way! My daughter is a Type 1 diabetic so have more than enough syringes around the house. I will look to request further tests to the dr in hopes they see things the way I see them. I have a follow up in 3 mos

daughter’s syringes might be #31 5/16" 0.3ml - too short for T, good for hCG

0.3ml is a bit too small to a man’s hand as well

Maintaining the testes is also part of sexual self-image and how one is regarded by women.

If you tell doc that you do not want kids, hCG may not happen, do have a conversation.

@KSman Got it, thanks man for all the info. One more question on the hCG is the 250iu EOD for a period of time? or basically for as long as you want to take it?

You could start out with biweekly, but I promise you it won’t be long before you truly find out why it doesn’t workout. The best protocol would for example, injection Monday morning and Thursday evening so you can perfectly time the half life of T, since it tends to start dipping Thursday evening. You would be able to keep you T levels super stable avoiding the dips that cause peaks and valleys. Your SHBG is likely going to go down once you start TRT so the twice weekly injection become very important, my SHBG was exactly the same as yours before starting TRT and last time I checked it was 18 at the 4 weekly blood test.

@systemlord I am just worried about accepting that 200mg every 2 weeks is the right amount for me. I want to ensure they have me on the proper dosage. My father-in-law is on TRT and was prescribed 200mg every 2 weeks but they adjusted after his first bloodwork to 200mg every week.

For IM injections you should aim to not use the same muscle more than once a week. Unless one of the three you mentioned is a problem, you can stick with those (no pun intended).

Typically 200 mg weekly is at the upper limit for weekly dosage, you won’t know what dosage is right for you until you start TRT, trial and error. I was given 200 mg every 14 days and it was too much T for me, settled at 75 mg weekly which puts me at about 600 ng/dL. Doctor will up dosage for me if she feels I need it, to soon to tell.

250iu SC EOD is forever, close to stimulation of natural LH levels. hCG is not a drug, it is a natural human hormone and this peptide has one lobe that is functionally the same at the active lobe of LH.

“The beta subunits vary. LH has a beta subunit of 120 amino acids (LHB) that confers its specific biologic action and is responsible for the specificity of the interaction with the LH receptor. This beta subunit contains an amino acid sequence that exhibits large homologies with that of the beta subunit of hCG and both stimulate the same receptor. However, the hCG beta subunit contains an additional 24 amino acids, and the two hormones differ in the composition of their sugar moieties.”

“The different composition of these oligosaccharides affects bioactivity and speed of degradation. The biologic half-life of LH is 20 minutes, shorter than that of FSH (3–4 hours) and hCG (24 hours).”

Half-life 24-36 hours.