T Nation

At My Wits End... Please Help!


#1

Gender: Male
Age 27 was when the problems started
Race: White british
Height: 6ft
Waist 31 inches
weight: fluctuates between 75kg and 82kg
body hair: always been very minimal
Facial hair: fairly normal, not thick but an average all over growth
Fat depositation: ectomorph which maily held fat on the abdominal area but nowhere else
Health condition: no underline conditions prior
Symptoms: fatigue, general lack of wellbeing, no energy, tired yet could not sleep, weight gain, serious loss of sex drive and anxiety. All symptoms seemed to get worse over a 12 month period.
Other changes noted: did suffer from spots on back however these seemed to disappear.
Diet before: didn't really have much of an idea about food so just ate three meals a day with no focus on real nutrition.
Diet during: started a planned diet which focused on low GI carbs and high quality protein with minimal fats, eating aprox 6 times a day.
NOTE: At this stage I only used proteine powders on the odd occasion.
Diet now: is similar but with more high quality fats included and high quality vitamins with no form of any other supplementation
Drug usage: Not applicable
Training regime before: low intensity 3 to 4 days general weight training with no concentration on compound moves or leg mussels
Training regime during: started a 5 to 6 day high intesity interval training and heavy compound moves
Training now: 5 day mixture of splits, compound moves and light interval training
Testicle pain before: never
Testicle pain during: a dull ache
Testicle pain now: only ever on heavy leg days
Night time errectiins before: like a 15 year old boy on heat
Night time errectins during: completely disappeared
Night time errections now: occasionally.

Now my story so far:

About 2 years ago I was an average 26 year old male but my life saw a dramatic change when I decided to take up the gym on a full time basis. Before I go into detail I want to describe what kind of person I was before all of this took place: As a teenager I was always a late developer and once I eventually started pubity I saw dramatic changes, I suffered from the usual facial acne, horny 24/7, left nipple gyno for about a year, very slow pubic hair growth but other than that just a standard teenager. I continued to be a slow developer but this was something that never bothered me as it kept me looking young.
At the age of 20 I started going to the gym 3 times a week with no real focus on nutrition or hard training and didn't really see much results over the next 6 years, it wasn't until my best friend who is a personal trainer finally talked me into taking things more seriously that I changed my ways.... And it was from this point I started to see many changes, I was put on a 6 day training resgime and a strict diet plan which I stuck to religiously which I almost became obsessed with. To start with I lost a stone within 1 month and dropped to aprox 8% body fat, within 3 months I started to notice my sex drive disappear, within 6 months I started to feel totally fatigued and unmale like, but I couldn't stop as the results were amazing and I had never looked like this before! 8 months on I was now aprox 12 stone and about 6% body fat during this period I started to model and found myself even more obsessed but the longer things went on the worse I felt inside and things did not seem to improve, even by reducing training volume and diet changes. A year passed and i started to really worry as my relationship fell apart and my life was flashing before my eyes, it was at this point something had to be done and so I went to the doctors.

First lad results:
Total testosterone at 9am: 7.9nmol/l (11 to 34) normal range
Tsh 1.16 mu/l
Thyroid status Normal
Sodium 140
Potassium 3.9
Cretinine 123 (60 to 120) normal range
Egfr (mere) 69ml/min
total bilirubin 15
Alanine aminotransferase 35
Gamma gt 15 iu/l
Alkaline phosphatase 144 iu/l (30 to 120)
Total protiene 75 g/l
Albumin 47
Globulin 28 g/l
Free t4 10.5 pmol/l (10 to 22)
Glucose not fasted 4.6 mmol/l

Second lab results taken by doctor:

Sodium 141
Potassium 4.2
Creatinine 130
Egfr 64
9am cortisol 453 mmol/l (150 to 680)
Fsh 4.7 iu/l
Lh 1.4 iu/l (1 to 11)
Prolactin 129 mu/l (0 to 360)
Total testosterone 10.4 nmol/l (11 to 34)
UHF/1 32.9 (13 to 50)

Third lab results taken by endo specialist:

Sex hormone binding globuling 44nmol/l (15 to 48)
MRI scan taken and normal, results show no pituitary problems
Vitamin b12 540ng/l (180 to 800)
Esr 6mm (3 to 10)
Serum ferritin 117 ug/l (25 to 300)
Serum folate 14.2 ug/l (3 to 20)
Iga tissue transgluteaminase ab 1 u/ml (0 to 10)

After these results the specialist decided that there was no real explanation for my low testosterone levels as everything appeared to come back normal and decided to start TRT. He started me sustanon 250 injections administered every 3 weeks, this seemed to have very minimal results and he soon progressed the injections to sustanon 500, during this 6 month period my body and mind were up and down likeca yoyo and although I seemed to regain my body composition I still didn't feel right and my sex drive was still missing, my gyno soon returned and although my body had come back I started to get back my spots and felt bloated all over. I decided to take matters into my own hands as my specialist seemed to be out of his depth and decided to stop all treatment as I was fed up. Two months passed with no treatment and I felt worse than ever for the first month, eventually my hormones started to slowly sort themselves out and I had another blood test done.

Fsh 3
Lh 1.6
Total testosterone 7.3 nmol/l
9am cortisol level 420
Free t4 13.8 pmol/l (10 to 22)
Tsh 3.31
Cholesterol 4.8mnol/l (0 to 5)
Hdl cholesterol 2.13 mmol/l (0.9 to 1.42)
Prolactin 143 mu/l ( 0 to 360)
17 beta 0estradiol less than 150 (0 to 200)
Sex hormone binding globulin 42 nmol/l (15 to 48)

After yet another discussion with my specialist he decided to try me on testogel 50mg daily which i took for a few months And this never really seemed to change things, the only thing I did get was a different sensation when having an orgasm.

Results whilst on testogel:

Fsh less than 0.1
Lh less than 0.1
Testosterone 5.5

I am now in a course of sustanon 250 every week and 40mg of tamoxifen ed (after a months usage of tamoxifen i started to notice slight hair loss and therefore stopped it until now) I have been on this for aprox 3 months and feel ok but still not 100%, my sex drive still never returned the way it used to be apart from when I hit that first sweet spot when starting the injections. NOTE I have also has two fatility tests both showing 0 sperm count which worries me??

I want is to be normal again, my specialist has no idea what is wrong with me or what has caused this but I am scared that I have been guided down the wrong path and after doing my own research wonder if I have done the right thing. I have nowhere else to turn and the guys in here seem to know more than most on this subject.

I would very much appreciate your opinions on this matter as this has had a massive impact on my life.

Have I had all the relevant tests possible?
Have I suffered from adrenal fatigue?
Have I damaged my testicles?
Is my treatment sufficient?
Is it possible to restart my hormones naturally again?

I have many more questions and queries but feel this is a good start..... Any help or advise would be appreciated as I am due another appointment with my specialist in 3 weeks and would like to get this sorted once and for all. NOTE I live in the UK and the NHS is shocking!!!


#2

For one thing your thyroid hormone (free t4) is too low. It is almost below the range yet your TSH was normal. Is your body temperature cooler than before? hand cold? Do you get cold hands and feet often? I'd like to see a free t3 and cortisol test.

Furthermore, I would like to see how your fsh and lh is with the tamoxifen because that can raise these levels and increase fertility. So since you have been on tamoxifen can you get another fsh and lh test done and sperm sample? Perhaps you can switch over to clomid if there is no improvement in fertility (a doctor shouldn't be against this since you indeed have a bad sperm count).

I would recommend going out and buying some kelp tablets and taking like 4 a day (like 2mg of iodine). This helped give me an energy boost and improved my well being. I had thyroid issues and low T like you (my tsh was elevated though). Also you should probably supplement with vitamin d3 since that helps with mood and the endocrine system and you most likely don't get much sun light.

Your SHBG is high which keeps your sex hormones bound up. I don't know how to reduce this but it needs to be reduced...

I think that estradiol test isn't for men...usually for men it is more specific than that.

Question though...is your T much higher than before treatment? I couldn't really decipher what you were saying thanks.


#3

Hi retinoid, really appreciate u getting back to me so quickly.

First of all I want to say sorry for the lack of clarity in certain areas but I have so much to say and just blurted it all out!!!

I used to feel the cold really badly before I started TRT, but now Im forever hot if anything???

I'll ask about getting my T3 test taken on my next appointment. Cortisol levels before treatment = 453 nmol/l ( 150-680 ) norm range and during TRT = 420 nmol/l, both taken at approx 9am.

As a side note my endo has also done a full chromosome analyse, which all came back as " normal "

Thanks for your suggestion on the Supplementation, I'll give them ago and see how I get on. I'll also stick to my tamoxifen for a while and get re- tested, do u think my dosage of 40mg ed is ok??

The funny thing is I've never had a proper blood test when on T as my endo says that bloods mean nothing and it is down to the way u feel???madness if u ask me!!! Altough after lots to discussion he has arrange another sample to be taken whilst on my current medication, again though I can't see how this can give an accurate result as sustanon 250 once a week will give me highs at lows dependant on the day that I inject and the day the blood is drawn??? I know that my t levels must be quite high At the mo as my gyno has really flared up as has my acne on my back!! Would I be better off on test cyp or prop once a week?? What about HCG??? I've also heard HGH can help with sex drive etc??


#4

OK well this case is a doozy.

You REALLY need your E2 checked on with a "sensitive" test, I have no idea how to interpret that. I'd bet my bottom dollar it is sky high.

Additionally, I would not be surprised if you have a problem in your pituitary. You have low FSH/LH despite low testosterone, and you have low TSH despite having low T4. I think your pituitary is not sending out the proper signals and I would get an MRI on it if at all possible. However, you did have elevated TSH on your 2nd test. I think you have subclinical hypothyroid along with your T issues.

Your cortisol is surprisingly fine.

Your "yo-yo" effect was probably because the testosterone shots were spread too far apart. If you could self-administer and divide your shots into 2-3x per week injection schedule I think you'd do a lot better.

Tests I'd recommend: Another TSH, Free T3, Free T4, E2 sensitive, DHEA-S, pregnenolone, DHT (tested along with Total Test and Free Test), and possibly pituitary MRI


#5

Thanks for your advice scj119.

Ive already had a pituitary scan and it came back normal???

I definitely need a proper e2 test as I know that my levels r through the roof from my nipple sensitivity. What dosage of tamoxifen do u recommend??

How do u guys cope with the pain of the injections??? Once a week in the buttocks is killing me, let alone 3 times a week lol.


#6

OK, well trust the scan... but something must be up because you have no sperm count and low tesosterone yet have low FSH/LH. Dunno what that is, maybe someone else can weigh in. The tests I recommended above may help paint a more complete picture.

I'm out of my realm of knowledge talking about tamoxifen dosage

edit - forgot to mention, being excessively lean for long periods of time (i.e. maintaining it instead of just peaking for a BB show) can indeed raise SHBG/E2, if your body doensn't like being at 6%bf


#7

My endo has no idea what has caused this and what the actual problem is, which is why I'm here to be honest. It just baffles me that I was fine before I started my " healthy " lifestyle??? I must admit I was a very low body fat at my peak, but I wasn't even trying??? I just seemed to go very lean naturally.

This is what I can't understand, although I felt like crap on the inside ,I actually looked awesome on the outside for about a year?? How could I have maintained this if my natural test levels were low?? This make me think that it was a gradual occurrence, perhaps consistently over training caused this????


#8

Are you using iodized salt? Sea salt does not count unless package stated iodized.
Please check and post morning and afternoon oral body temperatures.

You need healthy fats. Low fat diets are damaging.

You will feel better with frequent small injections. With T eth or cyp you can inject SQ EOD in fat over quads or belly fat - not a pain the butt. With small frequent injections, there is no need for "long relief" testosterone products.

Have you read the protocol for injections sticky?


#9

Boy, we are living in an estrogen dominant world where men (and women) are getting exposed to chemicals in our food, water, plastics, air that cause endocrine disruptions. My THEORY is that this is behind a huge increase in thyroid problems and men with low testosterone and women with hormonal issues.

Clomid and Tamoxifen can increase testosterone (through lh and fsh) because they are 'weak' estrogens and therefore block the stronger estrogens from chemicals or from our own bodies. Since these are much weaker in binding to the hypothalamus, they don't do the job as well and the pituitary begins to secrete hormones in order to increase sex hormones since it thinks it needs more. When stronger estrogens are binding to these hormone receptors, the pituitary sends out less lh and fsh because negative feedback says 'there is enough hormone'. This...in my opinion...is usually the cause of secondary hypogonadism or pituitary problems. There are other causes of course such as pituitary tumors or severe adrenal and thyroid disease, etc...

That is why perhaps the Tamoxifen will help. KSman is right about iodine, iodine is ESSENTIAL in dealing with estrogen dominance and has been shown to be helpful in treating fibrocystic breast disease, breast cancer, prostate cancer (all hormonal disorders) not to mention thyroid and adrenal issues. We do not get enough iodine in our diets and we bombard our bodies with other halides that occupy iodine receptors but do a poor job (like tamoxifen and clomid will do for estrogen in the hypothalamus). these halides include fluoride (toothpaste, drinking water, medications, foods) and bromide (foods, drugs) and chlorine to a lesser extent.