T Nation

Beginning my Journey with Low-T (Looking for Guidance)


#1

Hello,

Been two years with low T results from labs, and am seriously thinking about going on TRT, but know nothing about it, and want to be educated about what I really need.

Basics:
45 years old
6’1"
195lbs
Harry legs, chest and back
Bald spot on top
Carry fat on my belly.

I eat a fairly healthy diet, no fast and junky foods, although I do have high cholesterol. My LDL levels are 172. Interesting my HDL is 55 (good) and my triglycerides are 92 (good). I work out about 4 days a week. 2-3 full body workouts, lasting no more than 40min. I also swim laps on off days for about 20-30mins, not aggressively.

I am not taking any medications, except for spot CIALIS when sex is on the line for a weekend. Hard time maintaining erections without CIALIS, they are short lasting and weak. I have poor blood flow to they extremities. Nocturnal erections come and go … sometimes very strong.

My wife and I do drink a lot. We go out a lot and drink, and sit on the couch and drink. Usually lite beer and white wine. But often a bottle of wine each with a few beers to boot.

I am happy person, and have a very fun and sexy wife. I am lethargic in the morning, and have for my whole life, had a difficult time getting going in the AM, and waking up. Have struggled with confidence issues my whole life. But on the whole, I am not depressed. Often lethargic and forgetful however.

Here are my latest lab results. Prior to the below results, my previously testosterone totals were 323 and then 306. And now:

TESTOSTERONE, FREE
8.98 ng/dL
4.26 - 16.4 ng/dL
Testing performed by Equilibrium Dialysis.

TESTOSTERONE, TOTAL
264 ng/dL
240 - 950 ng/dL
Testing performed by Liquid Chromatography-Tandem Mass
Spectrometry (LC-MS/MS).

Test Performed by:
Mayo Clinic Laboratories - Rochester Superior Drive
200 First Street SW, Rochester, MN 55905
Laboratory Director: William G. Morice, II, M.D., Ph.D.

Please help my decide on the next step of the journey. Does TRT seem like something that would help me?

Thank you.


#2

Find a doctor. It seems like more of them are becoming receptive to trt. You need to get familiar with the language of trt first. Read over all the stickies in the Replacement forum menu. There is some great information there that will help you communicate to your doctor what your hopes are. After that a good start is to just start calling doctors offices. If a doc is treating patients for trt, the receptionist usually knows about it and has enough info to answer a few questions. Good luck…Im just getting started myself…my first appt is in 2 days!


#3

:Please read these; found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basis explained
  • finding a TRT doc

Labs:
TT
FT
E2
LH/FSH before TRT and while on SERM
prolactin
CBC
hematocrit
fasting cholesterol
fasting glucose
cortisol results with time of day
AST/ALT
TSH
fT3
fT4
rT3
DHEA-S
IGF-1

What is your history of [not] using iodized salt or vitamins listing iodine+selenium?

Post your oral body temperatures as per the thyroid basis explained sticky.


#4

Here is my CBC WITH AUTO DIFFERENTIAL labs. Not sure if this helps? Sorry I am such a noob. Do I need to request a specific bloodiest? List out all of the items to my doctor and ask for that work?

Component Your Value Standard Range
WBC’s 4.29 10(3)/mcL 4.00-12.00 10(3)/mcL
RBC 5.24 10(6)/mcL 4.40-5.80 10(6)/mcL
HEMOGLOBIN (HGB) 15.9 g/dL 13.0-16.5 g/dL
HEMATOCRIT 47.5 % 38.0-50.0 %
MCV 90.6 fL 82.0-96.0 fL
MCH 30.3 pg 26.0-32.0 pg
MCHC 33.5 g/dL 31.0-36.0 g/dL
PLATELET COUNT 220 10(3)/mcL 140-440 10(3)/mcL
RDW 12.7 % 11.8-15.5 %
MPV 10.3 fL 8.0-12.6 fL
NEUTROPHILS 50.1 % 40.0-68.0 %
LYMPHOCYTES 33.3 % 19.0-49.0 %
MONOCYTES 11.9 % 3.0-13.0 %
EOSINOPHILS 4.0 % 0.0-8.0 %
BASOPHILS 0.7 % 0.0-1.0 %
ABSOLUTE NEUTROPHILS 2.15 10(3)/mcL 1.40-5.30 10(3)/mcL
ABSOLUTE LYMPHOCYTES 1.43 10(3)/mcL 0.90-3.30 10(3)/mcL
ABSOLUTE MONOCYTES 0.51 10(3)/mcL 0.10-0.90 10(3)/mcL
ABSOLUTE EOSINOPHILS 0.17 10(3)/mcL 0.00-0.50 10(3)/mcL
ABSOLUTE BASOPHILS 0.03 10(3)/mcL 0.00-0.10 10(3)/mcL
NRBC PER 100 WBC 0


#5

Please note all points/issues in my posts, not just one or partial.

Yes, if you want labs, ask for them.


#6

Ok, here are the results you requested (below). Doctor wants to put me on TRT and Triiodothyronine (T3) 12mcg : Levothyroxine (T4) 12.5mcg. Anxious for second opinion. Thanks all!

Testosterone, Total (ng/dL): 317.4 (249.0~836.0)
Free Testosterone (ng/dL): 7.89 L (9.00~30.00)

FSH (mIU/mL): 2.0 (1.5~12.4)
LH (mIU/mL): 4.4 (1.7~8.6)
Prolactin: 5.4 ng/ml (4.0-15.2)
Hematocrit (%): 48 (36 - 50)

Total Cholesterol: 234
LDL: 148
HDL: 44

Cortisol AM: 42.624 nmol/dl (8.5-9)
Cortisol Noon:7.449 nmol/dl (5-6.5)
Cortisol Evening: 3.354 nmol/dl (3-5)

ALT: 24 U/L (<51)
AST: 29 U/L (<41)

TSH: 1.25Uiu/mL (0.400-4.500)

T4 Free : 1.1 ng/dl (0.7-1.8)
T4 Total: 4.1 ug/dl LOW (4.5-11.7)
T3 Free: 2.8 pg/ml (2.0-4.4)
T3 Total: 80 ng/dl (80-200)
T3 Reverse: 10 (8-25)

DHEA-S (μg/dL): 239.4 (44.3~331.0)
Human IGF-I* (ng/ml): 124 (61~303)


#7

Please edit your post above, find pencil icon, and add lab ranges.

Your IGF-1 is low, indicating low GH levels. You would do better with hGH injections, but the costs are ~$10 per day. So if you cannot manage the costs, then no need to repeatedly test IGF-1.

Lethargy [alcohol related?] can be from low thyroid function and/or low-T. Many guys here have issues with both.

TSH is not bad.
fT3 is a bit low. - might be leading to low body temps and low thyroid function.

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.

Your low rT3 suggests that you probably do not have any problems with rT3 interfering with fT3 and adrenal fatigue is not suspected.

You have secondary hypogonadism and prolactin is not the cause. You need TRT. At age 46, you might work with hCG injections for a few years, but may need to go straight to self-injected T, but hCG still required to support the testes if that is important to you.

What is your history of [not] using iodized salt or vitamins listing iodine+selenium?

You repeatedly miss my points and questions. Please review this whole thread.


#8

KSman, thanks for your response.

I have edited my post above to reflect the lab ranges.

My wake up temp is 96.7º
My lunch time temp is 96.8º

I do not take any vitamins, never really have. I eat table salt (Idoized) sparingly.


#9

Lets assume that you are iodine deficient. Now you need to fix that.

The big concern I have is that I have never seen a doctor ask about iodized salt use. But they will treat iodine deficiency with Rx thyroid meds. Read the thyroid basics sticky.

Find a good B-complex multi-vit with trace elements and 150-170mg iodine + 150-200 mcg selenium. A selenium deficiency can be dangerous. Get a vitamin that does not list added iron.

Your Hematocrit, HTC=48 is quite high relative to your FT. This strongly suggests a risk of high HTC, RBC and hemoglobin with TRT and you need to avoid iron fortified foods: rice, pasta, bread, cereals.

Cortisol is scary. Describe body shape and proportions. Thin limbs? You carry/gain fat easily or are thin and how has that changed and how were you when T levels were assumed OK? Edgy or nervous? Energy levels and fluctuations?