T Nation

BirdHunter Case Thread


#1

BirdHunter

Age 48
Height 5' 10''
Waist 48"
Weight 255

No signs of hair loss on head but very fine hair. Facial hair grows somewhat uneven, light mustache.
Body hair is thin and light, especially armpits where hair has always been almost non-existant.

Almost all fat is on my belly. Some underarm boobs. I have been fat since about age 10. Ass is (too) small. Legs are ripped. Calves are big and well defined. I get compliments on my legs (25" thighs)/calves(18").

Health conditions include a history of moderately high blood pressure up to 160/100 when taken at doctor or dentist. Usually more like 140/85 outside medical setting. Hypoglycemia diagnosed 15-20 years ago with GTT and managed with low carb intake. Obviously induced by poor diet. My teeth are bad. Always a 'night person'. Traditionally very difficult to sleep at a normal time and very tired in the morning.

The only food that ever gave me energy was sugar. For years I was confused when people said things like 'I am tired I need to have a bite to eat'. Food made me tired. At times I would sleep minutes after eating dinner. Sugar gave me energy to make it through the day. I have had some success with a low carb diet. Always had very sensitive stomach. Commonly alternated between constipation and diarrhea.

I have successfully managed it with digestive enzymes and/or probiotics and tons of fiber. I suspect insulin resistance. I suspected Hashimoto's, my sister has it and has taken Synthroid since she was about 13 years old. Discussed with multiple doctors, and repeatedly told I didn't have it because it is a woman's disease.

No Rx drugs for 5 years at least. I tried various supplements. Digestive enzymes, vitamin B complex, potassium (history of electrolyte issues in family), large doses of C, chromium, iodine, Trillium Tribellus, fish oil. More recently focused on testosterone related supplements including, vitamin D, DHEA, Zinc, fish oil, Magnesium (to aid sleep).

Currently limiting or eliminating them in anticipation of blood work. Never touched hair or prostate meds. I have done several rounds of corticosteroids for a lower back injury.

The following was performed by LabCorp (via PrivateMD Labs)

TT, LC/MS 291.9 348.0-1197.0 ng/dL LOW
FT 5.6 6.8-21.5 pg/mL LOW
E2 <5.1 7.6-42.6 pg/mL LOW Roche ECLIA methodology
LH 4.3 1.7-8.6 mIU/mL
FSH 3.9 1.5-12.4 mIU/mL
Prolactin 11.6 4.0-15.2 ng/mL

TSH 3.390 0.450-4.500 uIU/mL
T4 Free 1.43 0.82-1.77 ng/dL
T3 Free 3.3 2.0-4.4 pg/mL
TPO Ab 10 0-34 IU/mL
Thyroglobulin <1 0.0-0.9 IU/mL

Lymphs (Absolute) 3.3 0.7-3.1 x10E3/uL HIGH
Sodium, Serum 147 134-144 mmol/L HIGH

Cholesterol, Total 193 100-199 mg/dL
Triglycerides 197 100-199 mg/dL HIGH
HDL Cholesterol 35 >39 mg/dL LOW
LDL Cholesterol Calc 119 0-99 mg/dL HIGH

I am surprised by the E2. Given my body fat I believed I would be high estrogen. I included things out of range. I can upload the full lab report if it is helpful. I can't explain Lymphs. I suspect Sodium was mild dehydration. I had a hard time producing for the urinalysis. Doctor already tried to put me on 2 hypertension drugs (losartan and amlodipine). I told him I would investigate them. They look horrible. I suspect he will try to get me to take a statin. I suspect he will try to give me T cream. I plan to push for self administered injections 50mg E3D.

Currently breakfast with yogurt smoothie, glutamine, creatine, protein powder and a lot of psyllium. Low carb works pretty well for me if I carefully manage fiber. Eggs mid morning/pre workout, some high protein snack post workout, meat, vegetable and salad everyday for dinner. Not super strict low carb at this time.

Went strict about 2 years ago and dropped around 50 pounds in just a few months. I have been the same weight since then, but slowly changed body composition. More muscle, same weight on scale for about 1.5 years (Unusual for me. I can normally gain or loose weight easily. Maintaing a weight has always been very difficult for me). Now I feel stalled (about a year at 250) in weight loss and muscle/strength gains.

I train about 3 hours 3 days a week. I walk/run HIIT style on a track 2 miles to warm up then do some yoga/stretching. I have been focused on compound lifts for about a year. Learned to love deadlifts (actually rack pulls). I was always terrified of aggravating my back but found them very beneficial. I don't lift a lot of weight. My rack pulls are up to 185 and a couple inches below my knee. If I pull lower I feel it in my low back. I am scared to go much heavier. My back has seriously hurt me before. I have 2 herniated disks (L3-4 and L4-5). I am still numb on parts of both legs, I think it is permanent nerve damage. I have been working on squat depth and feeling some pain in the front of my right hip (flexor?) so my squat is light like 135. I do front squats. Regular squats hurt the base of my neck and make me learn forward too much. I think I lack shoulder flexibility to get the bar positioned correctly for back squats and I think the front squat allows me to protect my low back. My bench is a mess. I was up to 185 but never felt and pump or burn or DOS in my pecs. My shoulders were taking all the wear so now one is sore. My elbow (bicep/funny bone) has also been bothering me. I quit bar bench and do light dumb bell and mostly rotator cuff work. I watch the videos and read the articles, but I am considering a strength training coach to see if I can do something to improve my form or balance muscle so I don't get joint pain. I have to figure out how to go about finding someone in my area (south Florida), and the best kind for me to look for (Power lifter, maybe? I want perfect form to avoid injury).

Testes rarely hurt. One time many years ago I wore a union suit hunting and got some soreness after a long walk. I think the inseam was putting pressure on my testes. When I get a fever my testes usually ache a bit like my hands and other joints (general inflammation). About 9 months ago a noticed a varicocele. I didn't know what it was and thought it might go away. It didn't and I researched it and figured out what it was and that it was not going to just go away. It aches very mildly occasionally. It is one of the reasons I am suspected low T.

Morning wood is a thing of the past. I have started having problems maintaining an erection. I can usually (but not always) get hard, but any distraction or change of position and it is probably gone. My wife on the other hand is my age and hornier than she has ever been in the 30 years we have been together. This is another reason I am looking into TRT.

I read that fat guys should not be taking steroids. I read TRT can help weight loss.
I read T can increase blood pressure (is this for very high doses?). I read T can lower blood pressure...!?!?
At my weight and blood pressure should I be safe doing replacement doses?

Thank you


KSman is Here
KSman is Here
#2

What’s wrong with this: "Triglycerides 197 100-199 mg/dL HIGH "

No statin drug please.

TRT can:

  • lower blood sugars
  • lower BP
  • lower cholesterol
  • enable fat loss

TSH 3.390 0.450-4.500 uIU/mL
T4 Free 1.43 0.82-1.77 ng/dL
T3 Free 3.3 2.0-4.4 pg/mL

TSH is way too high.
Have you always used iodized salt?
T4 and T3 are nicely mid range. But we don’t care about bound hormones.
Your thyroid labs should be:
TSH
fT3
fT4

Check your overall thyroid function by taking your ORAL body temperatures

  • when you first wake up
  • AND mid-afternoon

If you don’t get much sun exposure, you may need to take vit-D3.

Labs:
TSH
fT3 [if midrange or higher and low body temps, then get rT3 tested
fT4
IGF-1
AM cortisol
vit-D25 or just take 5,000iu per day
CBC [should include HTC]
DHEA-S

Get those labs, focus on thyroid !!!

Stickies:

  • advice for new guys
  • thyroid basics
  • finding a TRT doc

You many need an age management doc who can think outside of the T-box.

Body temps and iodized salt use report are first deliverable.

Ping me on KSman is here thread when you have some new material here.


#3

[quote]KSman wrote:
What’s wrong with this: "Triglycerides 197 100-199 mg/dL HIGH "
[/quote]

I copied the wrong range, it should be
Triglycerides 197 and the correct range is 0-149 mg/dL HIGH

[quote]KSman wrote:
No statin drug please.
[/quote]

I agree 100%. I won’t take any of them.

[quote]KSman wrote:
TRT can:

  • lower blood sugars
  • lower BP
  • lower cholesterol
  • enable fat loss

TSH 3.390 0.450-4.500 uIU/mL
T4 Free 1.43 0.82-1.77 ng/dL
T3 Free 3.3 2.0-4.4 pg/mL

TSH is way too high.
Have you always used iodized salt?
T4 and T3 are nicely mid range. But we don’t care about bound hormones.
Your thyroid labs should be:
TSH
fT3
fT4
[/quote]

Those are free T3 (Triiodothyronine,Free,Serum)and free T4 (T4,Free(Direct) which came with TSH).

I have occasionally received gifts of fancy salt but 95% of the time use regular iodized table salt and plenty of it. I never eat seafood, but enjoy some seaweed and have tried a liquid iodine supplement. I didn’t notice any changes.

[quote]KSman wrote:
Check your overall thyroid function by taking your ORAL body temperatures

  • when you first wake up
  • AND mid-afternoon
    [/quote]

I did basal body temperature for 5 days prior to visiting my doctor. The average was 97.32 degrees with the lowest reading being 97.1. Doctor was irritated and told me it was fine and he had patients with much lower reading than that who were just fine (idiot, I know). I will start doing afternoon temperature. At the doctors office I was 98.5 at 11:30 am. I generally run hot and sweat profusely, but not in my armpits. I sweat in my face/head/neck. I can be soaked to my bellybutton and still dry under my arms.

[quote]KSman wrote:
If you don’t get much sun exposure, you may need to take vit-D3.
[/quote]

I live in south Florida so I do ok with the sun. I didn’t realize how great sunshine was until I moved here. When I leave I miss it. I take 6000 iu/day vit D3 anyway and came back with:

Vitamin D, 25-Hydroxy 42.8 30.0-100.0 ng/mL

I was planning on increasing to 8000 or maybe even 10000 iu.

[quote]KSman wrote:
Labs:
TSH
fT3 [if midrange or higher and low body temps, then get rT3 tested
fT4
IGF-1
AM cortisol
vit-D25 or just take 5,000iu per day
CBC [should include HTC]
DHEA-S
[/quote]

I was planning on reverse T3 next time since I didn’t see anything conclusive with Hashmoto’s. I don’t have a good explanation for Lymphs. My immune system is doing something but I don’t know what.

Lymphs (Absolute) 3.3 0.7-3.1 x10E3/uL HIGH

I got CBC, I am not sure what HTC means. I got Complete Blood Count with Differential.
I attached it to this message.

Do you have any preliminary thoughts on why my E2 is so low?

E2 <5.1 range is 7.6-42.6 pg/mL LOW

Given my % bodyfat I really expected it would be high.

[quote]KSman wrote:
Get those labs, focus on thyroid !!!

Stickies:

  • advice for new guys
  • thyroid basics
  • finding a TRT doc

You many need an age management doc who can think outside of the T-box.

Body temps and iodized salt use report are first deliverable.

Ping me on KSman is here thread when you have some new material here.
[/quote]

I will reread the stickies. I am also unconvinced that my thyroid is functioning correctly. My sister, aunt and 2nd cousin are all diagnosed with Hashimoto’s. My sister’s went to secondary/IBS symptoms recently.

I found a doctor who looks good and will use dried thyroid instead of just synthroid, but he is very expensive and essentially wants a retainer ($1200/ 6 months) and does not accept insurance. I have a follow up with family doctor early next week and won’t have the additional labs in hand. I am almost certain he will say my thyroid looks fine. Should I plan to say no thanks on blood pressure and cholesterol drugs and push for self injected testosterone, or do I need the additional labs before taking testosterone?

Thank you


#4

Sorry, my eye missed “free”.

“With those lab numbers, there is enough fT3 to maintain body temperatures.”

Suspect that rT3 is blocking rT3 from entering your cells via T3 receptors.

If rT3 is elevated, the more T4 you have or take, you get more T4–>rT3. So rT3 lab results will have significant meaning.

Please get afternoon body temps that are not at doctors office where you have been waking around and talking.

Lymphs: Your immune system is busy all of the time. This is slightly high and you might have been quietly fighting something off.

E2 is from fT–>E2. T+SHBG does not aromatize. And your liver is clearing E2 efficiently. We do see this level in many guys. So no big deal. You will feel better with some more E2.

LEF.org is near you and they have lab work on sale in April. If you get a membership, they can help with referrals as well, but probably not to low cost services. Refer to the finding a TRT doc sticky.


#5

I have been injecting Watson Test C at .25ml or 50mg every 3 days (116mg/week) since the end of March. I use a 1ml syringe with a 20g draw needle and change to a 25g needle for injection. I just did blood work and got the following results from Labcorp. The draw was first thing in the morning of the 3rd day after last injection.

Testosterone, Total 203 (348-1197)
Free Testosterone 5.9 (6.8-21.5)
Estradiol 13.2 (7.6-42.6)
LH 0.1 (1.7-8.6)
FSH 0.2 (1.5-12.4)

My normal/natural TT prior to starting TRT was 291. My E2 was low off the scale (<5). My doctor advised me to change to one 100mg injection once per week with a 3ml syringe and 21g needle for draw and injection. I have very little confidence that this will improve my situation. Anyone have thoughts?


#6

It is impossible that 100 mg once per week will work better than 50 mg per 3 days.

For you, the 50 mg per 3 days appears inadequate. I would try 70 mg (0.35 mL) per 3 days, which would come to 163 mg/week, which can still be within TRT range.

LH and FSH will stay depressed, as your present dose as well as the above dose are inhibitory.


#7

This is my latest blood work. I am injecting TestC 80mg E3D (186mg/week)

703.8 Testosterone, Total (348-1197)
34.2 Free Testosterone, Direct (6.8-21.5)
47.3 Estradiol (7.6-42.6)

Historically I have a hard time getting to sleep and a hard time waking up. This changed dramatically for a while after I started 80mg. I would fall asleep quickly and easily, and wake wide awake. I was not sleeping for long and started to wake earlier and earlier, as early as 4:45am. Some sort of morning insomnia I think. I was not tired during the day and enjoyed being wide awake first thing in the morning.

In the past week a couple things came up. One is that I am again having trouble falling sleep. When I wake up I am groggy. I am wondering if I blew through the sweet spot for my E2 level.

The other thing is the past 2 times I went to the gym my nipples became hyper sensitive while lifting. Both times it happened early in my workout while doing rack pulls. My shirt gets wet from sweat and my nips get as hard as rocks. It is not exactly painful and they are normal outside the gym. It might be chafing but it never happened before. I am concerned about gyno, but I am unsure at what E2 level gyno becomes a significant risk.

I am concerned about my E2 and have been thinking about adding some aromasin, not sure about the dose. As I understand it, this is a better choice than arimidex. I am unsure why the protocol recommended here suggests arimidex instead of aromasin.

I am planning to add some HCG, also undecided on dose but probably something like the recommended 250iu E2D.

I am unsure about the high Free Testosterone. As I understand it, freeT converts to E2. So high freeT means more E2? Is freeT something which can be managed or do I ignore that and try to reduce my E2 directly?

Summary is as follows: baseline/pre-TRT -> 116mg/week (50mg E3D) -> 186mg/week (80mg E3D)

Weekly Dose — 0 — 116mg — 186mg

Total Test — 291 — 203 — 703
Free Test — 5.6 — 5.9 — 34.2
Estrogen (E2) — <5 — 13.2 — 47.3

Thanks for reading and any suggestions or insight you may offer.


#8

Birdhunter,

Any improvement in the sexual function department with a rise in that T?


#9

Yes but I think it may be dropping off a bit. It might be getting a little harder to orgasm. I don’t have problems with oral but sometimes run out of gas during intercourse. Maybe leg lock helps. Cialis helps but not 100%. It might be conditioning. I stopped my cardio. It might be blood pressure related. I read HCG can help in the sex department.

I seem to be collecting soft tissue injuries. Shoulder first, then I sprained my ankle and hurt my jaw/tmj. The ankle still hurts when I try to do cardio. I am a bit concerned about suppressing soft tissue repair. I have a couple herniated discs and worry that TRT will increase their rate of degeneration. I am putting on a good bit of muscle and dropping belly fat. Scale is about the same.

Today my doctor ‘terminated our relationship’. We had been debating about subQ at the last visit. He insisted that it is not possible to push oil through an insulin syringe and you can only subQ water based Test (prop). I showed him the canadian subQ study today. We are ‘not on the same wavelength’. No charge for the visit. So I am doctor shopping now. I am not sure if I should drop and PCT so I can start fresh or try to find a doc who will pick up where I am at now.

I still have 30 weeks of Test at my current dose. I am not sure if I should back off the dose to 160mg ish, start an AI+HCG on my own, try to find a new doc, or PCT off and start over with someone new.

If E2 is controlled is fT still an issue?


#10

Your E2 at 47 is very high for these T levels it should be between 20-25.are u using anti armoatase.


#11

I am not taking an AI. When I suggested it to my doctor he said he never prescribed it before and he would have to refer me to an endo if I wanted that. I heard enough stories about endos that I didn’t want to go down that road so I took the scrip for test and went on my way. My baseline E2 was was near zero so I hoped I would not require AI at TRT dose and didn’t feel I should be taking meds that I didn’t need. I understand this is not going to be the case.

After weeks of excellent sleep I am now having problems falling asleep. When I do sleep I am waking up soaked in sweat. I am again having erectile problems and when I do orgasm it does not feel as strong as it has felt. I am not sure if I should use aromisin or arimidex. I am not sure if an AI will solve all my problems or if high fT needs to be addressed.


#12

Low energy:
rT3, thyroid, iodine and temperatures
IGF-1 to eval GH


#13

Oh sorry i missed ur E2 its pretty low it should be 20 around.urs is less than 5 it can cause problems it should be 20 around.
Either retest may be bad test. how ur E2 is so low.


#14

[quote]sonudv8 wrote:
Oh sorry i missed ur E2 its pretty low it should be 20 around.urs is less than 5 it can cause problems it should be 20 around.
Either retest may be bad test. how ur E2 is so low.[/quote]

My baseline E2 before any TRT was <5.
At 116mg/week E2 went to 13 with TT 203.
At 186mg/week E2 went to 47 with TT 703.

I know I need an AI. I am not sure Arimidex or Aromasin.

My freeT went high out of range to 34 while my TT is at 703.
Do I need to address freeT or just get on something to get E2 down?


#15

FT is above youthful levels and your T dose is high. TT is not high, so SHBG must be lowish which it quite odd considering your high E2.

Yes, you need AI. Anastrozole is the most cost effective product.

You can try 15-20% less T.


#16

[quote]KSman wrote:
FT is above youthful levels and your T dose is high. TT is not high, so SHBG must be lowish which it quite odd considering your high E2.

Yes, you need AI. Anastrozole is the most cost effective product.

You can try 15-20% less T.
[/quote]

‘Lowish is quite odd’ because E2 raises SHBG? My baseline E2 was below measurable value.

So as fT aromatizes into E2 this should stimulate SHBG? I ordered Armidex and will take the first .5mg as soon as it arrives. This should lower E2 which will in turn lower SHBG which in turn will further raise freeT, correct? I read low SHBG individuals tend to over respond to Arimidex. Can anyone corroborate this? Should I begin with .5mg E3D with my injection?

I will continue to investigate thyroid. I have long suspected an issue as my sister, aunt and cousin have all been diagnosed with Hashimoto’s. However, my thyroid antibodies came back in range.

I am very curious about the relation of low SHBG and metabolic syndrome. I had a 5 hour Glucose Tolerance test in the 1990’s and did not fare well. I was diagnosed hypoglycemic. I have suspected insulin resistance for quite some time and have considered taking Metformin to improve my sensitivity.

My most recent blood test had an unusual related value:

Serum Glucose 60 (LOW) 65-99 mg/dL

This was the draw that came back with 703 TT, 34 fT, and 47 E2.
My prior blood work both came back at 94 and 91.
I am not sure why my Glucose went so low. I felt good.

Finally I read that more frequent and possibly daily subQ injections may help. I inject TCyp E3D now. I am not sure more frequent TCyp injections will make a difference. I read Test Prop may be a better choice as it works and clears before it can be bound and thus converted(?). Is TProp a better choice for me?


#17

Metabolic syndrome aka syndrome-X, in males, is characterized as low T, estrogen dominance and elevated SHBG. So you do not fit neatly into that.

Thyroid auto-immune diseased can be promoted by selenium deficiencies. Perhaps there is a familial sensitivity to lower selenium intakes.
Iodine deficiency leads to high TSH which can promote autonomous thyroid nodules, making high levels of hormones and then you are hyper and cancer can happen. Accelerated thyroid function [hyper or high TSH] with low selenium is also a problem.

These improve insulin sensitivity: improving cell wall permeability and mitochondrial metabolic rate
TRT
lower E2
fish oil
CoQ10 - ubiquinol type please
r-lipoic acid
cetyl-l-carnatine
natural source vit-E
vitamin C
vit-D3 5,000iu
chromium picolinate
B-complex multi-vits with trace elements and anti-oxidants including iodine and selenium
optimal thyroid function, >>>>check body temperatures as per thyroid basics sticky<<<<
DHEA is DHEA-S is low

Your info about prop is wrong. When the ester groups are removed, all T esters yield bio-identical T.

You need E2 near 22pg/ml. If very low, you will never feel right.