Can't Wait To Feel Better

Pharma / TRT Testosterone Replacement
1

Hey Everyone. Been lurking here for a while now trying to educate myself on everything I see popping up on the boards. My initial thoughts were that I was Low T because what I believe is an almost non-existant sex drive and EQ problems. Through my research I have found that there are numerous reasons for these complications as well as other symptoms that I have exhibited but am now beginning to think are just not normal.

-age: 25
-height: 6’-6’1"
-waist: 39"
-weight 240
-describe body and facial hair:Can’t grow a full beard but noone in my family can. Facial hair seems to be growing in a little faster recently. Large amount of hair around my naval, lighter hair on my chest (Not sporadic but not a forrest either), legs are pretty hairy, upper arms and shoulders sporadic hair, almost no hair on my back.
-describe where you carry fat and how changed: Have always carried most of fat around my midsection with a thinner coating on upper chest. My legs and arms are fairly lean.
-health conditions, symptoms. Low Sex Drive, EQ issues, lethargic (Getting out of bed normally takes 10-15 minutes to get enough motivation to do it, get tired around 10am and sometimes I practically fall asleep driving home from work ~3:30PM), brain fog and difficulty concentraiting on the task at hand, the list goes on.
-Rx and OTC drugs: 2x dose Opti-men multi, 1G Arginine 3x day, 2G fish oil 3x day, 5k iu D3 2x daily, recently started drinking GNCs Superfoods product before bed.
-lab results with ranges: Pending
-describe diet: I eat around 2300-2500 calories a day when I’m counting. I try to adhere to a keto diet although not as closely as I once did. I would think all of the extra saturated fats would have helped in the T/Libido area so I am beginning to think something else might be the culprit. A typical day for me will typically consist of 4 extra large scrambled eggs with some cheese on a low carb/high fiber tortilla, snack on almonds through out the day, today was some cheesburger with a dijonaisse sauce for lunch, dinner might normally be something like meatloaf, sausage and peppers, or a cream cheese stuffed chicken breast. Also have my PWO shake which is whey, creatine, and dextrose plus a GNC superfood shake before bed.
-describe training: Try to train 4 days per week but it normally winds up being 3. Day 1= legs (squats, good mornings, leg curls, calf raise and maybe leg press), Day 2= Chest/Shoulders (Powercleans, flat bench, inc bench, inc lat raises, shrugs, pec deck) Day 3= off Day 4= back (Deads, 1 arm row, seated rows, pullovers, trap 3 raise, face pulls) Day 5= arms but this normally winds up being the workout im ok with missing then I’m off sat and sun.
-testes ache, ever, with a fever? No
-how have morning wood and nocturnal erections changed: I do occassionally get morning wood. My erections have been somewhat better recently as I have discontinued all Pre-WO drinks and stims (caffeine as much as possible and 1,3 DMAA)a few weeks ago. I have also been taking 10k iu D3 daily for a handful of weeks now. As far as EQ goes I can get it up but then he tends to disappear without constant stimulation. Weird thing is sometimes I can just be driving around or sitting at my desk and a random one will pop up and hang around for a while on it’s on… Not sure if this has any bearing on anything but to my knowledge this has not happened while standing or laying down, only seated.

I am trying to get in to see my doc to get the following tests locked on:
-Metabolic Panel
-Fasting Lipids
-CBC
-LH & FSH
-TT
-FT or Bio T
-E2
-DHT
-DHEA-S
-Vit D 25 OH
-Pregnenolone
-TSH
-fT3
-fT4
-rT3
-Cortisol 4 sample test
-Prolactin

If you could please let me know if there is anything I failed to pick up on reading the stickies that would be beneficial. Also, if anyone has any advice for how best to approach this with my Dr. so he doesn’t think I’m a hypochondriac… I was thinking of just going about it from the “I want to see what my baseline is like and to satisfy my own personal curiosity”. My insurance carrier uses quest labs so I would also like to know what everyone thinks the ballpark cost for all of the above tests might be because I do have a bit of a deductible to cover first. Would it be cheaper for me to come out of pocket for another option like privatemdlabs??

Any help you guys can offer is greatly appreciated.

2

you only really need the extra thyroid tests if your TSH comes back > 1 and you have symptoms. Most docs won’t test the others on the first go around. heck, most won’t test even with a TSH of 3 or 4.

go for the basics first - if you can get more great, but have a defendable bottom line.
TSH
Total T
Free T
E2
SHBG
D25-OH

  • standard basic tests

then the could-be-helpful tests:
DHEA-S
Pregnenolone
Prolactin
ferritin
8am Cortisol or 4 sample saliva test
DHT
B12
etc. - per the blood test sticky.

3

Thanks for the reply, Purechance. I feel like I am exhibiting adrenal fatigue symptoms so should I fight for the cortisol as one of my must have tests or will one of the others cue me in on whether or not fatigue is an issue? Also, do I need SHBG? I thought I read somewhere that if you had TT FT and E2 that you could more or less infer what you SHBG levels were.

4

those are just my thoughts… by all means bump up cortisol to your must have list if you have concerns. It all really depends on how open minded your doctor is. low ferritin sometimes goes hand in hand with adrenal/thyroid issues so you might want to bump that one up as well.

and yes, you can infer SHBG levels, but it is also nice to have them to confirm.

5

So I had about 8 vials drawn the other day for the below tests and should have my results back in another day or so.

-TT
-FT
-E2
-8 (6:45) AM Cortisol
-D25-OH
-TSH
-Complete Metabolic Panel
-Fasting Lipid Panel
-STD screen for good measure… haha.

So this morning I started monitoring my body temp as per the advice found in the forum and I am going to track my daily temps on that temperature spreadsheet. This morning when I woke up my temp was 96.2 and the average for the additional 3 temps throughout the day was 96.9. I would like to know if this is REALLY low or just kind of low.

Also, through the end of the day I was suffering mind numbing exhaustion and I could barely stay awake driving home and at the gym. As I mentioned above I try to adhere to a keto diet… Is it possible that I am going hypoglycemic or is it more likely that I probably have some hypothyroidism or other associated issues more commonly found in this forum?

6

could be any of the above - glucose levels, adrenal issues, thyroid issues, or hormonal issues… most likely adrenal. a 4 times daily saliva cortisol test by Quest or LabCorp could easily confirm.

yes, 96.9 avg is really low (although most docs will dismiss it - there is a link in the blood test sticky that talks about body temps). low body temps = low metabolism = issues with weight gain, energy levels, lower muscle gain, etc. etc. etc. thyroid/adrenals are the dual main drivers of body temps although other systems also play a role.

if your TSH comes back > 1, I would recommend getting FT3, FT4, RT3 (if you cortisol comes back less than 15), and ferritin/total iron.

7

Houston, we have results! It would appear that I am indeed having a thyroid issue unfortunately my Dr. actually said over the phone that all of my labs looked good…

Cholesterol, Total 245mg/dl 125-200
HDL 71mg/dl > or = 40
Triglycerides 157mg/dl <150
LDL 143mg/dl <130

Glucose 84mg/dl 65-99

Urea Nitrogen (BUN) 19mg/dl 7-25
Creatinine 1.14mg/dl 0.60-1.35
Sodium 138mmol/L 135-146
Potassium 4.4mmol/L 3.5-5.3
Chloride 100mmol/L 98-110
Carbon Dioxide 26mmol/L 21-33
Calcium 9.6mg/dl 8.6-10.3

Vit D25 OH D3 45ng/mL 30-100
Vit D25 OH D2 <4ng/ml

Cortisol 18mcg/dl 4-22

TSH 5.41mIU/L 0.40-4.50

E2 17 pg/mL < or = 39

TT 946 ng/dl 250-1100
FT 210 pg/mL 35-155

So what kind of tests do I need to be thinking moving forward? I was thinking the following to tackle the thyroid angle as well as some others to try to track down the libido issue:
-FT3
-FT4
-RT3
-Ferritin/Complete Iron Panel
-B12
-Prolactin
-DHEA-S
-DHT

Also, is there some sort of blood test to determine if I am iodine deficient or would that be a test for later on? I currently intake around 300mcg/day through multi-vitamin supplementation. Can I go higher than 10k iu D3/day or will it just take time to get my levels up?

8

yes, there is a simple Iodine blood test by Quest or LabCorp. I take 12.5MG weekly (I think). The mcg dosages don’t do anything (at least for me). you should google “halogen displacement iodine” issues.

yes your thyroid is screaming out…
TSH > 1 is a possible problem
TSH > 3 is a serious problem
TSH > 5 is well… it’s bad.

PLEASE go read 18 Summaries of Things We Have Learned - Stop The Thyroid Madness as well as all of their other articles linked on the left side of their page.

yes, those look like good tests.

i was taking 15,000iu D3 daily to get my levels up to 60-70s.

your sodium is also below ideal levels. that makes me wonder what your aldosterone levels are at. You may want to search for “sea salt pupil test aldosterone”.

9

When my hypothyroidism went untreated, besides the crushing fatigue, I also had no libido and EQ issues. I think you’re on the right track.

10

Hypothyroidism most likely due to adrenal insufficency or low ferritin is most likely the solution. I see this situation on a weekly basis
Need to have FT3 to FT4 ratio to see if there is possible rt3 going on here from overtraining and other hidden stressors

Serum may have been falsely elevated due to external stress manly at the lab or anxiety of thinking about all the testing to get done
Confirm this with a follow up 4 point cortisol saliva which can be done at lab corp.

If there is low ferritin, you need to find out why (bleeding, malabsorption, ect, )

Dr should have had all these blood work done together to get an over all picture rather then getting bits and pieces prolonging the proper treatment. With 3-4 weeks one should have a damn good handle on the case they are currently working with other wise weeks turns into months and then years real fast. As long as Dr’s are getting paid they will keep you coming back…

11

Well my battle just became an uphill one. My Dr. told me that he felt my TSH was fine and that if anything I was subclinical. He said he usually does not hand out a hypo diagnosis unless someone has “an extreme TSH like 80”. He also said that he did not feel any additional testing was warranted. So now I need to fight the endo battle… hopefully I can find one that is open minded and likes to prescribe Armour. I do not know if that is the end all be all because we don’t have any additional tests at our disposal but that is going to be one of the criteria I am going to use to decide whether or not I am even going to spend my time using that endo. Wish me luck.

Note: Found out my TSH back in Feb-March was ~3.5

12

can you call around to local compounding pharmacies to ask for a referral to a thyroid/hrt specialist?

13

I actually called what appears to be the most reputable compounding pharmacy in the area earlier today and they indicated that they didn’t really know any endos that prescribed Armour. I am going to look for more and see if they are able to steer me in the right direction. Just called the Endo that my Dr. gave me and the receptionist said that he has prescribed Armour in the past. I am tentatively on the books for Feb 22 which is a real bummer… I am going to continue to look around though while I burn through these next couple weeks.

14

chances are you will not find a single endo who can help. just search this (and other) forums for “endocronologist” and all you will find are horror stories about terrible endos. you can find the rare endo, but the odds are stacked against you.

go see a regular doctor - one that specializes in HRT/Thyroid - they will help you more than any endo (in my opinion)

15

Well I may be in luck. Found an Endo near me that seems to have favorable reviews on sites like ratemds.com. Called the office and the Dr. does treat patients with desicated thyroid and does do testing for FT3/FT4. I have my initial visit Thursday evening so hopefully I will luck out. I will continue to look for other options though.

16

[quote]Greenwas wrote:
Well my battle just became an uphill one. My Dr. told me that he felt my TSH was fine and that if anything I was subclinical. He said he usually does not hand out a hypo diagnosis unless someone has “an extreme TSH like 80”. [/quote]

That’s frustrating.

If it were me, and I liked the doctor, I might try to salvage the relationship.

You may in fact be subclinical, that’s why the diagnoses is called “subclinical hypothyroidism”. Subclinical does not mean asymptomatic. Treatment of subclinical hypothyroidism is controversial. However, it’s definitely an angle I would pursue aggressively.

You may want to print out this position paper from the AACE. It calls for treatment of subclinical hypothyroidism when TSH > 10 or if TSH is from 5 - 10 and their is presense of a goiter. I know this doesn’t help you, but, when treatment is given they say that TSH should be driven below 3.

https://www.aace.com/sites/default/files/hypo_hyper.pdf

17

the newest guidelines from some endo society call for treatment if TSH > 3 (which means that > 2 is not ideal since our medical system is set up to treat problems rather than get people to ideal health.)

18

So I saw the endo tonight and I guess it’s kind of a mixed bag…

-He did not want to do any more tests because he believed that my thyroid was indeed producing insufficient amounts of hormones.
-He doesn’t really seem to buy into the RT3 argument.
-Didn’t want to test DHT or prolactin because he felt that because my T was so high that aromatization to DHT should be sufficient and my T would be lower if prolactin was an issue.

-I walked out with a prescription for 2 grain Armour thyroid… Should I take it all at once in the morning as prescribed or should I take half in AM and half later in the day to balance the levels? Also, should I start out with a smaller dose and taper up over a week or just jump right in?

19

[quote]Greenwas wrote:
So I saw the endo tonight and I guess it’s kind of a mixed bag…

-He did not want to do any more tests because he believed that my thyroid was indeed producing insufficient amounts of hormones.
-He doesn’t really seem to buy into the RT3 argument.
-Didn’t want to test DHT or prolactin because he felt that because my T was so high that aromatization to DHT should be sufficient and my T would be lower if prolactin was an issue.

-I walked out with a prescription for 2 grain Armour thyroid… Should I take it all at once in the morning as prescribed or should I take half in AM and half later in the day to balance the levels? Also, should I start out with a smaller dose and taper up over a week or just jump right in?[/quote]

Need a good team of medical professional in your area PM me. PS vballa will give his seal of approval for sure :slight_smile:

20

Hello again, everyone! So the last couple months I have been on Armour Thyroid (60mg/1 grain) and was beggining to feel better. Some of this may have been the medication and some may have been the placebo effect. I went in for a check up with my endo and he believed that there wass still some additional room for improvement in my TSH levels. Due to this he had me take an extra half pill (30mg) twice per week.

After leaving the Endo that week I the debilitating exhaustion reappeared. I was on the increased dose and was extraodinarily tired towards the end of the day. Obviously this is purely anectdotal but it appearead as if the onset of exhaustion was later on the days when I took the 90mg pill. I lived with this for a couple weeks because I wanted to see if it passed. Unfortunately it did not and I went in to my Endo to discuss my issues and run additional bloodwork.

My TSH came back at a 1.62 which prompted my Dr. to boost my Armour dose to 90mg (1.5grain) daily. He indicated that if this does not produce any improvement he would like me to visit with a sleep specialist to ensure that I am getting properly rested at night… I do tend to wake up about 4:30am every night. My most current bloodwork is below an I am interested to see if anyone else has any input.

SIDE NOTE **** After inputting all of these values it dawned on me that my total Iron is probably pretty low.

COMPREHENSIVE METABOLIC PANEL
Glucose =80 65-99 mg/dL This was not a fasting level
Urea Nitrogen =22 7-25 mg/dL
Creatinine =1.13 .6-1.35 mg/dL
Sodium =138 135-146 mmol/L
Potassium =4.1 3.5-5.3 mmol/L
Chloride =101 98-110 mmol/L
Carbon Dioxide =20 21-33 mmol/L
Calcium =9.8 8.6-10.3 mg/dL
Protein, Total =7.9 6.2-8.3 g/dL
Albumin =4.9 3.6-5.1 g/dL
Globulin =3.0 2.1-3.7 g/dL
Albumin/Glob Ratio =1.6 1.0-2.1
Biliruubin Tot =0.5 0.2-1.2 mg/dL
Alk Phosphatase =71 40-115 U/L
AST =32 10-40 U/L
ALT =21 9-60 U/L

TSH =1.62 .4-4.5 mIU/L
T4 =5.8 4.5-12 mcg/dL
FT4 Index =2.0 1.4-3.8
T3 Uptake =35 22-35%

CBC
White Blood Count =7.0 3.8-10.8k/uL
Red Count =5.23 4.20-5.80M/uL
Hemoglobin =15.4 13.2-17.1 g/dL
Hematocrit =45.0 38.5-50%
MCV =86.1 80-100 fL
MCH =29.5 27-33 pg
MCHC =34.3 32-36 g/dL
RDW =12.8 11-15%
Platelet Count =193 140-400k/uL
Absolute Neutrophils=4235 1500-7800 cells/uL
Abs Lymphocytes=2170 850-3900 cells/uL
Abs Monocytes =420 200-950 cells/uL
Abs Eosinophils=147 15-500 cells/uL
Abs Basophils =28 0-200 cells/uL

IRON AND TOTAL IRON BINDING CAPACITY
Iron, Total =74 45-175 mcg/dL
Iron, Bind Cap =354 250-425 mcg/dL
% Saturation =21 20-50%
Ferritin =196 20-345 ng/mL

LH =5.5 1.5-9.3 mIU/mL