Long time lurker, first time poster. I am 45 and I have struggled with fatigue (mental and physical) since high school. I admit to severe over training in my past (attempting to turn pro in triathlon). I am a PT. I stopped over training at around age 30 but the fatigue never went away. I also developed waking insomnia. At around age 32 I went to my GP and he did “thorough” blood testing (sorry I don’t have them anymore) and was told everything was fine. Had multiple sleep studies that were not diffinitive. Total T was in the high 200’s but was told I was in range. Thyroid (TSH and T4) were WNL. AM cortisol was WNL.
I was told to stop exercising because I was getting old. So I stopped exercise for a few years, Of course I got worse. I then re-started exercise in a controlled manner but was even more fatigued. At age 39, I insisted on a referral to a urologist. Was put on clomid (name brand) for secondary hypogonadism. I got up to around 500 TT. I felt OK but got scared about an eye floater then d/c’d clomid. I actually felt pretty damn good for about 6 months then slid into fatigue again. Went back to the urologist about a year later and was put back on clomid. No response in 6 months (discovered I was on generic). But the urologist said it didn’t matter. Was told I could either try trt (injection) or go on with no treatment.
Agreed to the injections. Wasn’t allowed to self inject. 400 mg depo q 3 weeks. Felt AMAZING after 2 months. (Trough 450 TT, peak must have been VERY high) This lasted 2 more months. Then felt terrible as I progressed toward 6 months. Was given the choice to go off trt or try testim. Testim 2 tubes daily for 3 months and nothing (of course it was high E2 all along). Went to a different dr. New dr put me on compounded transdermal T scrotal application. Again high E2 kept me from seeing benefits but he would not treat the high E2. Then tried an hcg stim test. Results were TT of 700 but skyrocketed E2 - felt awful. Decided to go off trt. MORE AWFUL!! Went to a naturopath at Tahoe a few months later at age 42. She tested cortisol via saliva (results were “flipflopped” causing waking insomnia).
Tested neurotransmitters (perfect). Tested all thyroid parameters (I will get to that). She started by treating the cortisol. Never saw much difference for about a year. Went to a psychitrist in early 2015 and was put on lexapro 10 mg. Didn’t help much. Currently weaning off. In early 2015 talked the naturopath into trying TRT again based on never treating E2 previously. She prescribed transdermal T 6% with chrysin 6%. Limited, if any improvement. She felt I wasn’t absorbing. Added 200iu hcg 2x/wk and I felt awful. She decided I cannot tolerate hcg. At age 44 she put me on injections of T cyp. I decided to inject EOD (she prescribed 1x/wk then later 2x/wk). Initially tried without AI but ended up with a TT of 850 and E2 of 66. I tried 80mg/wk, 100mg and 126mg with between 0.5 and 1.25mg/wk anastrozole I never could get my T:E2 in a range where I felt good (always had negative side effects).
The naturopath and I feel I am an over aromitizer and no amount of AI will work. Here we are at what I am going through in real time (aka right now). I talked to the naturopath on 4/4/16. My thoughts were to stop testosterone and do a HPTA re-start with 5 to 10mg tamoxifen qd (although my testicles are very atrophied I still am not willing to try hcg again). She countered with re-reviewing my thyroid test from 2014 that we never treated for, then revisiting a HPTA restart later. My thyroid test results show normal TSH, normal free t4, but very low normal free t3, and very high normal rt3. So she wanted me to do a 3 month trial of generic cytomel to “knock” the rt3 off my receptors. Here is the crux of the issue.
I started the cytomel at 5 mg morning and afternoon on 4/6/16. I feel the worst I have ever felt fatigue and brain fog-wise. I am at 10 days post final injection of T cyp. So either I am nearing a very hypogonadal state or I cannot tolerate cytomel. I feel I am a bad science experiment, ie she is throwing things at me and seeing what sticks. I feel the naturopath put the cart before the horse. But she is by far the best dr I have worked with. So my choices are the following:
- Get back on trt
- Stop the cytomel (or decrease the dose)
- Beg and plead to do tamoxifen before trying to treat the thyroid issue
- Stop everything
- A combination of 1,2,3, or 4 or something I haven’t thought of
Any thoughts, questions, etc are appreciated.