T Nation

Do I/Will I Need TRT?


#1

Hello All. First time poster, so sorry if I do something wrong.

Three-plus years ago I had battle with testicular cancer, and lost one of my soldiers in the fight. My Total T levels one month before the surgery was 298ng/dL and one month later 504ng/dL. It hadn't been tested since.

I have had nearly all the symptoms of low T: Depression (which I've had mildly since teens but disabling since two months before diagnosis), anxiety, hypertension, lack of motivation/sex drive, storing fat around the midsection, inability to gain muscle, etc. ect. ect.

So for nearly four years (I'm now twenty-eight) my doctors have been giving me anti-depressants and adderall, assuming it was just my mental health issues that were to blame. In addition I've been on cholesterol and BP meds, and have been given medication for every symptom I've had, but never had my T levels checked again.

Four weeks ago I decided to get my T level checked and wrote it in on my lab sheet when I went to get my cancer marker blood-work.

It came back at 285ng/dL.

I got a referral to an endocrinologist who sent me to the lab, and here's what I got (basic labs left out, but liver/kidney function and everything is normal):

E2 - <20pg/mL (test didn't give precise numbers)
SexHm BG - 48nmol/L
Free T - 60pg/mL
%TestoF - 1.5L % (I'm guessing this is Free T % by volume?)
Total T - 405ng/dL
FSH - 21.7mIU/mL
LH - 7.4mIU/mL
T4 Free - 1.1ng/dL
TSH - 2.48uIU/mL
Prolact - 15.6ng/mL

So, "unfortunately" my Total T levels went up some. Is this score high enough to where treatment, according to most doctors, would be unjustifiable? I was more certain that treatment was a sure thing when my score was 285, but 405 seems to be in that "borderline" zone for doctors who don't take age into account. I've only seen the Endo once so I don't know where he's at in terms of eagerness to treat, but he seems a little on the conservative side, although he is willing to treat if it's necessary.

Also, is my Prolactin level anything to worry about? I know on some scales 15.6 wouldn't be high, but this labs' range was 2.6-13.1, so according to them it's a little high. I had a brain MRI last year and it came back clean, but I know pituitary tumors can be incredibly small.

Any responses are much appreciated! I see him tomorrow morning and am a little anxious that this current round of labs will disqualify me from treatment. When I found sites like this, and read the list of low T symptoms and stories of people who have lived with it, it read like the last four years of my life. Any questions/comments I should bring up tomorrow?

Thanks again.

[chris]


#2

Chris,

I doubt you'll get a final answer tomorrow, so don't sweat it. Your T level is in the normal range, but you also have symptoms and apparently some out of range test scores (please post ranges). Your FSH is above range (assumed) so you might want to get a semen analysis. Your LH is elevated too, but within range (assumed). Your E2 seems pretty low (any sore joints?) and your SHBG seems high.

Hopefully your Endo will go through the numbers and be able to explain the whats and the whys. If he can't and yet you present with symptoms, well the onus is on him to keep digging for answers (and the onus is on you to push him to do so!). TRT is not necessarily the answer.

By the way, low T will lead to low dopamine (low libido, depression symptoms) and low dopamine goes hand in hand with elevated prolactin (so no need for a prolactinoma).

Please let us know how the appointment goes and good luck.


#3

Just a personal anecdote, but i had TC as well...My T levels were fairly low before, but absolutely crashed after the orchiectomy...we waited a few months, and even though they were on a bit of an upswing (mid 300's) I was feeling absolutely miserable.

I found a doc that put me on TRT and I haven't looked back. I haven't felt this good in years and things are going great for me.

So what I'm saying is, TRT MIGHT not be the solution for you, but if you think it might be, push hard until you get it. You deserve better than crappy doctors that want to keep you at the bottom of the ranges.


We need the ranges of your bloodwork. But McJabber pretty much said what I would.

T4 also looks low and TSH is mildly elevated. This could be influenced by the T issues.

Prolactin is elevated. Did you have sex or jack off before the test (within 12 hours)?


#4

What kind of cholesterol numbers are we talking about?

I was prescribed statins also but after reading all the negative feedback on them I never took them.

You may want to really look into them and evaluate your situation. But from what I have read it is pretty nasty stuff.

I'll try and dig up a site with some awesome information on cholesterol. I strongly suggest you read the articles and then decide if you want to continue with statins.


#5

Thanks for the replies guys.

First off: My doctor said that my FSH and Prolactin were on the high side, but he said that they're nothing to worry about, and that some labs wouldn't even consider those numbers out of range. That said, he asked if I wanted to start treatment even though I tested at 405. I said "yes", and he put me on Cypionate 100mg/ml 1ml per week, with blood work in about two months. Long road ahead, but I'm glad there's at least something I can try that might make my life better than the shit-hole I've been in for four years now.

"Your E2 seems pretty low (any sore joints?)"

I do get muscle aches and pains now and then (especially in my knees), but never thought they'd have anything to do with hormones. I asked my doc about it, and he said that since my E2 level wasn't 0 I shouldn't worry too much about being on the lower end of the spectrum. He said it may or may not be a factor in my joint/muscle pains (thanks for the info doc!), but we'll be keeping our eyes on it. Given that my E2 levels were on the low side he didn't want me to take propecia since it could lower my levels even further.

"What kind of cholesterol numbers are we talking about?""

I can't remember the numbers (I have them written down somewhere...trying to locate them), but I was 133 points over max on the total cholesterol and my trigs. were around double the max score. I was on lipitor for about four months last summer/fall, and about that time I started taking adderall and watching my sodium, so needless to say: when I dropped 55lbs I no longer needed the lipitor. I'm hoping too that TC will help my energy/muscle mass so I will actually be able to exercise regularly and get off the BP medication too, but I'm taking it one thing at a time!

It's been a nerve wracking few weeks, but luckily I haven't had any issues in this whole process. I feel awful for the guys who have been to several doctors, all of whom subscribe to the archaic ideas about "testosterone range" where a 30 year old guy with 200ng/dL is told that there's nothing wrong!

Thanks for the replies guys. Hopefully after having some experience with this I can give back to the forums. Noobs with only one injection to their name aren't much sought after for their "expertise".


#6

Good stuff. You lucked out with your doctor I think. At least he's moving on symptoms.

On the E2, yes low E2 can cause joint aches. Lots of people on this forum complaining about that. However, as your T goes up you can expect your E2 to go up too, so it should all work out.

Please keep us updated (mood, strength, body composition, etc.) as you go through your treatment. I'm sure there are plenty of people who would like to follow your progress.


#7

You cannot extrapolate much from that E2 test as it is the wrong test. It is not for males, it is the female test designed to test high levels of estrogens. It is not precise enough for men. Your E2 could literally be anywhere in the range (but probably towards the lower end).

Get the 4021X sensitive from Quest.


#8

So here I am, one week down. Giving myself shot #2 in the morning, but I thought I'd give a little update in case anyone is following along with this thread.

I'm currently recovering from my fourth shoulder surgery that I had in September. I have been on the same routine of exercises for the last four weeks or so and have made marginal but consistent increases in strength and function over this time-span.

That is, until this past week. After injecting last Tuesday I have had a pretty dramatic increase in strength! Last Wednesday I was biceps curling 10lbs per arm (don't laugh...too hard) for 3 sets of 20 (PTs orders, also, don't laugh), though for two weeks beforehand the last set was a struggle from rep 13-on and often I didn't make the complete 3x20. Today I did 3 sets of 30 (max reps PT wants per set, so going up in weight tomorrow) and I probably could have gotten at least 20 reps in a 4th set, though I didn't try. I haven't had this kind of gain since the first week of PT. I've also broken one of the therabands while doing internal-rotation which was a really cool feeling, except when I remember that the green band isn't hardcore. But, it's amazing how fast I've increased strength this week.

The first thing I noticed was two day after the shot, when I did my exercises and the "pump" my muscles got was huge. My fiancee noticed when I came in from the garage and said it looked like I gained 5lbs in my arms. Temporary, but exciting nonetheless.

My mood isn't necessarily better, but I have had the above things to feel good about, which helps. My energy level is a little bit better, and I feel that if it gets just a little bit better I will be able to say "goodbye" to the stimulants!

I'll keep you guys posted if anything new and exciting happens.

[chris]


#9

surgey causes a rise in RT3.

you really should look at getting more detailed thyroid tests - FT4, FT3, RT3, 8am cortisol. HRT is lifelong and can have unintended side effects.


#10

"surgey causes a rise in RT3.

you really should look at getting more detailed thyroid tests - FT4, FT3, RT3, 8am cortisol. HRT is lifelong and can have unintended side effects."

I'll ask my doctor next time I see him, but I have no reason to believe that anything is wrong with my thyroid. I've had 4 surgeries on my shoulder, and one for testicular cancer, over the last eight years, and have never had anything to indicate thyroid issues despite getting the more common thyroid tests. I don't see how getting more detailed test would indicate something that has been non-evident and none of the precursor tests have hinted at.

On the other hand, I have looked at my T levels over the last ten years and I was always below average. At 19 I was at 605ng/dl which isn't anything to worry about, but also is on the lower side for teens. Other T tests were in the low 500s, up until I had cancer four years ago, so it seems that I've always been behind the curve and losing a testicle didn't help anything.

I am aware HRT is a lifelong thing. I also know that the last several years of my life have been complete crap so I'm willing to try something that will hopefully help my situation, and make up for the hormones that my last remaining little guy has fallen asleep on the job for.

Thanks for your comment. I'll be sure to post what my doctor says about this. I don't mind asking questions if it will lead us to something he may have over-looked. If I wasn't prone to being inquisitive I wouldn't be where I am today! I nearly always get second opinions, too, if it's something that warrants it. Doctors are individuals and are only human, so getting extra input can't ever hurt. I've annoyed a few MDs in my time, but I'd rather be sure about my health than go out the door without knowing the ins-and-outs of what is or isn't going wrong with me. Boggles my mind how many people don't ask questions, or don't even care, and just take everything the doc says at face value!


#11

Hello all.

I was doing pretty good with the 100mg shot once a week, but found that I was starting to crash around day 4, and was pretty much stuck to the couch on days 6 and 7. I saw my doc and we switched it up to 50mg shots twice a week, hoping to prevent the end of the week slump. Before seeing him I had blood-work done on the forth day after a 100mg shot. My Total T was 648ng/dL (Range: 175-781ng/dL), and my Free T was 186pg/mL (Range: 47-244pg/mL). I was really impressed with my results seeing as my stats right before starting treatment were: Total T 405ng/dL and/or 285ng/dL (Range 300-1080ng/dL Oddly, same lab, different range than the new test), and Free T 60pg/mL (Range 47-244pg/mL Same lab, same range lol).

I'm two days away from the beginning of week 2 at the new dose (and therefore my next shot), and the third 50mg shot, total. I have had virtually no energy all week. I used to really enjoy the three days following the 100mg shot, but the dip was getting really annoying. This week has been about as bad as days 4 through 7 with my once-a-week treatment, and although I haven't had a "dip" I also haven't had a "peak" where I actually feel good.

How long should I wait before I can say that things won't be getting better at this dose? Are there any/many guys out there that need to do more than 50mg twice a week? What would the next step be: 75mg twice a week or something? Is it "normal" to need more than 100mg a week?

Hopefully my doctor will be cool about it if I need to up my dose.

Thanks for your thoughts.

[chris]


#12

It could be any number of things. Cortisol comes to mind.

The additional T puts more strain on your other systems. Adding more T might make you feel worse. It would be best to get the bloodwork recommended in the stickeys at your follow-up (instead of just Total/Free T) and go from there.


#13

I'll have my doctor order the blood-work tomorrow. The thing is, I'm not taking in more. Wouldn't 50mg 2x a week cause less of a rise in T compared to 100mg 1x a week?

Thanks for your reply.

[chris]


#14

That's a good point. Its hard to say. Its possible you could need a little bit more to get you to that peak feeling. If you and your doctor think thats the best option, then go for it.


#15

Thanks man. I'll keep you posted on what happens. I've spent nearly all of today in bed, anxiously awaiting injection day tomorrow. I'll be putting a call into my doctor's office as well. I'm not sure which is better, three great days and then four crappy ones, or 7 slightly-less-crappy-than-before-treatment days.


#16

You need to look into the pathology of cause to see where the hidden stressors are at. We Deal with these cases on a daily basis. Majority of people do not need HRT if the other variables are explored before committing them to HRT. You need to find out why T is low then work by evaluating thyroid , adrenals, lifestyles and other hidden stressors.

From being out in california, I have a mess load of people who are low hormones. The main cause of why is due to high levels of toxin exposure causing alterations in their liver pathways causing stress to the HPTA starting the typical stress response.


#17

With all due respect (which isn't much), keep your pseudo-science out of my thread. My T is low because I lost a god damned testicle to god damned cancer, and my stupid body didn't up its production afterward.

While I was being treated for cancer I had TONS of vultures like you swarming around, telling me how evil doctors are, or how we haven't really looked at every angle. I have had all of my lab work done and everything is normal, except my T levels. My thyroid is fine, my adrenals are fine, and my lifestyle has had little to no impact on my T levels as my diet and exercise program was geared toward not burning out my system.

If the stressors (a word which you are probably using incorrectly) are hidden, how do you expect to find them? What can you do that every other doctor I have seen has failed to? Publish your techniques in a medical journal and win a Nobel!

I live in California. I live in the East Bay, one of the most densely populated areas of the most densely populated State in America. I am the only person I have even heard of that has needed TRT. And it's not because I'm the only one who's checked: Nearly all of my friends get their hormone levels checked as part of their yearly physical. There is not some epidemic of Low T guys out here, and if you disagree please site your source. The reason many of us here on T-Nation turn to the forums is because this phenomenon is so uncommon and we need to turn to people who know what we're going through because they've been there. According to you, I can just walk around and find several guys who have had the same experience.

I looked into the "pathology of the cause": It is because my retarded testicle (just the one now) is being fucking lazy and not pumping out the good stuff. He's getting the signals. but he's not doing his job. I have been through a battery of tests the last four years of my life; No stone has gone un-turned. I even spent four months at the NIH as a lab rat; There was not one single aspect of my health they didn't check both before and after taking part in a drug study. The tests I had done would have cost well over $250,000 had I done them on my own. They didn't screw around: If something was wrong with me, they wanted to know before I entered the study. We have explored every variable which has contributed to my laundry list of issues that, for some strange reason, have been steadily going away ever since I started hormone therapy.

Go peddle your hippie newage bullshit elsewhere.

Thanks.

[chris]


#18

1) sorry chris, but your thyroid is not fine. TSH > 1 indicates a possible problem. You and your doc may feel otherwise, but a TSH of 2.5 is indicating issues just like your high LH/FSH. Now if you have the other detailed thyroid tests and they all came back at ideal ranges AND you have zero thyroid symptoms, then maybe 2.5 is your norm, but that is a long shot.

2) you are correct that no one knows everything - that includes you, your doctor, HANS, myself, etc. but that doesn't mean that you can't glean helpful pieces of information from all sorts of different sources.

3) doctors are not evil per say but most sure seem to be at best ambivalent to the damage and harm they are causing by their misdiagnosis and neglect. The system is just set up against them from having the time and knowledge necessary to offer truly helpful advice for those who fall outside the 'norm'.

4) how many guys sit around having conversations about their T levels or who would admit to having libido issues or would even think to ask their doctor about testing their T levels? a tiny fraction compared to the number of people who are having issues and who should be treated. is this one issue an epidemic? probably not, but add in thyroid issues, weight issues, unhealthy eating, unhealthy lifestyles, then yes, we have a health epidemic going on that everyone seems happy and content to ignore until they are the ones acutely suffering.

5) slamming other members of the board who are offering help is very counter productive and may stop others from offering assistance. a polite thanks, but no thanks goes a whole lot further. just my opinion.


#19

1) I have no reason to believe that there's any reason that I have any thyroid issues. You may feel that my thyroid levels are high, but no doctor I've seen feels that there is anything that warrants further investigation. If it will make you feel better, I'll get the tests done. I'll kindly eat my words if anything comes back anomalous.

EDIT: I checked several Thyroid websites, including ones that are skeptical of the current medical understanding of TSH range, and they all said basically the same thing: TSH .5 - 5 used to be the norm. Now TSH .3 - 3 is preferable as euthyroid patients were consistently in the .4 to 2.5 range, and the extra .5 is there for margin of error and human variation. So I scored in the range of an extensive study done by the Academy of the American Association for Clinical Chemistry and the National Academy of Clinical Biochemistry. I'm getting the extensive thyroid labs done tomorrow anyway, just so we have number to talk about instead of guessing on both our parts. If this is my issue, then I'll gladly concede that you've been right all along, and I'd hope for as much from you as well.

It also seems odd that you go on nearly every other persons' thread and tell them that they too probably have thyroid issues. It almost seems like, since you've had thyroid issues, that you see them everywhere you look. I could be wrong about that, but it seems like the case to me.

2) No argument there. The thing is, if someone is incredibly wrong about incredibly important issues then there is no reason to listen to anything they say in hopes of finding a "nugget" in there somewhere. And when did I say I know everything?

3) Neglectful doctors are awful. Doctors who care about their patients aren't: They'll actually take the time to properly assess a situation with a patient. "The System" is set up so researchers can research and practitioners can practice what is discovered. Yes, there are doctors that refuse to come to terms with new information, and they are numerous, but it's up to the patient to find a good doctor. My primary physician, oncologist, psychologist, and psychiatrist, are all great doctors who defer to the research when faced with a problem. This is how it should work, as no doctor can know everything. I'm sorry if you've seen a bunch of doctors who don't do this - it's really sad to hear of neglect. I'd suggest finding doctors who do what they are supposed to do.

4) Nearly every guy I know gets his T level tested regularly, as well as other hormone/metabolic/lipid/etc. tests. It's good to keep tabs on what's going on in your body. I don't know why this seems strange to you. Maybe you feel that men don't take care of themselves or something. Since my testicular cancer I've told everyone who will listen about the signs and fallout of having it. I've also told dozens of people about my low T. Guys do talk about this stuff. Maybe you're in an area where guys don't talk about health issues, but that isn't the case where I am. Any time someone I know comes down with something they educate the people around them about it. Sucks that you don't have friends like that. And there is no "health epidemic". If you disagree with me please cite your source. I'm sure you'll find a bunch of non-scientific sources, but try and find one that shows that things are out of control. (And just in case you bring up obesity, be prepared for a long, drawn out argument.)

5) Slamming people who have nothing to offer and give bizarre pseudo-scientific bullshit is never counter-productive. If I start telling you that your health issues are part of a conspiracy, that your doctor (who has actual evidence for what he says) is wrong about his assessment, and that you have magical toxins dancing around your body, then I would hope you'd have the wherewithal to tell me to shut the fuck up. I don't want people helping me who have no clue what they are talking about, or the people who sympathize with them. If you want to go caudal unscientific, ignorant people, then by all means go for it. Blaming invisible and unprovable agents for my illness is WAY MORE counter-productive than taking a B.S.-peddler to town for not looking at the actual science of the matter.

If you want to continue arguing, that's fine, but it doesn't seem helpful. I didn't hi-jack your thread and tell you what you can and can't say, nor did I start an argument with you that would probably have been more suited to PMs.


#20

Temper Temper.....estogen must be rising

Pseudo science or speaking the truth because people are blinded by what the medical professionals is not telling you or know little of. If it was not for my pseusdo science bull shit, Vballa would not known half the issues we really had which were hidden, particular some which could possible saved his life down the road.

Research which is driven by big pharam...no suprise which is tampered with to falsify the data. End point here is if it aint in your hormones then look some where else. Yes you do need TRT no doubt, but there are numerous issues out side hormones which need to be explored to be well again. BTW insurances do not cover pseudo-science :slightly_smiling: