T Nation

Early 30s. Over-Trained Endurance Athlete


#1

Greetings

I’ve read the stickies and have done quite a bit of reading before finding this site. I’ve been diagnosed with Secondary Hypogonadism. I’ve gone from PC to Urologist to Endocrinologist. For different reasons, they’ve all given me advice I feel is inaccurate and not in my best interest. I found a Urologist who has a history of prescribing hCG. He’s in my insurance network and I’ve been given a referral to visit with him. I’ll be making an appointment on Monday. He is a professor and has authored studies on TRT, so I’m hoping he is open to more progressive therapies.

I have summarized all of my labs into an excel spreadsheet which I’ll paste below. I’ve also put together a word doc medical summary outlining my objectives and history. I’ll paste sections of that doc below, too.

I would really appreciate some input from some of the more knowledgeable guys here on the site. Specifically, I’m looking for input as to what some possible causes could be and feedback on my own self-diagnosis of over-training.

I recently stopped competing as a road cyclist. I was on a caloric deficit, raw-vegan diet while at the same time pushing an intense training load (~20-25hrs/wk or 200-400 miles/wk). Couple that with poor sleep and massive increase in life stress and I think I shut my endocrine system down.

There is a well-know condition in women called amenorrhea where over-training leads to hormone problems. There is a very small body of literature regarding the effects of over-training in men. I have not been able to find any protocols as to how to fix it.

I stopped training and abandoned the diet almost 6 months ago with no improvement. It doesn’t seem like my body is healing itself. Or, maybe, I was always low and this just put me over the edge… Not sure.

Does anyone know if KSman’s restart protocol has been successful with endocrine problems that resulted from over-training?

If some of you would be so kind, I would appreciate you looking through my “case” and giving feedback.

Many thanks!

Medical Summary:

Age: Early 30s
Height: 6’3”
Weight: 205 Lbs.
Waist: 34”

Body and facial hair description:

Athletic, muscular build, ~13% body fat. Male pattern balding with slow-growing facial hair. Facial hair growth rate has slowed and rate of balding increase recently. I’ve also noticed that my body-hair has thinned out severely in the last few years. I used to have “furry” arms and legs. The hair was course and dark, now I have a faint, sparse, lightly colored hair covering my arms and legs.

Testes:

Do not ache or hurt but are smaller than they used to be. Physical exam by urologist performed April of 2017 was normal.

Mood:

Apathy, irritability, low motivation, general pointlessness to everything – I am suffering from all of them.

Energy Level:

I have always been an energetic person. Recently, I can barely muster the energy to get out of the recliner. I constantly feel run-down and physically/psychologically tired. No amount of sleep or coffee seems to help.

Libido:

Extremely low Libido. I do not experience morning erections. When I do (very rarely), it is alarming – it happens so infrequently.

Thyroid:

I tend to get cold easily. This is very strange as I have always been “warm-blooded”. My skin is dry/scaly and nails seem to be more brittle than they used to be. Hair is thinning at an alarming rate. Body hair in addition to the top of my head.

I’ve read recently that Iodine and selenium are key factors in Thyroid function. I eat next to no salt, bread and seafood. I suspect I might be low on iodine. I am starting to track body temp, but I would like to get input on this.

Diet:

I eat a “clean” diet. Little to no processed foods including bread and pasta. I primarily eat whole foods someone from the 1700s would recognize as food. I consume very little iodized salt or sea food. I am a former competitive cyclist. I steadily decreased my weight from 220lbs in 2013 to 187lbs this last spring. I was <10% body fat and trying to lose more weight. For nearly two years I was a raw-vegan, consuming a net choleric deficit with macro rations near 80-90% carbs, 5-10% protein and <5% fat. I kept my caloric intake at a 500 calorie deficit per day. Despite maintaining the same deficit, I stopped losing weight and actually started to put some on toward the end of the spring.

I abandoned the raw-vegan diet and stopped counting calories late march 2017. Since then I’ve put on 20lbs. Not all of it has been fat, but a lot of it is and I’m disproportionately carrying it in my chest and belly.

Exercise:

For the last three years I increased my training from 10 hrs per week to an average of 20-25 hrs per week (200-400 miles). Despite increasing training volume and intensity, I started getting weaker and weaker toward the end of the spring of 2017. This, coupled with crippling depression and non-existent libido, is why I sought out medical intervention. Training harder should not lead to getting weaker. Something was wrong.

I stopped training in late March 2017. Since then I’ve seen/felt little to no improvement.

Sleep:

I suffered from insomnia throughout childhood. It got worse when I got heavier in my mid 20s and I believe the stimulants exacerbated the condition. I took a number of different sleep-aids for nearly 20 years. I stopped taking them in 2013 and haven’t since.

I have always struggled to get 7-8 hours of sleep on a regular basis. Normally I would get 5 or 6 hours. However, in the fall of 2016 my life stress led to greatly diminished sleep. I was back to getting ~5, maybe 6 hours of sleep.

I have not been tested for sleep-apnea, but my wife thinks I should.

Random:

• I don’t have any known exposure to noxious chemicals.
• I have never used hair loss drugs.
• Frequent urination at night.
• Dizzy/faint when standing abruptly.
• Swelling in extremities.
• Skin on the backs of my hands is thin and “crinkly” looking.
• Things that have stopped since I’ve gained weight/stopped training: numbness in fingers, extreme calf cramps at night.
• Had sever gum disease. Treated and overcome early 2017. Unknown duration. I suspect several years.
• I am not on any Rx drugs. Supplements are as follows:
o B-12: 1,000 mcg daily
o D3: 10,000 IU daily
o Calcium: 1,000 mcg daily
o Magnesium: 400 mg daily
o Zink: 15 mg daily
o Omega 3: 1900 mg daily
o B complex daily multivitamin
o Vitamin E: 1,000 IU daily
o Iron (ferrous sulfate): 65 mg daily

Unrelated medical conditions:

  1. As a child, I suffered from severe asthma. I was frequently prescribed prednisone and/or amoxicillin. Puberty reduced my asthma to the point where I only experience symptoms when I get very ill. Asthma has not been an issue in adulthood.

  2. At the same time I started getting weaker and fatter (spring 2017) despite increased training volume and continued caloric deficit, I was also experiencing repetitive knee injuries. I’ve had knee surgeries in the past but it’s been years since my last surgery without injury since. After I stopped training I went and got x-rays done. Turns out I have severe osteoarthritis in both knees. The doctor said “if you were 30 years older, I would tell you to have both your knees replaced.”

Life Stress:

In the fall of 2016 my life became extremely stressful.

Work: I hated my job to start with, but recent changes in the company made the situation very stressful.

Personal: Me not wanting to have sex made for a stressful home life.

Nearly 6 months ago I stopped training, abandoned my quest to lose weight, and quit my job.

For the last six months I’ve eaten a healthy, balanced diet, lived a relatively stress free life (including training stress), and gotten 8 hours of sleep come hell or high-water. But I don’t feel any better.

Medical Objectives:

  1. I need to increase my libido.
  2. Any therapy needs to maintain any endogenous sperm production.
  3. I have a feeling my training/diet/sleep/stress over-load destroyed my endocrine system. Or if nothing else, tipped it over the edge. If possible, I would like to “jump-start” my endocrine system and get it back to a functional state without ongoing exogenous intervention.

Questions for doc:

• What are your thoughts on hCG, Estradiol (e2), SERMs, Aromatase Inhibitors and testosterone cypionate dosage/frequency?
• What kind of temporary protocol would you put me on to “jump-start” my natural hormone production? Is this even possible?
• Have you seen any patients whose natural hormone production rebounded from levels like mine?
• Do you have any experience with or knowledge of Overtraining Syndrome or Amenorrhea?
• I am also including a summary of all blood-work to date. Based on that, what additional blood-work would you run and why?
• I’ve read that Nolvadex (SERM similar to Clomid but without as many negative side effects) could possibly be a better alternative to hCG for maintaining fertility do to its preservative effects to LH AND FSH. What are your thoughts on this?

Additional Labs I’d Like to Run:

PSA, E2 (estradiol: LabCorp serum E2 test or Quest Sensitive 4021x. PLEASE DO NOT USE Quest ULTRASENTIVE!), fT3, DHEA-S, Cortisol 4 (sample saliva), Pregnenolone,


#2

Update:

I’ve been tracking my body temps for the last three days. Here are my results so far:

image

Pair this with all the symptoms of poor thyroid function I’ve been experiencing and I’m thinking there’s something going on. I emailed my doctor to see if he would order a complete thyroid panel and all he would order was fT3, no Iodine or rT3. He also agreed to order E2 after I used some info I gathered from this site to educate him on how T --> E2 works.

I’ve also been taking an unofficial survey of all the people I know. In the last 3 days I’ve visited the houses of 4 friends or family members. Not a single one of them had a significant source of Iodine in their house. I went to buy Iodized salt and actually struggled to find it! There was only ONE container on the shelf and it was on the bottom shelf tucked in the most obscure spot. I’m a little alarmed by all of this, to be honest.

I looked up on the CDC’s website the rates of iodine deficiency in the US and, while rates of major defects are not on the rise yet (birth defects and goiter etc…) the overall blood concentrations have been plummeting since the 80s. The average blood concentration of Iodine in the US is now nearing the WHO’s threshold for “Iodine sufficient populations.” I feel like a proselytizing vegan wanting to tell EVERYBODY about this. Crazy…

On my way to a health-food store to pick up some Lugal’s and Solenium.


#3

I use iodoral at 12.5 mg of iodine. Might check that out.

Also should read the thread on responses guys have had from their doctors when trying to get them to treat their Test deficiency. Its alarming but may prepare you for what your dr will tell you.


#4

Labs suggest a GI bleed possible, screen in/out with occult blood test. Are you avoiding red meat and limiting iron. While lower T does lead to lower HTC and RBC, this situation is beyond that.

Thyroid: fT4 is well below midrange. Please eval overall thyroid function via oral body temps, see below [done] . Problem could be caused by not using iodized salt [yes].

In 1700’s, most people had goiters from iodine deficiency.

Vegans easily have multiple amino acid deficiencies. Some nutrients are not available without cooking.

Your profile suggests adrenal fatigue from training with Adrenalin to compensate for low T and low thyroid function.

Skin showing loss of collagen reflecting a catabolic state that threatens all connective tissues. [joints]

Is ferrous sulfate causing constipation?

In the thyroid basic sticky, find references to stress, adrenal fatigue, rT3 and Wilson’s book. There is no simple fix for this, read the book.

With your thyroid issues, you might feel worse with low thyroid function, and well sub-optimal cortisol. The restored metabolic demands of higher T levels could outstrip your capacity.

Get these labs:
TSH
fT3 - the active hormone.
fT4
rT3 - reverse T3 that blocks/limits fT3 activity.
IGF-1 to eval GH status. - do not test GH directly!
DHEA-S [-not DHEA]

  • later on you will need to be testing E2 -estradiol

CO2 probably elevated from holding your breath waiting for needle stick or during blood draw.

You will need to keep studying these issues as finding a doc who can address all of these issues in a proper sequence is not probable. You cannot be passive. You have a failure of the big three, testosterone, cortisol and thyroid. In USA, you can order your own labs from on-line services, in most States.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • Thyroid basics
  • protocol for injections
  • finding a TRT doc

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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#5

Thanks for the input, @studhammer. I made my way over to a natural health store looking for Lugal’s but they didn’t have it. I picked up iodoral instead. I took 12.5mg iodoral and 100 Selenium for two days. I felt great and upped the dose to 25/200 this morning.

I’ve felt more energetic throughout the day since I started supplementing. I also was delighted to have my wife and I woken up by my hard-on poking her in the back yesterday morning. I can’t remember the last time that happened and it turned into a great start to the day!

Another thing I’ve noticed since starting Iodine/selenium is that I CRASH in the evenings. 9:30pm rolls around and I hit a fucking wall. I almost fell asleep in the chair last night. I’ve been sleeping like the dead, too. I wake up sore and I think it’s because I don’t move all night…

No impact on body temp yet. In fact, my temp was DOWN this morning (96 vs. 96.4).

Been reading through other’s threads. It seems like there is a lot of give-and-take with doctors. Part of me wants to walk in and say “here’s the treatment plan I think would be best, can you write a script for me?” But it seems like the most productive approach is to focus more on finding one piece of common ground and building on that over time. I made an apt with the new doc. He doesn’t have an opening until mid Oct, but I got put on a cancellation list. The scheduler said chances are good that I’d get in much earlier.


#6

Appreciate the feedback, @KSman. You’ve given me some things for consider, for sure!

I’ve not had anybody mention a GI bleed to date. Everyone, myself included, has just chalked my low HTC and RBC up to sports anemia (i.e. increased plasma diluting total blood values). Both possibilities seem plausible, thought. I read up on occult blood tests, finding that I need to severely restrict my diet for 3 days prior to the test. I begin a restricted diet today in preparation for a self-administered test on Saturday.

I am no longer avoiding red meat. I don’t eat a lot of it, but I get steak or pork a few times a week. I’ve been taking an Iron supplement for ~6 months. I’ll be getting a new round of labs done in the next week or two to see where these values are at after supplementation and cessation of training.

This has made itself horrifically clear to me in the last few months. I’ve been back to a “normal”, balanced diet which includes animal products and COOKED veggies for ~6 months. My general rule for food is “GOOD food (i.e. whole), not too much, mostly plants.” I’m stealing that from somewhere but can’t remember where…

Not really. As a raw-vegan, I shat every morning. It was clockwork. Given the sheer volume of food I had to intake in order to hit 3000-6000 calories on a raw-vegan diet, I had MASSIVE shits. They were and still are quite loose, if that means anything. The only thing that’s changed since Iron supplementation and inclusion of animal products is that sometimes I shit EOD instead of every day.

I read through the sticky again and plan to read Wilson’s book. The ATA and just about every other well-known scientific/medical institution is quite skeptical about Wilson. To be honest, anybody who names something after himself has too much ego, if you ask me. On the surface, it smells like quackery to me, but I’ll give it a read and see if it resonates.

This review of Wilson’s Syndrome gave me pause: https://www.thyroid.org/american-thyroid-association-statement-on-wilsons-syndrome/

This is disheartening. It makes sense, though. All three systems act in symbiosis, so if one out-paces one or both of the other two, no net improvement will be made. I got my old urologist to order fT3 and E2 for me. I’ll have those drawn this week. I’ll have to order the others on my own. I’ll research online options. Any recommendations?

And thanks again for your input. You’ve clearly put a lot of time into researching the HPTA. My PC told me that I’m well on my way to getting an honorary degree in Endocrinology; you must already have emeritus status!


#7

Private MD Labs. My HRA account covered the costs. Just had to submit my lab order (from the website) and my receipt.

https://www.privatemdlabs.com/


#8

KSman was here


#9

I just had more blood drawn and am expecting results any day now. In anticipation I was looking through my previous results. I realized that the Endo told me my ACTH stim test was perfectly normal, but I have no idea how to interpret it myself. Here is a copy/paste of the results:

CORTISOL, BASELINE 13.4 MCG/DL 3.0 - 33.0 MCG/DL
CORTISOL, POST STIMULATION 21.4 MCG/DL 6 - 66 MCG/DL

The normal response to ACTH is a significant rise above the
baseline cortisol value (Unless the baseline value already
exceeds the normal range). Generally, cortisol level may
rise 10 ug/dL or more.

Now the question is… Is this actually normal or is the Endo being a dip-shit? The test itself says I should see a rise of 10mcg but mine only rose 8. Then I saw on wiki that the value should DOUBLE. Mine most certainly did not double.

Any insights?


#10

I’m the same age and dealing with similar issues caused by similar circumstances.

Have you looked into the possibility of adrenal fatigue? I’m kind of operating under the assumption that that is what caused my issues (two docs I’ve seen were no help).

I started taking a product called “Adrenasense” last fall and started feeling better very quickly.

You should check out a guy named Dr Lam, he has written a ton of material on his website about adrenal fatigue. He also offers a health coaching service to help strengthen your adrenals but it’s pretty expensive. He essentially just pumps you full of vitamin C and B and runs you through several detox protocols. I felt a lot better after doing it for 6 months. Still not back 100% yet but feeling much better.


#11

See references to adrenal fatigue, stress, rT3, Wilson’s book - in the thyroid basics sticky. This was referenced above.

Yes, stimulation test was weak.


#12

Time for an update. Here is a summary of the tests I’ve had run since my last update.

Test Value Range Value Range
date 11/15/2017 11/15/2017 1/10/2017 1/10/2017
Total Testosterone 275 264-916 ng/dL 876 264-916 ng/dL
Free Testosterone 5 8.7-25.1 pg/mL
LH 1.6 1.7-8-6 mIU/mL
FSH 3.3 1.5-12.4 mIU/mL 5.8 1.5-12.4 mIU/mL
TSH 1.08 .45-4.5 uiU/mL
Free Thyroxine (fT4) 1.55 .82-1.77 ng/dL
Total T3 74 71-180 ng/dL
Estradiol 31.7 7.6-42.6 pg/ml

Doctor: I finally found a good one. My god how big a difference it makes to have a good doctor! He is a professor of Urology specializing in male fertility. His protocols, while not identical, are very similar to what’s recommended here. I had my first appointment with him on Dec 20th 2017. We had a long conversation about protocol options, advantages/drawbacks to each and my life-goals. It was a far cry from the rushed 10 minute BS lectures from the previous docs I’ve seen. I’m so immensely relieved its impossible to put into words. He is in Portland, Or. If anyone needs a recommendation, drop me a line.

Protocol: I want a family. I would prefer not to be on HRT for the rest of my life. Those are my two main goals shared with the doctor. He recommended we try Clomid mono-therapy first. Best case scenario, clomid might jumpstart my HPTA eliminating the need for HRT. He said that he has had several cases of young men with secondary hypogonadism regaining their endocrine function after a short course on Clomid.

Worst case: I don’t respond well to it and we switch to HCG mono-therapy. If that doesn’t work, we add test. All the wile he places a high priority on monitoring E2 and subjective well-being. I could not ask for a better doctor. I am so happy!

Starting December 21, I’ve been taking 25mg Clomid ED. The first two weeks were amazing. I slept like a baby, energy level was higher than I can ever remember it being, mental clarity was tip-top and I was a fucking horn-ball! I would get random hard-ons throughout the day, something I haven’t had happen since high-school. I was also STARVING all the time. I couldn’t stop eating… After two weeks, though, the benefits started to fade.

I reverted back to felling almost the same as before treatment began. A little bit better, but not much at all. In addition, my right nipple started bulging out of shirts. It was making me very uncomfortable. At the 3 week mark, I had labs re-drawn and saw the E2 had risen to 31.7. That’s not SUPER high, but higher than what’s recommended here on this site. At first the doc didn’t want to change anything but I asked if there would be any harm in lowering E2 down closer to 20. He said no and prescribed me Arimidex at 1mg/week.

I took my first 1mg arimidex two days ago and feel on top of the world again. I realize 1mg once per week is not ideal. will most likely divide the dose into .5mg twice per week next week. I’m also scared of crashing my E2. I’ll be checking my E2 again in 3 weeks. If I start feeling like crap I will probably stop the AI all together for a week.

Another interesting thing was that my thyroid panel looks better after I began Clomid. Might just be a coincidence…

So that’s that. If you have questions, please feel free to ask. Input is also very much appreciated. I’ll try to keep this updated periodically as I still feel very strongly that my extreme endurance training and diet program did this to me. There’s got to be more people out there like me…


#13

Keep us updated man. AM actually thinking about retrying the clomid after reading your story, But am 10 years older. clomid got me to 500 T and free t to 16 with 25 EOD. So being it only got me to 500 I went on to injections.