T Nation

Formula for Success

-age - 55
-height - 6’4"
-waist - 38
-weight - 230
-describe body and facial hair - spare tire and mustache
-describe where you carry fat and how changed - all in the waste (pun)
-health conditions, symptoms [history] - previously healthy
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - None
-lab results with ranges
-describe diet [some create substantial damage with starvation diets] - 3 clean meals and 3 protein shakes w/ multi vit/min. Use Beverly Intl exclusively
-describe training [some ruin there hormones by over training] - lift 4 days/week for 45-60 min
-testes ache, ever, with a fever? - recently a little
-how have morning wood and nocturnal erections changed - none recently

Up until the last 2 years or so, I have been healthy and fit - I’ve had one physical in 25 years. I’ve stayed away from the health care cartel.
Began putting on weight on the waist, feeling sluggish and lacking libido. Added a slight amount of cardio - no help. Began having sleeping problems, not sleeping through the night, not feeling like I was recovering, or benefiting from workouts, no morning wood. I have never used steroids - I use creatine and beta-alanine. Been lurking and reading, so I recently added some RC Anastrozole (.5mg 2x/week).
My sister was diagnosed with sleep apnia, and suggested I look into it. So I hesitantly went to a Dr. for a sleep test - no apnia. But I convinced him to do TT and FT along with his Vit D and A1c tests.

VITAMIND, 25 HYDROXY 27.6 ng/mL (30.0 - 100.0 ng/mL) - am now supplementing.
GLYCOHEMOGLOBIN A1C 5.3 % (4.5 - 5.6 %)

Testosterone 230 L

Reference range: (240 to 950 Unit: ng/dL)
-------------------ADDITIONAL INFORMATION-------------------
Testing performed by Liquid Chromatography-Tandem Mass
Spectrometry (LC-MS/MS).

Free Testosterone  5.98   

Reference range: (3.87 to 14.7 Unit: ng/dL)
Testing performed by Equilibrium Dialysis.
Test Performed by: Mayo Clinic Laboratories 3050 Superior
Dr. NW, Rochester,MN 55901, unless otherwise specified.

I met with that Dr today. He said that I did not have hypogonadism - primary or secondary
because my FT was within range. I wanted more tests as listed on this forum. He did not want to order expensive tests as they are not warranted. FRUSTRATION! He referred me to an Endo w/no appointment till 12/1 - more frustration/castration, whatever.

I’ve been supplementing with iodine the last few days. My body temps have always been good, but I have seen an improvement of waking temps by about 3/10ths. This morning was 98.2.
Thyroid seems good:

Component Your Value Standard Range
WBC 6.1 K/mcL (4.2 - 11.0 K/mcL)
RBC 5.20 mil/mcL (4.50 - 5.90 mil/mcL)
HGB 16.5 g/dL (13.0 - 17.0 g/dL)
HCT 48.5 % (39.0 - 51.0 %)
MCV 93.3 fl (78.0 - 100.0 fl)
MCH 31.7 pg ( 26.0 - 34.0 pg)
MCHC 34.0 g/dL (32.0 - 36.5 g/dL)
RDW-CV 12.0 % ( 11.0 - 15.0 %)
PLT 205 K/mcL (140 - 450 K/mcL)
LYMPH 23 %
Neutrophil 71 %
Absolute Lymph 1.4 K/mcL (1.0 - 4.0 K/mcL)
Absolute Mid 0.4 K/mcL (0.1 - 1.1 K/mcL)
Absolute Neutrophil 4.3 K/mcL (1.8 - 7.7 K/mcL)

TSH 0.559 mcUnits/mL (0.350 - 5.000 mcUnits/mL)

Could my recent use (2 months) of Adex skew the FT levels into his acceptable range?
At 55 yrs, should I go to TRT and not collect go? - stop fighting the Cartel and pay out of pocket? OR, should I try to get the Endo to run the tests first, have more data points, then make a decision? (Is it worth it to wait?) I have no libido, fatigued, gaining fat around mid-section, moody, and I’ve always been able to motivate myself but it is becoming difficult.

Thanks for any suggestions,

Your free trt is not exactly optimal and your total trt is low. If your budget can handle it you might consider shipping those test results to a Dr who specializes in male hormone replacement. It is true that these T clinics are testosteron mills. The best of them will look into thyroid issues and other causes and not just put you on the Big T for life. But your levels are low. And your symptoms are classic low T

Using Adex strikes me as a bad idea. With low TrT your E2 is likely not very high. You need to know what your e2 level is before trying to lower it. There is a good chance that when not taking TrT you are taking E2 too low. Not s good thing. I do not know if Adex changed your free t much. It likely did lift it a little bit. But that is a guess

Thanks for your reply, Verne
Yes, I need more tests. Where to pursue those tests is my question (time & $$), and you accurately described a concern of mine - T Mills. I can find a way to afford it, if it is the right course of action.
I didn’t go looking for T, as I went through a sleep study. I wasn’t sleeping through the night, wasn’t recovering from my workouts, couldn’t drop the fat, and thought it might be lack of REM’s.
I quit the RC Anastrozole last week, once I got the tests back (was surprised at the results), and am finishing the IR two week load. I don’t think thyroid is an issue for me, but I did improve from 97.9 awaking temp to 98.2 during the 2 weeks - still worthwhile.

I argued with the sleep doc, that you treat the symptoms not treat the blood-work ranges, but we can all see that one coming. I suspect the Cartel Endo will arrive at the same conclusion, and I would have to wait 3+ months for the privilege.

I suspect you are right: Go directly to TRT and do not pass go. That TT is a low number and I’m 55. I’ve been feeling the symptoms for awhile - slow to seek help.

This is not a medical reality show where everyone gets to vote the ending, but I wouldn’t mind hearing more opinions. I live in NE WI - I could go to Chicago (multiple reasons to go).

You will hear more and from much more informed guys than me. It looks like you have been reading the stickies here. I would encourage you to read them all. The info is golden

I would not cancel the endo appointment until you have better options.

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Get your own labs done. For $299 you can get discountlabs to run the full pre TRT work up. You get the bloods drawn at labcorp. Or ask Labcorp for a cash price and it will be close to the same. No need for a doc to write it up.

You probably have a lower SHBG hence your free T being ‘ok’. Its all about how you feel. I would like to see the full labs including FSH, LH importantly as they relate to your T. You can do a remote consult through Dr Crisler at Defy Medical. One of the top guys in the industry.

Stop taking the arimadex. Not necessary without labs and it can make you feel worse by driving your E down. Jitters, depression, insomnia, energy etc.

TSH is lowish. 98.2F when waking: Suggestive of possible low level hyperthyroidism. Body temps are more useful than labs in many cases.

Were you not using iodized salt?
Iodine+selenium in vitamins?

Labs were before taking iodine?

FT in natural guys, you, is released in pulses with a short half-life. So a lab can catch a peak or low level. So FT labs introduce unknowns and you can’t judge.

0.5mg/week anastrozole in divided doses might be an option. 1,0mg/week was a bad idea. E2 would be low and may have increased T levels and skewed the labs.

HTC strong with low T. Watch HTC on TRT, might get too high.

See the stickies again and read the finding a TRT doc sticky and protocol for injections.

At age 55, we have less interest in LH/FSH as we fully expect age related decline in T and not looking for a resolvable causative pathology.

Thanks KSman,
Yes, labs before IR. Lab was taken 1:30pm, but I read here that 55+ they don’t take into account AM or PM valleys.
I was not using iodized salt, and use very little salt. My Vit/Min has 150 mcg of ki, and 80 mcg of S.

I guess I am typical in that as my symptoms started to become more pronounced, I tried to increase workouts/diet and I had no success. I’m single so lack of libido was not effecting anyone else. When I was failing to sleep through the night, I finally sought some help knowing that my sister found help. I thought lack of REM sleep was causing problems.

I contacted Defy Medical (Verne’s advice), paid the blood test, and have it scheduled for tomorrow morning - that was quick! I took 25mg of iodine this morning. I think I’ll forgo the 25mg tonight, hydrate, and go to the test at 8 am.
Scheduled a general physical through my network for next Wed, 8/24.

After reading through all the mood symptoms, I am shocked just how moody I had become. Even on Defy’s questionnaire, I did not admit the full extent of moodiness. For some reason, that seems to be really hard to admit to myself.
I’ll have some data, soon.

Dr C at Defy is an industry leader. You are in good hands.

You are on the right path. make sure you take those temperaturs. I was a little surprised by the results when I did it. I supplemented my iodine and my temperatures rose by one full degree in the morning and about a half a degree in the afternoon.

Got Labs back. They did not retest the TT and FT as they were within 60 days (saved some $$):
LH - 7.3 mIU/mL (1.7 - 8.6)
TSH - 2.750 uIU/mL (0.450 - 4.500)
TT - 230 ng/dL (240 to 950)
FT or bio-T - 5.98 ng/dL (3.87 to 14.7)
E2 - 11.8 pg/mL (8.0 - 35.0)
DHEA-Sulfate - 154.5 ug/dL (48.9 - 344.2 )
Progesterone 0.4 ng/mL (0.2 - 1.4)
PSA - 0.4 ng/mL (0.0 - 4.0)

I can see a rationale for my mood/symptoms. SBHG was not measured. Broke a tooth last weekend - need two titanium screws and a crown.

Had a physical this morning by a PA. I gave him the sheet to fax to Defy. He said TRT will lead to heart attack, stroke, and cancer. I told him that I was looking for healthy normal levels, and I did not see 18 year old males dying of heart attacks, strokes, or cancer. He had no response. I never removed my shirt, he never checked for hernia, what a joke.

Consult with Dr. Crisler set for 9/6.

Anything strong enough to help you is strong enough to hurt you. For some reason with TRT a lot of doctors act like the rare side effects are the norm. But they never do that with other treatments. Lets look at the antidepressants that some doctors pass out like candy.

“Whether for children or adults, antidepressants have other risks in addition to the possible risk of suicide. Common side effects include nausea, anxiety, restlessness, decreased sex drive, dizziness, weight gain or loss, tremors, sweating, sleepiness, fatigue, dry mouth, diarrhea, constipation, and headaches.”

And just like any good doctor does with anti depressants, which are far more hazardous and do far less good at their best than TRT. Dr. Crisler will keep an eye out for bad side effects

TSH is expected to be inflated when taking high dose iodine.

Definitely secondary hypogonadism.
Should also be testing FSH as it is more accurate for diagnostics than LH alone.

E2 consistent with lower FT.

TT better indicator than FT as both LH and FT have a lot of variation over time.

Had my consult today:

80 mg T 2x/week (ex. T & Fr)

500 IU hCG 2x/week (ex. M & Th)

25 mg DHEA 2x/day

Blood re-test at 8 weeks.

That’s a generous amount of T. Here is my prediction. Initially you will feel great. You’ll have more energy, high libido, morning wood, you’ll be stronger in the gym and sleep better. THEN about 8 weeks from now you’ll start feeling like shit. You’ll wonder wtf happened?? Spoiler alert… You’re E2 will be too high because you aren’t doing anything to control it.

I understand where you’re coming from Nash. I don’t come here for an internet reality show where everyone votes and determines my protocol. :smiley: I do appreciate your opinion, though.
I’ll follow the doc’s protocol. If I don’t like it at 5- 6 weeks, I’ll call in and push up the blood work.
At my low numbers, I’m not concerned about no AI - to begin with. Have to get the numbers up, then see what’s what.
I’m OK with a fast ride up, and I hope you’ll help me interpret along the way. Doc must have some reasoning.

Has anyone created a spreadsheet for blood work & subjective feelings? Would be nice to graph the correlation and the change over time.

Got it. Good luck to you.

Started the T(80 mg) on Wed., and the first hCG (500 IU) today. Nothing noticeable, so far. Like Nash has warned, I’ll watch for high E2 about weeks 4-5; but I’ll stick to the protocol. I’m still ok with it as an initial start-up protocol.

Dr. John Crisler left Defy - I must have been one of his last consultations. We seemed to have good rapport on the phone. Only news I’ve heard is “amicable” - of course.

Next week is my 8th week - labs scheduled 11/4:

CBC With Differential/Platelet
CHM 322000 Comp. Metabolic Panel (14)
CHM 004020 DHEA-Sulfate
CHM 140244 Estradiol, Sensitive
CHM 221010 Lipid Panel w/ Chol/HDL Ratio
CHM 004317 Progesterone
CHM 010322 Prostate-Specific Ag, Serum
CHM 004259 TSH
CHM 140103 Testosterone,Free and Total

First week - nothing. I did feel the first hCG shot - immediate mood elevation then faded.
2nd & 3rd weeks - felt like I was going backwards (mood, energy, gained 8 lbs).
4th & 5th weeks - slight incremental improvement (mood, energy, sex thoughts/impulses, no ED improvement), muscle fullness is definite.
6th & 7th weeks - still incremental improvement but definite improvement, oily skin on back (2 or 3 zits), no abdominal fat loss.

I never felt like I went through a sweet spot. When I started; E2 was 11.8, Progesterone 0.4, TT 230, FT 5.98, DHEA-S 154.5. Looking forward to viewing the new tests.

Date Weight

9/15/2016 240.6
21-Sep 239.6
29-Sep 245
1-Oct 248.4
6-Oct 248
12-Oct 245
28-Oct 246.8

Good thread. I’ve been following this – and can appreciate the concern going into this decision, as well as the frustration finally finding a doctor who doesn’t treat TRT like some kind of drug addition.

IMHO - it was a very good decision for you to start – given where your numbers were coming in at. Also, E2 looks great and seems you had some positive body recomposition changes. Libido gets a little funny- I know - never exactly what we expected. Even if the noticeable effects have lessened - you are far healthier with normal T levels.

I was reluctant, but yes, I am the classic candidate.
My goals:

  1. Mood and energy
  2. Ab fat loss
  3. Libido

I had bloods drawn last Friday. I do not know my E2 values, but it may be too early to expect fat loss 8 weeks in.
Pre-TRT 9/14/16

8 weeks 11/2/16