T Nation

Full Story and Latest Labs


#1

So guys,
As long as i can remember, i felt always weak, tired, moody.
10 years ago, i begun to have panic attacks, really intense, so the GP gave me Effexor, i took it for 10 years.
In that laps of time, i had less panic attacks, but developped phobias, had a normal life, but was tired, complete loss of well being, inability to gain muscle despite weightlifting.
In end of January i took Finasteride and this made me heavily crash, i got heavy anxiety attacks, depression, suicidal toughts, muscle and joint pain, heavy heartbeats, night sweats, crying spells.
And of course, loss of libido, and ED
My GP told me it is in my mind, so i went to an endo.
Here are my latest labs :
Total T : 271 ( vs 288 last month, vs 307 2 months ago)
SHBG : 18 (18-54 nmol/l)
E2 (normal assay) : 25 (27-52 pg/ml)
Free T (calculated) : 6.77 ng/dl (2.5%)
Bioavailable T (calculated) : 171 ng/dl (63.8%)
FSH : 1.5 UI/L (1.5-12.4)
LH : 3 UI/L (1.7-8.6)
TSH : 0.64 mUI/l (0.27-4.2)
FT3 : 3 ng/l (2.6-4.4)
FT4 : 11.7 ng/l ( 9.3-17.1)
CRP < 1
As you can see i don’t have the classical post finasteride syndrome with High T, High E2 and low DHT.
Those labs are made, as I am lifting 3 times per weeks.
I’m 30, 180 cm, 70 kg. No specific diseases.
So what is the next step ?
Stay like this with the T of an old 70 men?
Advice needed !

@KSman ?


#2

finasteride syndrome is characterized as an induced case of secondary hypogonadism and you fit that exactly with low LH/FSH. However, you may have been somewhat secondary prior to finasteride.

Your FT levels are low so FT–>E2 production is low. E2=25 may be indicating impair E2 clearance in the liver. Some of your meds, Rx or OTC might be doing this and AD meds have been known to. In any case, your low FT with E2=25 makes you significantly estrogen dominant and that is part of your symptoms.

SHBG is low. So less T is bound in non-bioavailable SHBG+T.

Your T levels are low, but a 64% is bio-available because of low SHBG.

Some guys simply have low SHBG. But low SHBG is also seen with low insulin sensitivity or diabetes. Your fasting glucose or A1C labs would be of interest.

Labs if available:

  • Hematocrit
  • fasting glucose
  • fasting cholesterol
  • CBC
  • AST/ALT
  • prolactin - can reduce LH/FSH

Where are you located? Affects diagnostic and treatment options.

Your sex hormones can easily be major players in you mood/depression.

Thyroid:

  • TSH is low a bit.
  • FT3 is below 3.5 midrange
  • FT4 is below mid-range
  • A bit of an odd combination. I need your history of using iodized salt and/or vitamins listing iodine. Also need you to provide both of the body temperatures as per the last paragraph in this post.

Looking back over the years:
Was libido strong once and when did that start slipping away?
Does body/facial hair suggest that you were well virilized years ago?
Loss of hair below the knees is from long term low-T.

I think that you should go after TRT with all of the energy you can muster.

If your testes are perfectly normal, you might be able to use hCG alone, otherwise after a trial, self-injected T is your best bet.

We also need a conversation about your needs to preserve fertility.

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
  • 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.


#3

Thanks for this response !

Yes i need to preserve fertility !

Hematocrit is 44.7 %
Fasting glucose : 0.96 g/L
Fasting cholesterol don’t have.
CBC :
RED CELLS… 5,16 T/L 4,28 à 6,00
(Mesure par impédancemétrie et colorimétrie)
HB… 15,5 g/dL 13,4 à 16,7
Hématocrite… 44,7 % 39,0 à 49,0
VGM. . . . . . . . . . . . . 86,6 fL 78,0 à 98,0
CCMH . . . . . . . . . . . . 34,7 g/dL 31,0 à 36,5
TCMH . . . . . . . . . . . . 30,0 pg 26,0 à 34,0
Coefficient de variation des GR 11,9 % 11,0 à 14,0

GLOBULES BLANCS. . . . . . . . 6 700 M/L 4 000 à 11 000
(Cytométrie en flux multidimensionnelle)
PN Neutrophiles . . 36,4 % 2439 M/L 1800 à 6900
PN Eosinophiles . . 7,9 % 529 M/L inf. à 630
PN Basophiles . . . 1,3 % 87 M/L inf. à 110
Lymphocytes… 47,5 % 3183 M/L 1000 à 4800
Monocytes . . . . . 6,9 % 462 M/L 180 à 1000

AST : 22
ALT : 14

Prolactine is 399 ( a bit over range but I’m on Effexor ) was normal one month ago.

I’m in France.

My libido was strong, but fatigue over years made it disappear.
I don’t have a lot of body hair, nor beard.

@KSman


#4

CBC looks good and consistent with your low-T.

Please respond to other points in my post.

  • Iodized salt history…
  • And need those body temperatures.
  • These really are major concerns as so many guys who come here have some related problems.

Fertility:

  • Injecting T or T creams/gels will shut down LH/FSH to near zero. You have to inject 250iu hCG subq EOD or use a low dose SERM to maintain LH/FSH. But you then need to check LH/FSH to confirm that LH/FSH levels are useful.

  • If you do hCG as your only therapy, fertility will be OK, but need to see that TT, FT, and E2 levels are good.

  • Or you could do low dose SERM only and check LH/FSH, TT, FT and E2.

Sounds like your T levels never were high and then slowly dropped before your finasteride event.

Your glucose removes the concern re SHBG and diabetes.

I cannot recall what forms of TRT are available there. Injected is very effective, 100% absorbed and least cost. But many countries make TRT very difficult. You might find a conversation with a pharmacist useful as any one doctor might limit choices to his preferences.


#5

I havent understood what you will say here . Can you explain ? @KSman?


#6

It is essentially T enanthate (Androtardyl) or Nebido


#7

I use table salt. But do not add a lot .
I’ll take temperature tomorrow


#8

@KSman temperature was normal 3 times.


#9

@KSman is TRT a good indication in my case?


#10

Just seen the endo, he wants me to get on oral steroids Pantestone, what do you think about @KSman ?


#11

That is oral testosterone undecanoate. Not sure if its liver toxic like other steroid tablets.

Maybe Ksman can shed some light on it.

I think you would still be better off on injectables if you can get them


#12

@KSman ?