T Nation

Go Ahead for TRT or Other Therapy?


#1

Hi all,

First of all thanks for making this huge resource which is very useful for all kinds of people.

Let me write about my query, I am a 30 yr old male. I am quite active and workout with weights regularly. I consider myself healthy and fit, with only little fat. Apart from this I sometimes have some fatigue symptoms, most of which are not that consistent but will still persist. I especially suffer from sleepiness especially after carb rich meals. I did run bloods in the past and all was fine, however no hormones were assayed.

About 2 years ago I ran a couple of AAS cycles, ran these using correct protocols, PCT, etc. The following months I started to have more fatigue related episodes. I ran some tests and found that there was some thyroid issues. After a couple of months (must have been some 3 months+ since I finished the PCT) I also checked testosterone levels, which were low.

I always had some suspect that I might have low testosterone, however there were no strong symptoms.
Libido/erections were ok, energy was ok apart from that bad day, and the usual sleepiness.

I then visited an endocrinologist who ordered tests. After which he suggested starting TRT with Test E, 250mg every month. I started this but, after a couple of months began taking 100mg every week as many here do and a divided 1mg arimidex tab twice a week. I told this to the endo and he’s ordered Nebido to avoid the frequent injections and fluctuations.
I have also tried using Pregnenolone too but didn’t feel any effect. I’m also undecided if I should use HCG.
I have not done much blood checking after starting TRT but I am feeling better. Most improvements were mental (focus, drive, etc) more than physical.
I will run a follow up port trt blood test next week.

I shall post blood tests that were taken before the TRT started, so you can get an idea of how it was:

Free T4 (Serum) 9.94 L [11-18 pmol/L] Final
Thyroid Stimulating Hormone (Serum) 1.680 [0.3-3 mIU/L] Final

Free T4 (Serum) 13.10 [11-18 pmol/L] Final
Thyroid Stimulating Hormone (Serum) 3.720 H [0.3-3 mIU/L] Final

Free T4 (Serum) 12.40 [11-18 pmol/L] Final
Thyroid Stimulating Hormone (Serum) 3.300 H [0.3-3 mIU/L] Final

Free T4 (Serum) 13.50 [11-18 pmol/L] Final
Thyroid Stimulating Hormone (Serum) 1.520 [0.3-3 mIU/L] Final

Free T4 (Serum) 12.90 [11-18 pmol/L] Final
Thyroid Stimulating Hormone (Serum) 4.580 H [0.3-3 mIU/L] Final

Last test

Free T4 (Serum) 11.10 [11-18 pmol/L] Final
Thyroid Stimulating Hormone (Serum) 2.130 [0.3-3 mIU/L] Final
Free T3 (Serum) 6.25 [2.76-6.45 pmol/L] Final

I suspect that I might have been Iodine deficient in the previous tests. Last test and since I have been taking a multivitamin with Iodine. I did take multivitamin in the previous tests but they were less strong.

Hormone tests:

FSH 1.2
LH 2.2
PRL 354.7
Test 7.0

Oestradiol (Serum) 104.0 [0-206 pmol/L] Final
FSH (Serum) 1.9 [0.7-11.1 U/L] Final
Growth Hormone (Serum) 0.07 [0-3 ug/L] Final
Luteinising Hormone (Serum) 1.2 [0.8-7.6 U/L] Final
Prolactin (Serum) 136.0 [53-360 mU/L] Final
Total Testosterone 9.36 [5.55-25.2 nmol/L] Final
Cortisol AM (Serum) 372 [119-618 nmol/L] Final
DHEAS (Serum) 6.89 [2.17-15.2 umol/L] Final

Total Testosterone 8.98 [5.55-25.2 nmol/L] Final
Luteinising Hormone (Serum) 2.4 [0.8-7.6 U/L] Final
Progesterone (Serum) <0.64 L [0.86-2.9 nmol/L] Final
Oestradiol (Serum) 110.0 [0-206 pmol/L] Final
Cortisol AM (Serum) 331 [119-618 nmol/L] Final
FSH (Serum) 2.7 [0.7-11.1 U/L] Final
Prolactin (Serum) 164.0 [53-360 mU/L] Final

A bone density test was also ordered and Femoral neck was -1.4 and Spine -1.8
Other tests such as an EEG, ECG, chest x-ray and brain MRI were all ‘OK’.
Blood pressure is 120/80.
Have quite a hairy body and got my gf pregnant easily during the months i had these labs.

A separate doctor ordered a sleep study which resulted fine, but none the less he suspected narcolepsy and prescribed Modafinil, which although helps I feel is not the solution.
So apart from the lab showing low test and low bone density, I dont have much low t symptoms except for occasional lethargy.

Do you think that I need to run any other bloods extra to the ones taken, and is it necessary that I run trt, or can I restart the HPTA and maybe get acceptable natural test levels, if test suppression was caused with the AAS use, unless this is a genetic issue.

Thanks for any feedback.






#2

TSH should be closer to 1.0
fT3 and fT4 should be near mid-range.
How has stress been a factor in your life?

DHEA-S is low for your age. - adrenals
Take 25mg DHEA ED

E2 should be closer to 80 pmol/L and is way to high relative to FT.
E2 clearance by liver is suspect. Test AST/ALT and stop lifting for 3-4 days prior.

Do not eat iron fortified foods, breads, cereals, vitamins

Please follow these links found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics explained - POST ORAL BODY TEMPERATURES AS SUGGESTED

Low thyroid function can cause lethargy.
What is your history, years, of using iodized salt and/or vitamins listing iodine+selenium

Labs:
fasting glucose
fasting cholesterol
A1C
Vit-D25 or take 5,000 - 6,000iu Vit-D3


#3

Dear KSman, thanks for your reply.

I have moments of stress, but I don’t think they are serious enough to cause issues. Could be sleep related maybe? Since I sometimes wake during the night’s sleep.

I’ll order DHEA, as recommended. What about my Progesterone level, Is that OK? I had also tried supplementing Pregnenolone but felt no effect.

Last ALT result was: ALT (Serum) 24 [5-41 U/l] - which looks OK? I will a have updated results soon. I also refrain from training for some days before bloods. Can you have a look at the blood tests shown above fore more general info?

Btw, since it was not clear in my post - SHBG was 25.70 prior to starting TRT.

Typical fasting glucose levels, around 5mmol/l
A1C: 35mmol/l or 5.3%

Last fasting cholesterol results:
Cholesterol (Serum) 4.02 [2.0-5.0 mmol/l]
HDL Cholesterol (Serum) 1.31 [0.9-1.45 mmol/l]
LDL Cholesterol (Calculated) 2.38 [mmol/l]
Non HDL Cholesterol 2.71 [0.00-3.36 mmol/l]
Total:HDL Cholesterol Ratio (Calculated) 3.07
Triglyceride (Serum) 0.72 [0.1-2.26 mmol/l]

Morning oral temperature never exceeded 36.5 C. Tried this again during different times in a couple of days and I’m always in the same region between 36.5/36.6C. Tried different thermometers.

I have taken a blood test today which included test, e2, Vit-D25 and other stuff. I will update results here.

I have been taking multivitamins for years, but the current type I’m using for the last 2 years has a daily dose of 240mg Iodine, Selenium 150mcg, strong in B vitamins, but also contains 8mg Iron.
I also take extra Calcium, Magnesium, Zinc and Vitamin D, 4000mg Fish Oil, Whey protein, creatine and glutamine.

Could it be that I have low test due to some E2 or Progesterone/DHEA issue or other deficiency, and may get better T levels by doing an HPTA restart and supplementing DHEA and maybe arimidex?

Once again thanks for your attention and help.


#4

Hi again,

Got lab tests result if you’d like to have a look:

Bicarbonate (Serum) - 26.1
Glucose - Fasting (Plasma) - 4.81 [3.88-6.38 mmol/l]
Alkaline Phosphatase (Serum) - 64 [0-129 U/l]
ALT (Serum) - 26 [5-41 U/l]
Bilirubin (Serum) - 8.9 [0-21 umol/l]
Gamma Glutamyl Transferase (Serum) - 23 [8-61 U/l]
CEA (Centaur) - <0.5 [0-2.5 ng/mL]
PSA (Centaur) - 0.91 [0-4 ng/mL]
Total 25 (OH) Vitamin D (Serum) - 33 [30-100 ng/mL]
Oestradiol (Centaur) - 134 [0-146 pmol/L]
Total Testosterone - 24.00 [2.5-29.57 nmol/L]
Progesterone (Serum) - <0.64 L [0.86-2.9 nmol/L]
Cortisol AM (Serum) - 295 [145-619 nmol/L]
Fibrinogen Assay - 3.84 [2.00-3.93 g/l]
C3 (Serum) - 1262 [900-1800 mg/l]
C4 (Serum) - 346 [100-400 mg/l]
Basophils Abs - 0.03 [0.00-0.10 x10^9 /L]
Eosinophils Abs - 0.20 [0.10-0.70 x10^9 /L]
Haematocrit - 48.8 [40.4-50.4 %]
Haemoglobin - 16.9 [14.1-17.2 g /dL]
Immature Granulocytes - 0.03 [0.00-0.09 x10^9/L]
Lymphocytes Abs - 1.69 [1.30-3.60 x10^9 /L]
Mean Cell Hb - 29.2 [27.0-32.0 pg]
Mean Cell Hb Conc - 34.6 [33.0-36.0 g/dL]
Mean Cell Volume - 84.4 [79.0-93.0 fL]
Mean Platelet Volume - 9.9 [9.2-12.6 fL]
Monocytes Abs - 0.45 [0.40-1.10 x10^9 /L]
Neutrophils Abs - 4.64 [2.10-7.20 x10^9/L]
Nucleated Red Blood Cells - 0.00 [0.00-0.01 x10^9/L]
Platelets - 264 [146-302 x10^9/L]
Red Cell Count - 5.78 [4.60-5.90 x10^12 /L]
Red Cell Distribution Width 12.1 [11.9-14.6 %]
White Blood Cell Count 7.04 [4.30-11.40 10^9/L]

Any further advise please?

Thanks