T Nation

Got Bloodwork - Need Protocol Advice

Hi all

I am 35, male, never had any great tendency for putting on muscle mass. Used steroids and recreational drugs (coke, ecstasy, speed, weed) for a solid 10 years between the ages of 17 and 27. I’ve been prescribed Atomoxetine for ADHD and aripiprazole for what my psychiatrist has dubbed minor psychotic episodes. I am prescribed both medications at sub therapeutic doses.

My main issues are: depression, fatigue, an inability to pack on any meaningful muscle mass and an inability to become aggressive in pursuit of my goals. My libido is average I would say, morning wood is pretty much daily, although erections could be fuller. Also not experiencing any hair loss. And now the bloodwork.

Total Test: 4.40 nmol/L (2.5 - 29.57)

Free Test: 2.91 nmol/L (lab didn’t provide a range for this!! Is this crucial?)

SHBG: 56.00 nmol/L (10-57)

Thyroid stimulating hormone: 2.803 micIU/ml (0.3 - 3.0)

Free T3: 5.5 pmol/L (3.5 - 6.5)

Free T4: 16.88 pmol/L (11 - 18)

FSH: 2.6 U/L (0.7 - 11.1)

LH: 1.4 U/L (0.8 - 7.6)

Oestadriol: 100 pmol/L (0 - 146)

My concern is that the Atomoxetine is known to lower libido in some patients so what I am experiencing might be the direct consequence of that medication. My battle plan at present is to discontinue the Atomoxetine and find a way to kickstart my test naturally or using temporary therapy. Is this just wishful thinking in your opinion? Would meds like HCG, Tamoxifen etc help? In the past I had used testofen (fenugreek extract) and felt great but this has somehow stopped working. I am now suspecting this was due to the introduction of Atomoxetine into my regime. Not sure.

All your kind feedback is greatly welcome.

We need you to go back and edit your post with the ranges for each parameter.

Edited above. Thanks

It’s very common for drugs to be prescribed when the problem is low hormones, managed healthcare generally has poor knowledge in sex hormones are therefore drugs are used instead.

Your testosterone is incredibly low and TSH too high, while Free T3 looks good I see you have no Reverse T3 labs. The balance of Free T3 to Reverse T3 must be balanced, Free T3 mid-range or better and Reverse T3 <15 ng/dL.

Missing the ranges on this lab value is not necessary, we see Total T is extremely low and SHBG high and therefore Free T is expected to be in the gutter.

LH is very low and is likely do to your abuse of drugs when younger causing damaged. You’ll never produce enough testosterone to be able to compensate for high SHBG which will create more inactive testosterone (Total T) leaving you with little Free T, the stuff in circulation which does all the amazing things.

Your Total T is basically 126 ng/dL, SHBG high and testosterone levels are lower than 90 year old men! Most men would have what appears to be psychotic episodes at these levels because your body is short on essential hormones needed for normal functioning.

You’re going to have a real problem controlling estrogen on TRT, it’s already on the higher end while testosterone is extremely low and that will change when your testosterone levels are elevated, you will probably need injections ED or EOD or an AI to block estrogen.

You may not need very high levels since you seem to be able to get erections at these lower levels.

Thanks for taking the time to give me your valuable insight. Do you have any idea what dosages I might require?

At your age, with your numbers, and your past history, I would not mess around and waste time. I would start with 150mg once weekly. Did you have any trouble with E2 when you were taking anabolic steroids? If possible, I would hold off on an aromatase inhibitor and see how you respond. Did you have your lipids evaluated?

Discontinuing the Atomoxetine is a good idea.

I was never ripped but neither did I have a good diet. You know how some guys can get shredded even on d bol? that wasn’t me. I did get some soft tissue around the pecs but not much. There wasn’t much by the way of info on proper cycling and good food at the gym I frequented.

Also my lipids are very high both LDL and HDL but triglycerides are super low - 0.84 nmol/L range is 0.1 - 2.26.

Is your suggestion for me to get on 150mg enanthate per week? is that sub q? How long till I run these tests again to check on E2 etc?

Yes, I do.

Yes, that or cypionate. Wait at least six weeks. Hopefully, you won’t have trouble with E2 as higher E2 will help with your lipids.