T Nation

Guidance on Low T, Obesity, Etc


#1

Short Introduction - I am 50 year old male, morbidly obese,low T, depression (take Citalopram and Wellbutrin), high blood pressure (take Lisinopril), osteoarthritis in hips and knees. Sedentary life style, use a CPAP for Sleep Apnea. Also on Allopurinol for Gout. Also take Vyvanse for ADHD

I was prescribed Testosterone Enanthate at my request by my primary care physician. He did not augment the treatment with HCG,SERMS, etc.
He wasn’t too familiar with TRT, it seems. I was referred to an Endocrinologist who did nothing (“your numbers are fine?!”).

I was on TRT for about two and a half years.

Height: 6’2"

Weight: 440 lbs

Do not drink alcohol

Do not smoke

Do not take any illegal drugs (ever)

Have never used any Anabolics or performance drugs (other than TRT)

Normal Body Temperatures

Do not feel cold very often.

Do have lessened libido, some ED, no “morning wood.”

Have used “hair growth shampoo” 3 or 4 times approx. 6-8 months ago.

Nails are not brittle.

Regularly feel brain fog, lethargy.

Diet is poor. Drink a lot of sugar soft drinks.

I do use Iodized table salt.

Eat Seafood approx. once a month.

By March, 2015 my blood work was as follows:

Component Your Value Standard Range
TESTOSTERONE TOTAL 744 ng/dL 302 - 903 ng/dL
TESTOSTERONE FREE 134 pg/mL 47 - 244 pg/mL

Testosterone, Free Pct 1.8 % 1.6 - 2.9 %
Sex Hormone Binding Globulin 47 nmol/L 13 - 110 nmol/L

I had a Thyroid Stimulating Hormone Test (HST) done at that time too,
with the following results:

Component Your Value Standard Range
TSH 2.88 uIU/mL 0.36 - 3.74 uIU/mL

We decided to take a break, due to Prostate Enlargement/Urinary issues
and because I was losing hair rapidly (I have always had a full, thick head of hair before TRT).

It is now nine months later. I feel terrible, weak, constant aches and pains, chronic fatigue, inability to lose fat, fluid gathering in my feet and lower legs. I seem to worry a lot?

I had a Total Testosterone test done a couple of days ago (lab orders screwed up and they didn’t do the full panel). Result was:

Component Your Value Standard Range
TESTOSTERONE 170 ng/dL 302 - 903 ng/dL

EDIT - ADDITIONAL LAB WORK and HISTORY - From last 10 Days:

Component Your Value Standard Range
LIPASE 8 U/L 5 - 88 U/L

COMPREHENSIVE METABOLIC PANEL (first 3 tests low due to dehydration)
Component Your Value Standard Range
NA 131 mmol/L 135 - 144 mmol/L
K 3.3 mmol/L 3.7 - 5.5 mmol/L
CL 96 mmol/L 99 - 110 mmol/L
CO2 30 mmol/L 20 - 31 mmol/L
ANION GAP 5 4 - 13
GLUCOSE 111 mg/dL 60 - 99 mg/dL
BUN 14 mg/dL 6 - 23 mg/dL
CREA 1.03 mg/dL 0.60 - 1.30 mg/dL
Calcium 8.9 mg/dL 8.3 - 10.4 mg/dL
ALK PHOS 83 IU/L 32 - 110 IU/L
BILIRUBIN TOTAL 1.2 mg/dL 0.2 - 1.2 mg/dL
AST (SGOT) (REF) 36 IU/L 11 - 39 IU/L
ALT (SGPT) (REF) 43 IU/L 6 - 42 IU/L
Total protein 7.0 g/dL 6.1 - 8.0 g/dL
ALBUMIN 3.9 g/dL 3.2 - 4.9 g/dL

CBC WITH DIFFERENTIAL

Component Your Value Standard Range
WBC 9.2 10^9/L 3.9 - 10.6 10^9/L
RBC: 4.70 10^12/L 4.40 - 5.90 10^12/L
Hgb 13.5 g/dL 13.5 - 17.7 g/dL
Hct, Final 39.8 % 40.0 - 53.0 %
MCV 84.7 fL 80.0 - 100.0 fL
MCH 28.7 pg 26.3 - 33.8 pg
MCHC 33.9 g/dL 31.5 - 36.3 g/dL
RDW-CV 13.3 % 11.5 - 14.5 %
Platelet Count 157 10^9/L 140 - 444 10^9/L
MPV 7.3 fL 6.8 - 10.8 fL
NEUTROPHILS % 83.1 % 40.0 - 81.0 %
LYMPHOCYTES % 9.6 % 20.0 - 53.0 %
MONOCYTES % 6.8 % 1.0 - 10.0 %
EOSINOPHILS % 0.1 % 0.0 - 6.0 %
BASOPHILS % 0.4 % 0.0 - 2.0 %
NEUTROPHILS ABS 7.7 10^9/L 1.8 - 8.0 10^9/L
LYMPHOCYTES ABS 0.9 10^9/L 1.0 - 4.8 10^9/L
MONOCYTES ABSOLUTE 0.6 10^9/L 0.0 - 0.8 10^9/L
EOSINOPHILS ABSOLUTE 0.0 10^9/L 0.0 - 0.5 10^9/L
BASOPHILS ABS 0.0 10^9/L 0.0 - 0.2 10^9/L

I need to figure out a diet plan and exercise/lifting plan.
I have so little energy that I hope I can start.

Where to start?

Thanks


KSman is Here
#2

Short Introduction - I am 50 year old male, morbidly obese,low T, depression (take Citalopram and Wellbutrin), high blood pressure (take Lisinopril), osteoarthritis in hips and knees. Sedentary life style, use a CPAP for Sleep Apnea. Also on Allopurinol for Gout. Also take Vyvanse for ADHD

I was prescribed Testosterone Enanthate at my request by my primary care physician. He did not augment the treatment with HCG,SERMS, etc.
He wasn’t too familiar with TRT, it seems. I was referred to an Endocrinologist who did nothing (“your numbers are fine?!”).

I was on TRT for about two and a half years.

Height: 6’2"

Weight: 440 lbs

Do not drink alcohol

Do not smoke

Do not take any illegal drugs (ever)

Have never used any Anabolics or performance drugs (other than TRT)

Normal Body Temperatures

Do not feel cold very often.

Do have lessened libido, some ED, no “morning wood.”

Have used “hair growth shampoo” 3 or 4 times approx. 6-8 months ago.

Nails are not brittle.

Regularly feel brain fog, lethargy.

Diet is poor. Drink a lot of sugar soft drinks.

I do use Iodized table salt.

Eat Seafood approx. once a month.

By March, 2015 my blood work was as follows:

Component Your Value Standard Range
TESTOSTERONE TOTAL 744 ng/dL 302 - 903 ng/dL
TESTOSTERONE FREE 134 pg/mL 47 - 244 pg/mL

Testosterone, Free Pct 1.8 % 1.6 - 2.9 %
Sex Hormone Binding Globulin 47 nmol/L 13 - 110 nmol/L

I had a Thyroid Stimulating Hormone Test (HST) done at that time too,
with the following results:

Component Your Value Standard Range
TSH 2.88 uIU/mL 0.36 - 3.74 uIU/mL

We decided to take a break, due to Prostate Enlargement/Urinary issues
and because I was losing hair rapidly (I have always had a full, thick head of hair before TRT).

It is now nine months later. I feel terrible, weak, constant aches and pains, chronic fatigue, inability to lose fat, fluid gathering in my feet and lower legs. I seem to worry a lot?

I had a Total Testosterone test done a couple of days ago (lab orders screwed up and they didn’t do the full panel). Result was:

Component Your Value Standard Range
TESTOSTERONE 170 ng/dL 302 - 903 ng/dL

EDIT - ADDITIONAL LAB WORK and HISTORY - From last 10 Days:

Component Your Value Standard Range
LIPASE 8 U/L 5 - 88 U/L

COMPREHENSIVE METABOLIC PANEL (first 3 tests low due to dehydration)
Component Your Value Standard Range
NA 131 mmol/L 135 - 144 mmol/L
K 3.3 mmol/L 3.7 - 5.5 mmol/L
CL 96 mmol/L 99 - 110 mmol/L
CO2 30 mmol/L 20 - 31 mmol/L
ANION GAP 5 4 - 13
GLUCOSE 111 mg/dL 60 - 99 mg/dL
BUN 14 mg/dL 6 - 23 mg/dL
CREA 1.03 mg/dL 0.60 - 1.30 mg/dL
Calcium 8.9 mg/dL 8.3 - 10.4 mg/dL
ALK PHOS 83 IU/L 32 - 110 IU/L
BILIRUBIN TOTAL 1.2 mg/dL 0.2 - 1.2 mg/dL
AST (SGOT) (REF) 36 IU/L 11 - 39 IU/L
ALT (SGPT) (REF) 43 IU/L 6 - 42 IU/L
Total protein 7.0 g/dL 6.1 - 8.0 g/dL
ALBUMIN 3.9 g/dL 3.2 - 4.9 g/dL

CBC WITH DIFFERENTIAL

Component Your Value Standard Range
WBC 9.2 10^9/L 3.9 - 10.6 10^9/L
RBC: 4.70 10^12/L 4.40 - 5.90 10^12/L
Hgb 13.5 g/dL 13.5 - 17.7 g/dL
Hct, Final 39.8 % 40.0 - 53.0 %
MCV 84.7 fL 80.0 - 100.0 fL
MCH 28.7 pg 26.3 - 33.8 pg
MCHC 33.9 g/dL 31.5 - 36.3 g/dL
RDW-CV 13.3 % 11.5 - 14.5 %
Platelet Count 157 10^9/L 140 - 444 10^9/L
MPV 7.3 fL 6.8 - 10.8 fL
NEUTROPHILS % 83.1 % 40.0 - 81.0 %
LYMPHOCYTES % 9.6 % 20.0 - 53.0 %
MONOCYTES % 6.8 % 1.0 - 10.0 %
EOSINOPHILS % 0.1 % 0.0 - 6.0 %
BASOPHILS % 0.4 % 0.0 - 2.0 %
NEUTROPHILS ABS 7.7 10^9/L 1.8 - 8.0 10^9/L
LYMPHOCYTES ABS 0.9 10^9/L 1.0 - 4.8 10^9/L
MONOCYTES ABSOLUTE 0.6 10^9/L 0.0 - 0.8 10^9/L
EOSINOPHILS ABSOLUTE 0.0 10^9/L 0.0 - 0.5 10^9/L
BASOPHILS ABS 0.0 10^9/L 0.0 - 0.2 10^9/L

I need to figure out a diet plan and exercise/lifting plan.
I have so little energy that I hope I can start.

Where to start?

Thanks


#3

Short Introduction - I am 50 year old male, morbidly obese,low T, depression (take Citalopram and Wellbutrin), high blood pressure (take Lisinopril), osteoarthritis in hips and knees. Sedentary life style, use a CPAP for Sleep Apnea. Also on Allopurinol for Gout. Also take Vyvanse for ADHD

I was prescribed Testosterone Enanthate at my request by my primary care physician. He did not augment the treatment with HCG,SERMS, etc.
He wasn’t too familiar with TRT, it seems. I was referred to an Endocrinologist who did nothing (“your numbers are fine?!”).

I was on TRT for about two and a half years.

Height: 6’2"

Weight: 440 lbs

Do not drink alcohol

Do not smoke

Do not take any illegal drugs (ever)

Have never used any Anabolics or performance drugs (other than TRT)

Normal Body Temperatures

Do not feel cold very often.

Do have lessened libido, some ED, no “morning wood.”

Have used “hair growth shampoo” 3 or 4 times approx. 6-8 months ago.

Nails are not brittle.

Regularly feel brain fog, lethargy.

Diet is poor. Drink a lot of sugar soft drinks.

I do use Iodized table salt.

Eat Seafood approx. once a month.

By March, 2015 my blood work was as follows:

Component Your Value Standard Range
TESTOSTERONE TOTAL 744 ng/dL 302 - 903 ng/dL
TESTOSTERONE FREE 134 pg/mL 47 - 244 pg/mL

Testosterone, Free Pct 1.8 % 1.6 - 2.9 %
Sex Hormone Binding Globulin 47 nmol/L 13 - 110 nmol/L

I had a Thyroid Stimulating Hormone Test (HST) done at that time too,
with the following results:

Component Your Value Standard Range
TSH 2.88 uIU/mL 0.36 - 3.74 uIU/mL

We decided to take a break, due to Prostate Enlargement/Urinary issues
and because I was losing hair rapidly (I have always had a full, thick head of hair before TRT).

It is now nine months later. I feel terrible, weak, constant aches and pains, chronic fatigue, inability to lose fat, fluid gathering in my feet and lower legs. I seem to worry a lot?

I had a Total Testosterone test done a couple of days ago (lab orders screwed up and they didn’t do the full panel). Result was:

Component Your Value Standard Range
TESTOSTERONE 170 ng/dL 302 - 903 ng/dL

EDIT - ADDITIONAL LAB WORK and HISTORY - From last 10 Days:

Component Your Value Standard Range
LIPASE 8 U/L 5 - 88 U/L

COMPREHENSIVE METABOLIC PANEL (first 3 tests low due to dehydration)
Component Your Value Standard Range
NA 131 mmol/L 135 - 144 mmol/L
K 3.3 mmol/L 3.7 - 5.5 mmol/L
CL 96 mmol/L 99 - 110 mmol/L
CO2 30 mmol/L 20 - 31 mmol/L
ANION GAP 5 4 - 13
GLUCOSE 111 mg/dL 60 - 99 mg/dL
BUN 14 mg/dL 6 - 23 mg/dL
CREA 1.03 mg/dL 0.60 - 1.30 mg/dL
Calcium 8.9 mg/dL 8.3 - 10.4 mg/dL
ALK PHOS 83 IU/L 32 - 110 IU/L
BILIRUBIN TOTAL 1.2 mg/dL 0.2 - 1.2 mg/dL
AST (SGOT) (REF) 36 IU/L 11 - 39 IU/L
ALT (SGPT) (REF) 43 IU/L 6 - 42 IU/L
Total protein 7.0 g/dL 6.1 - 8.0 g/dL
ALBUMIN 3.9 g/dL 3.2 - 4.9 g/dL

CBC WITH DIFFERENTIAL

Component Your Value Standard Range
WBC 9.2 10^9/L 3.9 - 10.6 10^9/L
RBC: 4.70 10^12/L 4.40 - 5.90 10^12/L
Hgb 13.5 g/dL 13.5 - 17.7 g/dL
Hct, Final 39.8 % 40.0 - 53.0 %
MCV 84.7 fL 80.0 - 100.0 fL
MCH 28.7 pg 26.3 - 33.8 pg
MCHC 33.9 g/dL 31.5 - 36.3 g/dL
RDW-CV 13.3 % 11.5 - 14.5 %
Platelet Count 157 10^9/L 140 - 444 10^9/L
MPV 7.3 fL 6.8 - 10.8 fL
NEUTROPHILS % 83.1 % 40.0 - 81.0 %
LYMPHOCYTES % 9.6 % 20.0 - 53.0 %
MONOCYTES % 6.8 % 1.0 - 10.0 %
EOSINOPHILS % 0.1 % 0.0 - 6.0 %
BASOPHILS % 0.4 % 0.0 - 2.0 %
NEUTROPHILS ABS 7.7 10^9/L 1.8 - 8.0 10^9/L
LYMPHOCYTES ABS 0.9 10^9/L 1.0 - 4.8 10^9/L
MONOCYTES ABSOLUTE 0.6 10^9/L 0.0 - 0.8 10^9/L
EOSINOPHILS ABSOLUTE 0.0 10^9/L 0.0 - 0.5 10^9/L
BASOPHILS ABS 0.0 10^9/L 0.0 - 0.2 10^9/L

I need to figure out a diet plan and exercise/lifting plan.
I have so little energy that I hope I can start.

Where to start?

Thanks


#4

AST/ALT are a bit elevated. This might be from the effect of your medications. That and the effect of drugs making demands on the same enzyme pathways in the liver that clear estrogens may be increasing estrogens. That can contribute to higher SHBG, lowering FT fraction as well as repressing your HPTA. Estrogens also make prostate enlargement worse, all the more with your estrogen dominance as FT is so low.

If you take 5mg/day, 10ng/EOD Cialis/tadalafil, that can reduce BPH and improve erections. Erections are important for the health of the penis.

Need this lab data, you have some now.
TT
FT
E2
PSA
homocysteine
AM cortisol
TSH
fT3
fT4 [ please not T3, T4]
Vit-D25
IGF-1
DHEA-S
fasting cholesterol
fasting glucose
A1C

Pay for labs out of pocket is needed and then best if not via a doc. LEF.com has lab work as well as some other sources on the web. Available in most USA states.

Blood is quite thin. Much of that is from low T. Any digestive issues or food sensitivities? Ever had an occult blood test?

Try meloxicam Rx for your osteo. Dose is low, easy on your body and very affordable.

You need TRT and need frequent doses to avoid T spikes that will feed T–>E2 axiomatization. There is a lot of aromatase in fat, so that is a challenge. You will need anastrozole. You need high or high normal TT and FT, managing E2 in lower 20’s.

Thyroid Stimulating Hormone Test only determined that your pituitary can make TSH. Need a bigger picture.

Please read these stickies [again?]:

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Please post oral body temperatures as per the thyroid basics sticky.

Your TRT should include:
injected testosterone
anastrozole
hCG if you care to preserve your tests [many simply feel better with hCG]
Cialis/Tadalafil

Also consider metformin, it has a lot of benefits beyond the obvious. Cheap too.

Supplements:
high potency B-complex multi-vit with trace elements including iodine+selenium, should be iron free
5,000iu vit-D3, find tiny oil based caps, take 25,000 for first 5 days
25mg DHEA
EFA’s fish oil, flax seed oil/meal, nuts
natural source vit-E
vitamin C and other antioxidants
50mg ubiquinol form of CoQ10, must be ubiquinol
chromium picolinate

Thyroid if very critical for weight loss. So is good T levels and lower E2.


#5

KSMan;

Thank You so much for this information.

I will get on it!


#6

I have had an Occult Blood Test, results were negative.

I had some extensive testing done a couple of years ago concerning

food sensitivities and allergies, including blood, saliva and stools.

Tests indicated intolerance for a bunch of food groups, including wheat,

gluten, and many others I can’t immediately recall.

These were ordered by a Naturopath (ND) who recommended a bunch of supplements I took for a few months that seemed to help my well being
a bit.


#7

I had an appointment with my Primary Care Physician, and discussed all the the issues that KSMan addressed in his responses to my post.

He was impressed with how thoroughly all of the relevant issues were touched on by KSMan, and ordered all the different blood tests which were suggested.

I was most impressed by my Doctor’s humility, in saying that if I do end up starting on HCG, and then TRT with AIs, etc he will refer me to a specialist in my area that has a lot of experience with these treatments.

I will report back with my blood test results in a few days.


#8

You could offer to the doc that these issues are relatively easy to deal with and that you are willing to work through these things with him and then he will be able to offer services to other males in this situation, You can tag me in the KSman is here thread for faster response. After a thread gets older, I let it drift on its own, considering that I gave it a good launch.

Your doc may not know of a “specialist” and referrals to endos and urologists typically fail and the doc is just getting you out of his office.


#9

NEW LAB RESULTS - 12/31/2015.

TESTOSTERONE TOTAL 309 ng/dL 302 - 903 ng/dL

TESTOSTERONE FREE 35 pg/mL 47 - 244 pg/mL

Testosterone, Free Pct 1.1 % 1.6 - 2.9 %

Sex Hormone Binding Globulin 72 nmol/L 13 - 110 nmol/L

FSH 7.7 mIU/mL 1.5 - 33.4 mIU/mL

LH 6.8 mIU/mL 0.5 - 76.3 mIU/mL

Estradiol 45 pg/mL 0 - 357 pg/mL
MALE: 0-40 pg/mL

Homocysteine, Plasma 11.8 umol/L 4.3 - 11.4 umol/L

Hemoglobin A1c 5.5 % 4.0 - 6.0 %

TSH 2.15 uIU/ 0.33 - 4.70 uIU/mL

Free T4 0.97 ng/dL 0.89 - 1.76 ng/dL

INSULIN LIKE GF 1LC/MSMS 147 ng/mL 94 - 163 ng/mL

Vitamin B12 552 pg/mL 211 - 911 pg/mL

Vitamin D, 25 Hydroxy 37.4 ng/mL 30.0 - 100.0 ng/mL

DHEA SO4 26 ug/dL 80 - 560 ug/dL

Cholesterol 142 mg/dL <=199 mg/dL
HDL Cholesterol 47 mg/dL 40 - 59 mg/dL
Triglycerides 113 mg/dL <=149 mg/dL
LDL Cholesterol 72 mg/dL <=99 mg/dL
Chol/HDL Ratio 3.0
VLDL 23 mg/dL

NOTE FROM DOCTOR:

The DHEA-S is low, but with all else the way it looks I do not believe this is a problem other than the weight affecting the steroid hormone levels adversely and the low normal total testosterone is also consistent with weight being the driver.
The free testosterone is not as reliable a measure as the total.
The testicles and the brain seem to have appropriate responses
Repeat total Testosterone on another day may give more context as there is some day to day variation.
The homocysteine level is high, please start folic acid 1 mg daily.



#10

Please review my earlier posts.
Body temps?

Homocysteine is too high. You have arterial inflammatory processes going on, aka heart disease.
Take the supplements that I suggested.

TSH should be closer to 1.0

You need to take DHEA!!!

Cholesterol is too low, better near 180. 160 and below are associated with increased all-cause mortality.

Did you read those stickies?

You need TRT and E2 management to enable weight loss and restore health.
You ability to loose weight is been negatively affected by low thyroid function.

You may need to find an age management doc. Your doc does not have any sense of urgency.


#11

KSMan:

Thanks Again, it is appreciated.

My body temperature (checked daily) has varied from 98.2 F to 98.6 F.

I am gathering the supplements to start ASAP.

Cheers.


#12

There are two different situations:

  • morning/waking temps are low, afternoon is good
  • both morning and afternoon temps are low

KSman is Here
#13

I will record a week’s worth of waking and afternoon body temperature readings and report back then.

Thanks Again.


#14

Recorded Body Temperature Readings:

Mornings were 97.1/ 97.8/ 97.6/ 96.9/ 97.1 / 97.3

Afternoons were 98.3/ 98.7/ 98.3/ 98.4/ 98.1/ 98.3

KSman I will tag you in to this posting.


#15

Your PM temperatures are not so bad. So the problem is not so deep.

Our reference articles can be found linked in the 2nd post of the one sticky in this forum.
Please read/review the thyroid basics sticky.

And your total cholesterol is too low. 180 is deal.
<160 is associated with increased all-cause mortality and hormone problems.

Are you taking DHEA?
Your DHEA levels are a big problem.
DHEA may be rate limiting DHEA–>T inside your testes!
Your doctor is saying insane things about DHEA, you need a doctor who in not ignorant and guessing.

Pregnenolone could be low, reducing pregnenolone–>DHEA in the adrenals, or adrenals are not right. You should also check AM Cortisol and do that at 8AM.


#16

Update:

I am now taking recommended supplements:

DHEA (25mg x1 per day)

Ubiquinol (50mg x 1 per day)

Vitamin D-3 (5,000 iu x 2 per day)

Chromium Picolinate (200mcg x 1 per day)

Folic Acid (800mcg x 1 per day)

Will start on Vitamins C, E, B Complex & EFAs when they arrive by Mail.

Start going back to gym in 2 weeks (using Jim Wendler’s 5/3/1 Program)

Looking for a good practitioner concerning TRT and related issues. Search continues…

Starting to clean up diet, eat more regularly, plan out the week’s meals.

Thanks again to KSman for all he does here on the Forum!!


KSman is Here
#17

The stickies are no longer stickies, but are linked from the 2nd post in the 1st thread in the forum.

Any change in diet to try to increase total cholesterol?


#18

KSman:

I am reviewing the “former stickies.”

One of my main issues is eating, period.

I am a morbidly obese bugger, but I eat infrequently.

That does not jive with the simplistic “calories in, calories out” mantra that allopathic medicine is wedded to.

At least I have started what will be a very long process and journey.

Cheers,

D.B.


#19

Your metabolism is slow and efficient.

T, cortisol, thyroid and growth hormone are all critical hormone factors. Mitochondria are on the front line.


#20

This may sound far fetched, but I feel better already on these supplements.

I suppose it is more likely a placebo effect, but I feel less “stress” (for want of a better term)

on my system, like I am breathing easier or something?

Is that even possible?