T Nation

Having a Real Hard Time


#1

-37
-6’3”
-50 in
-350lbs
-was into body building then blew up and got fat; full beard and body hair; widow’s peak hairline

  • fat is mostly visceral; own a health/fitness company; body fat jumped from 15% at 250lbs to way too high now
  • a couple years ago things took a turn for the worse, had a hernia surgery, noticed workouts suffered and weight gain was uncontrollable. Thought at first it was just laziness and age; headaches, extreme sleepiness and fatigue; mood swings; constantly hot;
    -taking omeprazole 40mg/day for acid reflux (thinking due to weight gain); taking 800mg mucinex d daily for congestion; taking Fluticasone 50mcg/ 2/day for allergies

TRT(11/17-present)
-taking 200mg once weekly of cyp
-750ml hcg once weekly

Only Labs so far:

3/18/17

Cholesterol total = 184 (125-200)
HDL = 40
Tri= 220 (<150)
LDL= 100 (<130)
Cholesterol/HDLC ratio = 4.6 (<OR = 5.0)
Non HDL cholesterol= 144
Glucose = 96 (65-99)
BUN = 12 (7-25)
Creatinine = .97 (.60-1.35)
eGFR NON-AFR. AMERICAN = 100
eGFR AFRICAN AMERICAN = 116
SODIUM = 144 (135-146)
POTASSIUM = 4.5 (3.5-5.3)
CHLORIDE = 104 (98-110)
CARBON DIOXIDE = 21 (20-31)
CALCIUM = 10.5 (8.6-10.3)
PROTEIN, TOTAL = 7.7 (6.1-8.1)
ALBUMIN = 4.6 (3.6-5.1)
GLOBULIN = 3.1 (1.9-3.7)
ALBUMIN/GLOBULIN RATIO = 1.5 (1.0-2.5)
BILIRUBIN, TOTAL = .6 (.2-1.2)
ALKALINE PHOSPHATASE = 83 (40-115)
AST = 45 (10-40)
ALT = 92 (9-46)
TESTOSTERONE, TOTAL, LC/MS/MS = 148 (250-1100)
TSH = 1.48 (.4-4.5)
WHITE BLOOD CELL COUNT = 7.4 (3.8-10.8)
RED BLOOD CELL COUNT = 5.45 (4.2-5.8)
HEMOGLOBIN = 16.3 (13.2-17.1)
HEMATOCRIT = 48.6 (38.5-50%)
MCV = 89.2 (80-100)
MCH = 29.8 (27-33)
MCHC = 33.4 (32-36)
RDW = 13.9 (11-15%)
PLATELET COUNT = 297 (140-400)
MPV = 8.8 (7.5-12-5)
ABSOLUTE NEUTROPHILS = 4484 (1500-7800)
ABSOLUTE LYMPHOCYTES = 2146 (850-3900)
ABSOLUTE MONOCYTES =636 (200-950)
ABSOLUTE EOSINOPHILS = 89 (15-500)
ABSOLUTE BASOPHILS = 44 (0-200)
NEUTROPHILS = 60.6
LYMPHOCYTES = 29.0
MONOCYTES = 8.6
EOSINOPHILS = 1.2
BASOPHILS = 0.6

10/24/17

GLUCOSE = 110 (65-99)
UREA NITROGEN (BUN) = 12 (7-25)
CREATININE = 1.03 (0.6-1.35)
eGFR NON-AFR. AMERICAN = 93
eGFR AFRICAN AMERICAN = 108
SODIUM =140 (135-146)
POTASSIUM = 4.2 (3.5-5.3)
CHLORIDE = 103 (98-110)
CARBON DIOXIDE = 22 (20-31)
CALCIUM = 10.0 (8.6-10.3)
PROTEIN, TOTAL = 7.5 (6.1-8.1)
ALBUMIN = 4.7 (3.6-5.1)
GLOBULIN = 2.8 (1.9-3.7)
ALBUMIN/GLOBULIN RATIO = 1.7 (1-2.5)
BILIRUBIN, TOTAL = 0.4 (.2-1.2)
ALKALINE PHOSPHATASE = 98 (40-115)
AST = 45 H (10-40)
ALT = 93 H (9-46)
TESTOSTERONE, TOTAL, LC/MS/MS = 165 (250-1100)

1/3/18

ESTRADIOL = 107 (<OR = 39 pg/mL)
ALBUMIN = 4.1 (3.6-5.1)
TESTOSTERONE, TOTAL, MALES (ADULT), IA = 645 (259-827)

-diet is Sporadic currently, emphasis on protein
-current training is non existent based upon symptoms
-testes have ached, but never with fever
-morning erections aren’t consistent

Went to Dr and he diagnosed me with sleep apnea (moderate episodes but down to 70% oxygen); had low T at the time but he thought it was due to weight gain and apnea; after apnea was controlled T still came back way low so he started me on 200mg cyp. He didn’t do enough testing so I went to a urologist. He added the HCG AND ordered blood work to be drawn after being on HCG for a few weeks.

I reached out to him after my 5th week on T (without HCG yet) about symptoms; major swelling in hands/feet/neck/ankles/face along with itching and swelling at injection site; I asked about estrogen and AI twice but he ignored me both times; he suggested a diuretic for swelling that didn’t work; blood work came back showing way high estradiol. I’m wanting to go back to my GP and see if he’s willing to work with me and do what I need, but I’m so lost and confused about what exactly I need because every time I look I see something new.

I’m assuming at minimum:
-need testing with FREE T and E2 sensitive
-need AI
-somewhat consistent testing to see how E2 is affected

Please offer some guidance as I’m at the end of my rope


#2

They are gonna tear your doctor up on here boss man.


#3

The reason why the doctor ignored you when you mention E2 testing and AI’s is because even he knows he’s clueless and didn’t want to acknowledge that you may know more than he does. Doctor hate informed patients because it shows how little they actually know. The problem is all doctors learn next to nothing about TRT in medical school for the simple fact there’s little money to be made, most of the money is in thyroid disorders and diabetes.

It’s not going to be easy to find a doctor that will prescribe an AI because of a lack of knowledge, doctors can’t just look something up on the internet and go ok, I’ll just prescribe him an AI. They have guidelines that must be followed and these guidelines are outdated. It’s amazing to me that a doctor will prescribe testosterone and when the patient converts too much of his T to E2 they chose inaction instead of action. They do this because their knowledge is seriously lacking and they don’t want to get into trouble and lose their license prescribing something they know little about.

You need to keep looking for a doctor who is knowledgeable and understands the importance of monitoring E2 levels.


#4

AST/ALT indicate liver issues and liver may not be able to clear E2 from blood properly. Meanwhile your T dose appears too high and FT–>E2 probably too high.

FT needs to be tested.

Your meds might be affecting liver.

Glucose=110 too high.
Was this fasting lab work?
Test A1C to eval diabetes

When injecting once a week, your lab work is mostly determined by lab timing and changes can be swamped by timing changes. You need steady T levels. You need to manage E2 with anastrozole and that also requires steady T levels.

your docs are idiots

Inject 100mg T twice a week
take 1mg anastrozole at time of injections
250iu hCG SC EOD

Target is E2=22pg/ml

Your heart burn can be from a hiatal hernia caused by abdominal fat. Your heart burn meds might be causing mineral deficiencies and low B-12 from low stomach acid.

Food or leg cramps? Magnesium deficiency.

Have you been using iodized salt to support thyroid hormone production? Thyroid critical to weight gain/loss.


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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#5

The initial AST/ALT values were prior to T & the PPI; the second AST/ALT values were only the PPI (I’m also aware that my current weight gain and/or ibuprofen use could contribute )

Prior to starting T my GP assured me that I need not worry about E2 or FT because I wasn’t taking a high enough dose; my urologist didn’t order the FT and I meet with him Thursday (basically to flip the fuck out on him); my GP seems like he might work with me so I’ll ask for those tests

The glucose wasn’t a fasting and I ate breakfast shortly prior to test (not sure if it mattered)

I will also see if I can have the GP write for anastrozole; would the HCG be taken on the same day as the T ever? I will have him look into the hernia too

Definite cramps

I don’t really use salt of any kind…should I start?

Thank you so much…I finally have a little hope smh


#6

TT does nothing for you, it’s FT is what goes to work for your body and is where your E2 levels come from. Most doctors make informed decisions based off TT, FT, E2 and SHBG because it paints a more complete picture of what’s going on. Your doctor needs to work for you not with you, you shouldn’t have to hold your doctors hand like this, if you’re having to inform your doctor regarding treatment it’s time for another doctor. The internet is a power tool in finding competent doctors.


#7

Update:

Wrote to Doc today and asked for the AI script (1mg 2/wk) he wrote it no questions asked. However, I’m assuming that I should start my T/HCG/AI protocol next week as I’ve already taken the 200mg T this week. I meet with him on Thursday to further discuss how we move forward.


#8

Update 2:

Met with urologist today finally and we decided it best that I find a different doctor. He tried to convince me that Free T tests didn’t need to be done because they’re unreliable, the optimal TT is 500 and optimal E2 is 70…among other nonsense


#9

Your doctor doesn’t even know estrogen dominance when he sees it, your better off without him. He’s right about one thing though, directly measuring FT isn’t accurate, that’s why we use TT, SHBG and albumin to determine FT.