T Nation

High Direct T


#1

Hey all. I am new to T-Replacement and hoping to ask a few questions. Been through quite a few posts here, but still really new to all of this.

Its been 7 weeks since I started TRT via an Endocrinologist. I won't bore everyone too much with the 2 years of tests and re-tests and different doctors before I finally got to that point. However, I should mention that I did all the MRI's and other tests that from what I understand from this forum and others are necessary before taking that first step.

For reference my last test at the Endocrinologist before I started T was:

Cortisol Total Volume - 3000 ml
Cortisol Free, Urine - 41.2 mcg/24 Range 4.0-50.0
Creatine, 24-hour urine 2.89 g/24 Range 0.63-2.50
Prolactin 4.70 ng/ml Range 2.1-17.7
FSH 3.20 mIU/ml Range 1.4-18.1
LH 2.60 mIU/ml Range 1.5-9.3
Free T-4 0.91 ng/ml Range 0.60-1.55
TSH, Sensitive 2.08 mIU/ml Range 0.35-5.50
T-3, Free 3.08 pg/ml Range 2.3-4.2
Insulin-Like Growth Fact I 240 ng/ml Range 86-220
Testosterone, Total 213 ng/dl Range 250-1100
Free Testosterone % 1.80 Range 1.50-2.20
Testosterone, Free 38.3 pg/ml Range 35.0-155.0
Waking body-temperature 96.8

My starting protocol is 200ml bi-weekly. After 6 weeks and the day before my 4th shot I went to get an independent blood test for DHT (I have some male pattern baldness), Testosterone and Estrogen.

All of which I did so I could get some facts together before I see the doc again, as from these posts I sense that I should ask for Hcg and an AI. I also choose that day as the doc wants to re-test my blood the day before my 6th shot. My tests came back today with the following

Dihydrotestosterone 21 ng/dL Range 30-85
Testosterone, Serum 418 ng/dL Range 280-800
Free Testosterone(Direct) 29.5 pg/mL Range 6.8-21.5
Estradiol 14.9 pg/mL Range 7.6-42.6
Estrogens, Total 55 pg/mL Range 40-115
Estriol, Serum <0.3
Waking body-temperature 96.8 (still)

Finally, I am a 6'4" 42 year old male, weighing 260lb (I was 300 5 months ago) and bent on getting to 220lb (or whatever level, gets my body fat below 14%) Not sure of % now, but I do have plenty of fat to lose. I am a lifetime sports guy with about 15 years of lifting experience, so I do have a fair bit of muscle under there. I am also on a 2,200 calories a day regimen (all good food, steel rolled oats and all), with one day a week at 3,400 calories. Bike 30+ minutes a day, 5 days a week and workout (medium intensity) 30 minutes 2-4 times a week. Shooting to lose 2lb a week. I supplement with OxyElite Pro, 1 DHEA 25, a Multi-vitamin and two Gaspari Novadex Xt

So on to my question. My test results surprised me both with low DHT and lower Estrogen (I do take two Gaspari Novedex Xt every night). Though what really got me was the high Free Testosterone. I had been planning to ask the doc to increase the dose and make it weekly as I do feel better than before in that if I was at 0% before I feel 60-70% now and want to get to that banging 100% if that makes any sense. So now with this high Free, moderate total, low DHT and Estrogen I am wondering if I can even make that request.

So to the point, please let me know what you think of my tests, what I might want to consider going forward and what I might be missing here. Would certainly like to get the dose to 150ml weekly with some Hcg at the very least. AI option as well if possible. Certainly do not want him to reduce the dose as this is the best I have felt in 5 years even if it is still sub-optimal.


#2

I am not an expert here, but I know enough to be dangerous.

Thyroid looks good, but do you have results for your E2, vitamin D, ferritin, DHEA-S, and Pregnenelone levels before HRT?

also since you read the stickies -

you know the ideal protocol is 100mg T-Cyp weekly broken up in EOD shots, Arimidex (daily or weekly) for E2 control, and 200-250iu HCG EOD or E3D.

you also know how bad the hormone swings from biweekly shots can be.

you know the impact of vitamin D and ferritin (or lack thereof) can cause.

I have no knowledge of Gaspari Novadex Xt. Were you on that before the first test you posted? It seems that you may need to cut back on the dosage if it is driving your Estradiol that low - or at least try cutting back and see if that helps any.

I would switch to EOD shots, introduce HCG, and cut back on the Gaspari Novadex Xt to one per day. Plus possibly starting the generally recommended supplements.


#3

Injecting 200mg every two weeks is totally wrong. Doctor = idiot.

Levels after 14 days are not useful at all. Complete waste of blood, time and money. Doctor = idiot*2

Are you self injecting? If so, just inject the way that you want and stick to the weekly total dose.

Waking body temp does not support the conclusion that thyroid levels are good. ARE YOU using iodized salt? It would be better if fT3 and fT4 were mid-range. hCG might improve thyroid status and steady T levels would too.

You need to take charge.


#4

PureChance;

I have about everything but the E2, vitamin D, ferritin and the rest, go figure. Anyway, thanks for the info. I am gonna read up more on the vitamin D and ferritin (been all over the posts since I found this a few weeks ago) but my reading is way ahead of my retention at this point. Part of why I started this post. Hopefully it will get some of this to stick. I'll try cutting back on the Novadex too and see what happens. Did not really expect it to have a big impact (over the counter and all) but maybe it did.

Also, just to double check an assumption of mine, by EOD do you guys mean "End of Day" ie take shot at night and E3D "End of 3rd Day"??? Pure newbie question I know, but just to be sure.

KSman,

Yea, I am starting to get that feeling (doctor = idiot). Admittedly, I was in such a bad place before starting (depression, total lack of energy, aches and so on) that I was pretty much happy with whatever the doc said as long as it got an improvement. Now that it has, I am certainly trying to take control and get the most out of it.

For the thyroid, I avoid salt like the plague. Always have. Wife buys the iodized stuff so if she cooks with it then I guess I get it, but that's rare. Maybe I will look in to a iodine supplement (thoughts?) For the body temperature, I put it in there because I am 2 degrees below normal (not something the doc cared about, he said that was fine) and it seems to me that would suggest a slow metabolism. Though I had a blazing fast one when I was younger. Maybe 2 degrees in not a big deal but I wanted to at least bring it up.

I was planning on keeping the current protocol until my next doc visit in 3 weeks and then going to the weekly, hopefully with his blessing and if not, without it. Probably not gonna wait now though. The old, knowledge is power only if use it thing.


#5

EOD = Every Other Day
E3D = Every Three Days


#6

In a doc's office, talking lowers your oral temp. They are looking for a fever and sub normal temps are not an concern. Check your own temps during the dau when not eating, drinking or talking during the day and waking temp is important. If your 96.8 temp is typical, you need to take iodine and see if you can get that up. When you find a supplement, you need take a lot a first to build stores then drop to a maintenance dose.

Why do you avoid salt?

EOD is every other day, aka E2D
nothing to do with end of day

Cholesterol numbers?


#7

Curious as to why you avoid salt? If it is taste considerations, I can understand. But if it is for health considerations, you are shortchanging yourself by operating on a VERY outdated premise. Salt in moderate amounts poses absolutely no health detriments, and too low salt intake can be harmful. Google 'salt deficiency'. Need it to maintain digestion and hormones, and it is an excellent anti-inflammatory.

-34-


#8

EOD, E3D, got it thanks.

When I started lifting, 24 years ago, salt was this big no-no, or at least that was what I read in the old Muscle Mags. Kinda stuck with me all these years and now I just don't think to add it. I'm gonna have to get over that I guess.

The 96.8 is my morning typical temperature. Late afternoon, I will sometimes get up to 97.4. So I will try that iodine idea and let you know how it goes. I will most likely smack myself in the head if it works. Hoping that it does though.

Cholesterol numbers just before starting TRT were:

Total Cholesterol 172 F mg/dL Range 5-199
Triglycerides 79 F mg/dL Range 10-149
HDL Cholesterol 43 F mg/dL Range 40-135
CHOL/HDL Ratio 4.0 F
LDL Cholesterol 113 H F mg/dL Range 0-99


#9

Cholesterol numbers are great. Are you using a statin drug?


#10

Thanks. The only thing, besides general supplements, is the Testosterone so far.


#11

Also hes smack in the goiter belt of american and does not take salt. Hes working a number on his adrenals that for sure as well as thyroid from potential low iodine. Also increasing chances of cancer risk as well. So I advise you to get with a good DR and get this sorted out now. Illinois Dr J is there in michagen or if you have good insurance can fly out to see me and DR overbeck for primary visit.


#12

lef makes a vitamin D supp with iodine that is a great combo


#13

I use iodized salt at least twice per day and also supplement with kelp just to make sure. It has made a world of difference IMO. I have never had a problem with blood pressure or anything and I salt a lot of stuff.

I have noticed that the anti-salt thing is on the rise again. More and more articles are starting to point to salt (sodium) as pure evil. I guess the drug companies have figured that they have tapped the cholesterol market enough that they need to make more money somehow.


#14

I actually just started taking Kelp supplements (for Iodine) + switched back to Iodized Salt (wife bought the wrong type and I had no idea for the past six months).

I also forgot to refill Armour so I was out for three days.... and I learned that I didn't need it... there was absolutely no change from when I was taking it compared to when I stopped it. The cortisol, Vit D, iron, iodine, and other supplements seem to have balanced out my thyroid.


#15

Just wanted to send a quick update. I tried KSMan's idea of loading up on the iodine. I normally take two multivitamins every day (GNC Mega Men) that have what they say is 100% of your daily requirement. Which is 150.00 mcg. So I went out to GNC and got some Natural Brand Kelp, which is 150.00 mcg per tablet. I added 7 a day for 3 days and then scaled back to 1 a day in addition to my multivitamin. So 1200 mcg for 3 days and now 300 mcg a day.

So far I have not really seen any dramatic improvement in my waking/mid-day temperatures. Though I do think there was a little lift. I am now waking up at 97.2 - 97.4 and it seems to stay in the mid 97.4-97.8 during the day. Every once and a while it drops back to the 96.8 range, but that is usually late at night.

Part of that might be that I am fighting a dosy of a cold my 3-year old gave me (man I don't know where these kids get em but the colds they bring back from day-care are brutal) and I stopped taking my diet-pills, so as give my system a break. Been trying to do that every other month.

Hoping that when this cold passes I will see more lift.

On that note, how does Vitamin D and Iron play into all of this. I see the "D" vitamin mentioned in this thread several times and am curious how that plays into the Thyroid issue.


#16

vitamin D is critical for all cell functions.

there are multiple articles about it on lef.org just search for vitamin D3.

"Vitamin D's applications in promoting optimal health stem from its ability to control production of vital proteins by switching genes on and off, and thus helping to determine the fate of cells. Cells affected by the active form of vitamin D, known as calcitriol, stop growing and reproducing, and rapidly mature into their final forms"

"Vitamin D plays many essential roles throughout the bodyâ??enhancing calcium absorption, contributing to healthy bone mass, supporting immune function, quelling inflammation, and helping to fight cancer"

iron is needed for correct red blood cell functions. if iron levels are not optimal then your system can not transport the hormones to where they need to go.

Vitamin D - general cell function
Iron - transportation
Cortisol - not enough = hormones, etc. can not pass through cell membrance as effeciently if at all / too much = supressed immune system (I believe).


#17

On the temperature note, I had an interesting result tonight. I ate a 8oz steak with some A1 steak sauce. Immediately afterward and for the next two hours my body temperature jumped to 98.8 - 98.9 and stayed there. I would not have thought much of it, except that I saw a temperature jump earlier in the week after eating a steak as well. Did not think much of a connection then, but now I am wondering.


#18

how much protien are you getting on a daily basis?

have you had your iron/ferritin levels checked? Red Meat = high in iron. Your reaction to the steak could show you how your body does when it gets the right nutrients.

Consume iron rich foods such as red meats, iron-fortified cereals, eggs, dark green leafy vegetables, beans, and dried fruits. In order to increase your blood iron levels, you need to consume more iron.

I am on 29mg Reacted Iron (still not sure what reacted means, but oh well). which is slowly increasing my ferritin and iron levels, and since I am improving my level of iron, iodine, Vitamin D, folic acid, and Cortisol, I have seen huge improvements and have even been able to stop my thyroid medicine, and I have cut my T dosage in almost half - which means less Arimidex is needed, etc.


#19

I've been doing the diet thing (ie, 2200 calories a day) though I try to keep my protein levels at least 150g a day with a goal of 200g.

When the doc tested me my iron levels in 08, which is when all of this testing started for me, I was in range but the lower end of it:

Iron, Total 52 mcg/dL in a range of 45-170
Transferrin 247 mg/dL in a range of 188-341

So I went out and bought some GNC Vitamin D-3 2000 and some GNC Ultra Iron 65 today and will add that to the iodine and see if I get any further results.

Was interesting that after that steak I stayed 98.6 all the way through the night and into the morning. So maybe that iron has something to do with it.


#20

ok, for full disclosure I am just a fellow HRT sufferer and not a doctor. The information I provide is just my opinion, and should be a starting point for your own research to confirm or contradict.

My ferritin was at 36 ng/mL (ideal at 150), and
My total iron binding capacity was 77 mcg/dL (range 45 - 170).

Taking the 29mg iron supp. EOD, I got my levels up to 59 ferritin and 109 iron. I then increased my dosage to every day trying to get my ferritin levels up.

We are also not talking about the same tests (transferrin vs. ferritin).

So I checked and the GNC Ultra Iron 65 equals 65mg of elemental iron. Are you taking that daily? If so, that seems like a huge dose to start out with (at least to me). Too much iron can cause a whole host of problems, and you don't want to trade one problem for another. Why not start off with smaller doses?