T Nation

HRT: Health Issues & Considering Test


#1

Newbie when it comes to steroids or hormone replacement therapy, and will be digging into the forums reading up on various topics. Just a few questions for starters. Is there any "steroid bible" or other book worth getting that is pretty comprehensive and up to date on hormone replacement therapy, steroids, PCT, etc?

I have a doctor who has spoken to me about the possible use of test, but has held off in hopes that Ill naturally bounce back once my overall health starts improving, I lose bodyfat, and stress is reduced once I find another career since losing my job due to my health issues.

A little over 3 years ago, I was early 30s, 245lbs, 10% BF, working sets 500+ squats, 330+ cleans, 550+ deadlifts, and could still motor pretty well in sprint and agility drills. I worked two jobs, busy life, but despite little sleep and lots of heavy exertion at work as a S&C coach, and mental and physical demands working in law enforcement, I still could make gains or even in the worst of times maintain serious strength and power. Mentally and physically recovered well and could be on the ball and rocking on a regular basis, really never got sick or injured. Always motivated and pretty intense personality.

Well, I am now about 250lbs, probably 35% BF, immune system shot, have had multiple surgeries in this time period, 3 GI surgeries all of which got infected (some of which were not caught until later), multiple bouts of anti biotics which caused other issues (killing too much of good bacteria is best way I can understand all the technical stuff doctors explain), and lots of backtracking that took a few years of doctors to figure out what happened in the initial surgeries to cause so many problems. Wasnt able to train because they werent sure what all the issues were and didnt want to take chances, and in the past 6 months or so they had me doing very light physical therapy and old man type workouts, walks, swimming, rubber bands, pelvic floor stuff etc...I wasnt even doing anything demanding and the distal head of my bicep ruptured right off the bone, so still in the recovery phases of that surgery. Blood pressure bounces around from normal to the 180s/100, back to normal on unpredictable basis. Im a major mess compared to my former self. I dont have the paperwork handy but test levels were in the 268 range I think, and although I didnt have baselines before that, I seriously cant imagine I was anywhere but near the top end of ranges to carry on the lifestlye Id been living for years, pedal to the metal, balls to the wall....my old S&C boss used to joke I lived on caffiene, adrenaline, and abnormally high levels of testosterone...and actually the doctors recently dealing with me have gone on about me being an adrenaline junkie and think the change in lifestyle has affected a lot of brain chemistry as well...

So anyways, this is a readers digest of a jumbled mess of my health issues...and since I have doctors willing to talk about giving me test, I want to read up and know more about it so I can push for it if I think its a good decision to get me a little back on track. But I dont know how it all correlates with blood pressure (they think my spikes are from stress and the weight gain), immune system (they said mine is beat up but will recover over time), and also take into consideration WTF how the hell could my connective tissue 3 years ago violently rip over 300 pounds off the ground for plenty of reps, or do 40lb weighted chins, heavy deads, etc etc, but now I slip and reach for the railing and my bicep rips off the bone? I dont know whats going on but it aint good...I need to get back on track...

Other than testosterone, is there any other products I could mention to the doctor to explore using, are there any steroids that might be low in side effects that the right doctor could be convinced to prescribe if the stars lined up right? Other than Test and GH, what can doctors get away with prescribing in the US under the right circumstances? I see on some sites people claim they have their doctors legally getting them Test, Deca, Anavar, Injectable Winny, Halotestin tabs, and PCT??????????????? Is that a bunch of BS?

If you read this far and have some input, I much appreciate it. At this point since I wont be able to be crushing the heavy weights like I used to due to all the GI surgeries, and now this bicep BS, Im thinking of dropping 40 lbs and shooting for 210 lbs bodyweight, getting the blood pressure under control, getting the bodyfat back to 10% or better, letting my immune system recover, and still being athletic but just keeping my connective tissue and joints alive at this point. I got a host of other joint issues and soft tissue damage in various places, that I used to just work around and abuse pushing it to the limit, backing off, then pushing it again, probably thinking I was invincible and just gut through periods of pain...I am sick of going under the knife and would like to just be healthy again and lean, see how my body feels and slowly find ways to crank it up in whatever ways I can without the wheels coming off anymore.

Ive been browsing posts on here just trying to get some general ideas, and it seems there is so much hormonal and blood chemistry stuff going on, even if I could get the Test from my doctor I dont want to screw anything else up or aggravate other conditions Im dealing with. Do all these HRT doctors have a similar knowledge base, and well versed on the types of topics discussed on this forum? or are there alot of doctors who just went through some minor course on life extension or something and its another avenue to generate income without a ton of specialized education and passion for the subject?


#2

Just an FYI…before this 3 year mess, I was training consistently for a good near 18 years, and not just lolly gagging around…been a lifting junkie and supplement addict since 6th grade, was competitive athlete all through college, football and powerlifting, and after college while coaching college athletes still trained alongside them lifting and running, all the way up until this mess, along with regular MMA.

But testosterone and juice is something Im not very well versed in, but dont want to get flamed anyone thinking Im looking for shortcuts or miracles without ever hitting the gym hard or being disciplined with diet and supplements. Looking for a little help in how to get back to that lifestyle.


#3

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#4

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#5

Wow, thanks for those responses…they are very very informative. And it gives me some info to go back to the doctors with.

Not only my old boss, but also the doctors treating me have said my chemistry is used to “nueroephinephrine overload” as part of normal functioning my entire life, but has been removed for nearly 3 years cold turkey…they prescribed guided meditation I was doing 2x week with someone than once a day myself, along with other breathing exercise daily multiple times.

I dont know all the brain chemistry they were talking, but said I was really out of whack, since pre-injury I had worked out a good balance on my own of doing high stress things (workouts, MMA, full contact sports, S&C, SWAT), then balancing it with spiritual things and meditation, etc, but the wheels came off when I lost all the exciting stuff…even after meditation and yoga and such, they hooked me up to biofeedback (all over my midsection and pelvic floor), and said even at what I felt was full relaxation all my organs were “jumping” all over the place for lack of a better term describing the readings on the computer screen…

between a few different doctors and physical therapists they all independently say stuff about my fight/flight system not knowing how to turn off and it causing lots of problems.

All the fat Ive gained, is around my gut, people who have not seen me for a while will think I look okay, like Ive LOST weight/muscle but still look “in shape”, but if they saw me with a shirt off they would see different…so all the fat is around the tire…and ive gained a ton of weight.

Sir that helped alot, gives me some areas to look into more…now if I can find a doctor or doctors who understand it and want to dig in.


#6

Are their technical names for this cortisol test and most appropriate hormone profile I could go to my doctor with? Otherwise if I show up and say I need a cortisol test and hormone test I dont know what Ill end up with…he checks my test levels every few months, but it doesnt have as many readings/items as the tests guys are posting up here.


#7

Bluecollarjock,

I am sorry to hear of the radical changes that have ravaged your health. I had a 24 hour cortisol test done and I believe BBB is referring to the simple procedure of urinating for one 24 hour period into a large container provided by the lab that will analyze. Cortisol fluctuates a lot over the span of 24 hours and this is a way of assessing the average rather than a snapshot sampling from a blood draw.

As for a complete hormone profile, check out lef.org (Life Extension Organisation). They have lots of examples linked from their home page.

This is their “Male Hormone Re-Test Profile”

DHEA-S, Dihydrotestosterone (DHT), Estradiol, PSA, Pregnenolone, Total and Free Testosterone, and TSH

In addition to those, it would probably be good to have Free T3 and Free T4 in addition to TSH (thyroid stimulating hormone) to get a good sense of thyroid function. Prolactin might be a good addition too. Also, FSH and LH (Follicle-Stimulating Hormone and Luteinizing Hormone). You can see what these items represent at lef.org.

I’ll leave it to BBB and others to further specify.

One thing that comes to mind with your prior high-stress lifestyle is adrenal fatgue/burnout. Elevated cortisol levels play into that possibility. When the adrenals burn out, it can take long term therapy to get them back in shape.

Good luck…


#8

wow again…thanks guys…wish I had a doctor who was up on all this…I have very open minded and caring doctors, but right now its just more of them hoping that once my medical retirement is settled, that Ill slowly regain some “general health” and learn to live with limitations…I know I have work to do mentally that I wont be running around kicking ass like I used to, but I dont want to resign to a life of complaceny. Nor do I want to be chubby with high blood pressure and falling apart.

If the adrenals are “burned out”, what kind of therapy are we talking about?

Ill read through the website you are referring to, and try to brush up enough on the understanding to convince my primary care to buy in to getting these tests done. Too bad one of you guys doesnt live close haha, could bring you along to explain/justify the tests for me.


#9

I posted previously but it didnt show up…keep it short in case it shows up later. THANK YOU both for the info, going to read up on that site about the tests to try to game plan a meeting with my doctor.


#10

Try looking up “adrenal fatigue” and see what you find. If I come across good literature, I’ll pass it along…


#11

The tests my doctor ran last summer I found, are from Quest Diagnostics Incorporated. Is this test good enough for you guys to get some insight if he ran it again, or should I push for the life extension tests plus cortisol?

7/08
Iron-Total Iron Bind Capacity
Iron 205 H Reference Range (45-170 UG/GL)
TIBC 278 (250-450 ug/dl)
% Saturation 74 H (20-50%)
UIBC 73 (110-370 UG/DL)

Ferritin
Ferritin 411 H (20-345 ng/mL)
Hemocysteine, Cardiovascular Homocysteine, Serum 9.8 ( less than 11.4 umol/L)

Testosterone, Free-TOT, LC-MS-MS
Testosterone Total 360 (250-1100 ng/dL)
Testosterone % Free 2.58 H (1.50-2.20%)
Testosterone, Free 92.9 (35.0-155.0 pg/mL)

Cardio CRP 0.3 mg/L (low cardiac risk)

T4, Free Non-Dialysis* 1.32 (0.8-1.8ng/dL)
TSH, 3rd Generation 2.39 (0.40-4.50 mIU/L)

Vitamin B12 & Folate
Folate, Serum 8.7 (>5.4 ng/ML)
Vit B12, Serum 392 (200-1100 pg/mL)

Then there is a page of CBC, everything is in range at time of test, then about a page of Comp Metabolic Panel W-eGFR, glucose is only thing out of range 102 (65-99), and then a lipid panel where everything is in range but LDL 108 (0-100MG/DL)

Then 3 different Vitamin D tests, he is big on Vit D supplements.

So he prescribed probiotics, B12, Vit D, EFAs, and has been hoping that over time with less stress, more rehabbing and working out, that bodyfat will go down, T-levels will go up, glucose down, BP down…but Ill plan on getting tested within the next month and try to get more specifics as you have listed above.

Im hopefully moving to LA for the summer to recoup and heal up, spend some time with family and friends in the area, so want him to test me before I head out that way.


#12

I believe Quest is a good lab. Amazing how your free test is in the upper 3rd zone of ref range while your total test is in the basement. Normally free test carries much more significance than total.

I’m not an expert at analyzing lab reports. Let others weigh in. KSman always has great input. You could try PMing him.


#13

I shot KSman a PM with links to these threads asking for input.

I dont see any of the -S, Dihydrotestosterone (DHT), Estradiol, PSA, Pregnenolone,TSH (thyroid stimulating hormone),Prolactin, FSH and LH.

So do you suggest I go in asking for the same tests as before with Quest, and see if the lab he uses can add in all those listed above, or if there was a grand daddy of them all company like Life Extension that is one shot deal hit all the markers and indications we would need to evaluate the situation.


#14

For a full hormonal panel, you would want most of those I indicated. Quest is probably fine, as is Life Extension. There are a couple of other decent ones too. Wait for KSman, he’ll outline it all for you.


#15

This is not a simple TRT situation.

You need to test for E2 - which MUST be the ultra high sensitivity serum E2 test if using Quest. If your E2 is below 32 and you use the regular Quest serum E2 it will only report <32.

If Labcorp, there standard serum E2 test is fine.

T4 is only part of the picture. It is inert. You need to have TSH, T4, FT4, and FT3. Some do not convert T4–>T3 very well and your system may have changed in that regard.

Cortisol: 24 hour urine testing will pick up average output. But is sounds like your cortisol can jump around. You will be better off with a 24 hour test that collects saliva a four different times per day. You may have abnormal release patterns that a 24 hour urine test would not detect. Your ‘history’ does suggest that you spike adrenal hormones. DHEA is also an adrenal hormone. You need to test for DHEA-S, not DHEA.

DHEA is made from pregnenolone. You might test for that now or later if DHEA-S is low.

If you used stimulants for years, then you have probably shifted your dopamine system in your brain. That is a mechanism that is the same as what occurs with drug addiction. This can create mood problems, depression, apathy and a lack of enjoyment or pleasure. This is of course highly individualistic. Ephedra is technically an amphetamine in its actions.

You have insulin resistance. TRT typically can improve that situation. If E2 is elevated, lowering that can improve things, in part from fat loss.

Excess cortisol weakens connective tissue. This is probably what caused your tendon to pull off of the bone. This may also be causing bone loss. You could get a bone density test. Excess cortisol also causes elevated blood sugar - insulin resistance.

While your T numbers do not look so bad, as you suggest, your past T levels may have been very high and your current levels may be quite low for your needs. Your FT ratio suggests that E2 would not be high.

Prolactin can be HPTA repressive. If your dopamine levels are low, as discussed above, one would expect prolactin levels to be increased.

If you increase your dopamine levels, prolactin will go down and the HPTA may improve. If you also have elevated E and reduce that, this will also help the HPTA.

If your dopamine levels are down from years of ‘supplements’, then you might do well with Wellbutrin, which is now available as a generic. If you feel better on that, that itself proves some points and a drug like that can be used as a trial and the results are diagnostic. If you feel better, but are over stimulated with Wellbutrin, you might find that small dose cabergoline does the job without over stimulation.

Adrenal fatigue is a serious issue. If you are hitting it with flight or fight reactions, that makes things worse.

What is your iodine intake?

Vitamin-D: I assume that you did not get sun exposure with your years of health problems. You would have been deficient. That weakens your immune system and metabolism in general. What is your Vit-D3 dose?

EFAs are good.

What antioxidants are you taking?

Muscle wasting can release iron and increase serum levels. You should reduce iron rich foods and use supplements that are do not have any iron. Watch the breakfast cereals, they have iron levels for growing kids that can create problems for adult males.

Read the above, this may be a source of some problems or compounding them. One can reduce iron with:
http://www.lef.org/Vitamins-Supplements/Item00513/Lactoferrin-apolactoferrin-Caps.html

More info here:
http://www.lef.org/protocols/metabolic_health/hemochromatosis_01.htm

Get tested for progesterone. That can block effects of T, as does E2, and is also repressive.

You are insulin resistant. Your cells may have general problems with receptors. You may need to focus on that. The vit-D and EFAs will be helpful. You need to take anti-oxidants. CoQ10, R-lipoic acid and acetyl-l-carnitine may can improve cellular function. You cannot be healthier than your individual cells.

Your biggest challenge is finding a doc who understands these things and what to do.

A good read: The Testosterone Syndrome by Eugene Shippen. You can find this locally or at Amazon.com.


#16

Thank you very very much. Ill look for the book this week.

I would love to find a doctor in the DC area who gets this, would be very beneficial.

Stimulants, in high school I did a lot of caffiene (17 years ago), maybe some of the original Ripped Fuel E/C/A, in college tons of caffiene and ephedrine. After college while in grad school and working two jobs, probably was still hitting some E/C/A stacks and living on coffee.

Post grad school essentially have been working two full time jobs with little sleep, not out of neccesity, but because I couldnt choose between being a S&C coach or being a cop, I loved both and so just worked both full time and somehow managed with just coffee and a good diet with lots of supplements.

I didnt take any stimulants after grad school I can recall (so about 9 years nothing other than coffee), just meal replacements, multi vit/min, anti oxidants, EFAs, BCAAs, creatine, glutamine, protein shakes, and probably tried every mainstream supplement as it came out but not many stimulants that I can recall.

As far as my history in spiking adrenal hormones, I do not claim to understand it much medically…but in sarcastic ways friends and co-workers always commented about me being an adrenaline junkie, and all the doctors recently and physical therapists all end up talking about the same fight/flight things independently when doing my case history and interviewing me…and of course adding in different biofeedback test results, and just getting to know me overall I guess, my body tension, fluctuations in pulse and BP, etc. They also think part of my history that is catching up with me is a high pain tolerance and ignoring my bodies warning signs, and overtraining abuse plus contact sports all these years.

As for dosages and which anti oxidants, Ill wait until I get back to my place so I can be specific. Out of town for few days and do not have bottles with me.

I usually take C, E, grape seed extract, CQ10, and will pluck whatever “Anti Oxidant” formula seems to be on sale and whatever it might contain. I was way more strict on supplementation when I was training and healthy, which I know sounds idiotic that now Im hurting and not as disciplined and regimented. I kept up my strict supplement schedule probably a year into the 3 year mess, than I think out of frustration and just being overwhelmed with surgeries, sickness, the mental and emotional transitions of not working out, not coaching, not doing certain things at work I used to (from the streets to a desk), etc, Ill be honest it kicked my ass and I just fell off track.

Not to mention for a very very long time, I could barely eat or drink without feeling like someone was stabbing me and having major spasms…they thought Chrons, Colon cancer, IBS, a ton of other things, but no matter how many tests and biopsies, couldnt find any hint of disease of any sort…I think it wasnt until 2+ years into it a Hopkins doctor looked at the records and was like “Stop taking any new medications from all these different doctors, they must not be reading your entire files or paying attention to notes from other doctors”…something about way too many anti biotic cycles, pain meds, GI meds, etc…and how much this has to do with it I dont know, but one of the doctors wasnt happy that in short periods of time I had been put under so much for surgeries, along with the other “amnesia” type drugs on a pretty frequent basis for biopsies and such, said it was like unplugging a computer without shutting it down properly over and over.

Then add in explanations about brain chemicals and structures that are altered by brain chemistry changes as drastic as probably happened with me going from 110mph my entire life to slamming the brakes on and being physically sick and under the knife, and emotionally beat up from the lifestyle changes.

Iodine, I havent paid much attention to that if at all…

Well Im rambling…better get some shut eye…but looking forward to getting that book, reading more into the things you discussed in your post, and trying to find a doctor who might be able to help me weed through these things and get the proper testing.


#17

How are you handling food now?


#18

Much much better…there was a very long period where I was hurting bad, after the initial surgery, then after the next two surgeries, cramps, spasms, and felt like I had food poisoning for extended periods…Id say in the last 6 months, being on probiotics, not taking any more GI meds like Levsinex and I forget the name of others, EFAs, no more anti biotics, and getting more sleep, it has helped.

I cant drink tons of coffee or booze, or combine even small amounts of coffee or beer with any fried food at all ugh…and I used to have an iron gut, chugging coffee all day, throwing back lots of red meat daily, and I rarely drank but when I did I could drink a few dark beers and eat lots of wings and steak and not even blink…now it would send me running to the restroom.

I sent out some emails today trying to find a doctor in my area that is familiar with all the tests listed in the posts above by you guys. Guess Ill wait and see, and keep searching on the internet for possible leads.

Another big factor Im sure at many points in this process, is I avoided eating at all during the day so I could work and not end up sick…so Id eat one or two meals late at night. So if I have a busy schedule, I tend to avoid eating until Im done with all my daily activities for fear of something going south.

But since getting pulled from work, Ive been trying to eat more regularly, small small meals. I also couldnt sleep much after the surgeries, pain, sickness, stress, so for the greater part of the past few years Ive had insomnia, so started Lunesta, which helps a ton but even then sometimes I still end up waking up every few hours.


#19

Good luck on your quest to find a knowledgeable doc…


#20

Thanks…so far a lot of the websites look like they are geared towards women, cosmetic stuff, and/or emphasize 40+ males…so I dont know if that means I could stroll in there, pay a bunch for all the tests, come in at the bottom of the normal low range, and not pursue anything.

Im going to keep looking, and if I dont find someone in DC before I move Ill be looking for one when I get to LA in the summer.