Age: 31
Height: 72in (6ft 0in)
Waist: 36
Weight: 188 lbs
Body/Facial Hair: on Arms-Legs-some Back; have Full Beard-Moustache
Fat: carried mostly in belly, back, flanks, thighs, neck-jowels
Health conditions: snore at night (? sleep apnea/ never formally diagnosed); having tonsillectomy in Nov 2013 for enlarged tonsils that likely contribute to snoring
Symptoms: poor recovery from workouts; drop in libido; poor motivation/enthusiasm in personal & professional projects; occasional brain fog; poor sleep; difficult to lose fat; difficult to gain muscle (muscle- may be a diet issue?)
Additional Symptoms: have been told by multiple friends/family members recently that face/cheeks look slightly swollen
Rx/OTC drugs:
-Note: all started only recently in July 2013
-Vit D-3 5000 units daily
-Zinc 50mg daily
-Creatine 5g daily (pill form)
-no hair loss or prostate drugs ever
Diet:
-try to limit carbs (bread, pasta, bagels, etc. only sparingly)
-eat meat daily (steak, chicken, sushi)
-usually a salad with meat for dinner ~3-4x per week
-attempt to do intermittent fasting ~4-5 days/week (eat only from Noon-8pm)
-usual first meal is around noon; second around 7pm after gym workout
-whey protein shake after every workout 4x/week
Workout:
-4 days per week with personal trainer @ 1hr/workout
-warm-up with mobility exercises
-do 1 major lift per day (bench, squat, overhead press, deadlift) (5 sets x 5 reps)
-remainder of work-out spent on core conditioning (planks, lunges, assistance exercises)
Erections:
-still get both nocturnal and morning erections from time to time; possibly at a lower rate
Stress:
-about usual baseline for me
-no recent job loss, financial troubles, relationship drama
-sleep is likely less than optimal (likely due to snoring at night; which hopefully will be addressed by tonsillectomy in Nov 2013)
I have been considering going to see an HRT doctor for above symptoms as well as just simply wanting to be completely on top of my overall health (both endocrine health as well as general health.) I want to be at a peak/optimal level of health and performance; and if HRT can help me achieve that goal without major adverse risk to my overall health and well-being then I am willing to investigate further/pursue treatment.
I have researched (via Internet and phone calls to staff) many docs in my area at various price points, levels of expertise, and willingness to Rx different forms of HRT.
I will post labs below.
I am slightly concerned by my elevated cortisol and DHEA-S.
(wondering if that is contributing to the recent roundness people are percieving in my face)
(am guessing another explanation of the cheek puffiness could be bloating/water retention from creatine that was only recently started in July 2013?)
[Note: Labs were drawn at 7:45am after a full night of sleep and fasting for ~12 hours.]
Total Testosterone 504 [348-1197]
Free Testosterone 16.1 [8.7-25.1]
Estradiol 37.3 [7.6-42.6]
LH 4.6 [1.7-8.6]
FSH 3.2 [1.5-12.4]
SHBG 34.2 [16.5-55.9]
DHT 35 [30-85]
Pregnenolone 116 [<151]
Prolactin 18.1 [4.0-15.2] HIGH
Progesterone 1.5 [0.2-1.4] HIGH
IGF-1 197 [71-241]
IGF-Binding Prot 4.9 [3.5-7.0]
PSA 0.5 [0.0-4.0]
Cortisol, AM 25.0 [6.2-19.4] HIGH
DHEA-S 727.8 [138.5-475.2] HIGH
TSH 3.74 [0.45-4.5]
Total T3 113 [71-180]
Free T3 3.1 [2.0-4.4]
Free T4 1.16 [0.82-1.77]
Reverse T3 12.0 [9.2-24.1]
TPO Antibody 23 [0-34]
Total Cholesterol 170 [100-199]
Triglycerides 56 [0-149]
HDL 60 [>39]
LDL 99 [0-99]
VLDL 11 [5-40]
Vit D, 25-OH 39.6 [30.0-100.0]
Vit B12 422 [211-946]
Methylmalonic A. 91 [73-376]
Folate 13.7 [>3.0]
Vit A 59 [18-77]
Vit E 11.0 [4.6-17.8]
Nicotinamide (B3) 16.1 [5.2-72.1]
Nicotinic Acid (B3) <5.0 [0.0-5.0]
Coenzyme Q10 1.29 [0.37-2.20]
Homocysteine 10.0 [0.0-15.0]
C-reactive protein 2.9 [0.0-4.9]
Phosphorus 4.2 [2.5-4.5]
Magnesium 2.0 [1.6-2.6]
Copper 105 [72-166]
Zinc 103 [56-134]
Selenium 141 [79-326]
Glucose 109 [65-99] HIGH
Hemoglobin A1C 5.6 [4.8-5.6]
Insulin 11.3 [2.6-24.9]
Hematocrit 43.6 [37.5-52.0]
MCV 87 [79-97]
WBC 5.4 [3.4-10.8]
Platelets 111 [155-379] LOW
Glucose 109 [65-99] HIGH
BUN 19 [6-20]
Creatinine 0.98 [0.76-1.27]
Sodium 146 [134-144] HIGH
Potassium 3.8 [3.5-5.2]
Chloride 101 [97-108]
Carbon Dioxide 22 [19-28]
AST 17 [0-40]
ALT 19 [0-44]
Total Prot 7.5 [6.0-8.5]
Albumin 4.5 [3.5-5.5]
T Bili 0.4 [0.0-1.2]
D Bili 0.11 [0.0-0.4]
Alk Phos 58 [44-102]
Serum Iron 110 [40-155]
Iron Saturation 29% [15-55]
TIBC 382 [250-450]
UIBC 272 [150-375]
Ferritin 131 [30-400]
Transferrin 324 [200-370]
a)I would love to push my T levels higher.
b)I notice that my Estradiol may be considered high. (Some fat loss may help with this?)
c)Considering my age and desire for future ferility, I’m wondering if HCG + Aromatase Inhibitor (without T injections) might be a good place to start in order to increase T levels and lower E levels a bit? (or am I being naive and instead ought to consider T supplementation + HCG + AI right off the bat… or should I put all of this hormone supplementation off until I’m a little bit older (only 31 now) and levels drop to numbers that are considered more classically treatable?)
d)I’m extremely wary of elevated DHT levels in the future and/or with any treatment regimen, given history of male-pattern baldness in my family. Aside from monitoring DHT levels every few months, are there any other treatment protocol related-DHT caveats I should be aware about?
e)Can I cut out the Vit D-3 (5000 units) and Zinc (50mg) supplementation I do daily, given my normal levels? Or are my levels normal because I am taking these pills? (I’m guessing one answer might be: stop taking them; re-check levels in a few months and if low, then go back to supplementation)
f)I’ve stopped taking creatine in the past week, hoping that the roundness in my face is due to creatine water-retention and not elevated cortisol levels (i.e. cushingoid features/moon facies) [Of note, I do not have a buffalo hump, nor do I notice any abdominal striae. However, in addition to some roundness of the face/cheeks people have pointed out; it has been difficult to get rid of some of that persistent belly fat]
Does this sound like a reasonable course of action to take re: creatine supplementation?
g)Given my current mineral/vitamin levels, would I benefit from any additional supplementation?
f)Any other related/unrelated advice is welcome.
Thanks in advance to all the helpful guys out there willing to lend me some advice.