T Nation

I Don't Know How I Should Feel or What to Do


Get over it. Re read what we have posted above. And continue to take charge of YOUR health.


Aromatase inhibitors and HCG is off label use for men on TRT, doctors are confined to guidelines, their bible, these guidelines don’t mention anything about the approved use of aromatase inhibitors and HCG for men on TRT, so they can’t prescribe it as there is no way to properly bill insurance.

Doctors who take insurance aren’t practicing medicine, they are powerless to take action unless the insurance and guidelines say they can. In range you’re fine, out of range you’re not fine. If only it were that simply.

Private doctors are bound by a different set of rules as they aren’t hogtied since the individual is paying out of pocket.


Very true. Ultimately, the person (private patient) or entity (insurance company or hospital) paying the doctor is the boss.


nah i truly want to maintain a cool status with everyone. im not the kind of guy who gets angry. i know its my health but its just easier to avoid and move on. ill just read up more about this and look for someone who is truly willing to help and is capable of learning new things, even from patients.


what??? if doctors follow this guidelines then how are we suppost to maintain or testis from shrinking? are we suppost to be infertile at such young age? atleast they say to freeze sperm. what if my e2 increases to the point i might have gyno? do i need to get off trt so they prescribe aromatase inhibitors?



this is madness! now i know why most docts don’t even worry about checking e2. its because they don’t even prescribe hcg or aromatase inh! imo



thanks mate im just super worried about my health and want to find the problem. i got an appointment with a gastro next monday. i will add the stuff you mentioned to get my labs.

read this one. so i got a doubt. it says high stress leads to low DHEA production BUT high stress does not correlate to low t. it says " Bottom line, there’s no scientifically demonstrated mechanism to explain how high stress, in and of itself, leads to low T."

the article mostly recommend avoiding stress to our gut by eating healthy and avoiding anti infammatory stuff.

also it recommends lowering carbs, when i always thought high carbs >lowers shbg.



It is difficult to get insurance companies to pay for estrogen testing for men. AIs are breast cancer drugs, difficult to get them approved for guys.


Get the paperv script from Dr and write in what you want. That’s what I do


Aromatase inhibitors in very small dosage can work. Now that I have gone private, I can get aromatase inhibitors, HCG if I want and competent doctors.

Insurance was the death of healthcare.


thanks guys! so tomorrow i have a gastroenterologist appointment and im going to ask for some testing.
other than what @charlie12 already pointed out that i should test. what other things you guys recommend?


just an update: tomorrow i will be doing my labs at around 7-8 am in the morning and on thursday i will be having the mri. will keep you guys updated when i get the results. thanks for your time.



shbg and Dhea still pending. i had to get these results because i have an appointment with neurosurgeon soon and he will need the labs and mri. shbg was always around 54-70 ish.
i had to cancel the endos appointment because of an emergency and they went and put it for january 25 (UGH).

MRI results: stable hypoenhancing lesion appreciated along the left posterior aspect of the pituitary gland on the dynamic postcontract images. the primary diagnostic consideration is that of a microadenoma (2.6x3.4)

no enchancing space-occupying intra- axial lessions

chronic sinus disease

suspected low lying cerebellar tonsils (what?)

abnominal ultrasound:

limited evaluation of the retroperitoneal vessels demonstrate no gross abnormalities.

the visualized portions of the pancreas are normal.

the right hepatic lobe measures 13.8 cm long homogeneous parenchyma

no cholelithiasis, gallbladder wall thickening or pericholecystic fluid.
the right kidney measures 10.0 cm long the left 11.3

the spleen measures 10.3 centimeters long.

impressions: no sonographic evidence of cholecystitis.

now to labs:
testosterone Total: 2.87 ng/dl reference 5.05-19.8
testosterone free: 191 ng/dl reference 240-950
Estradiol: 5
tsh 1.81
t4 free 1.05 from .93-1.70
t3 free 1.87 from 2.00 4.40
SHBG : STILL PENDING but i saw results varying from 56-74.
LH: 2.3 FROM 1.70-8.60
FSH:1.48 FROM 1.50-12.40
IGF-1 NG/ML 87,50 FROM 116.00-358.00
prolactin: 13 from 4.0-15

other labs:
white blood 4.09 range 4.30- 11.00
red blood count 4.13 range 4.60- 6.20
hemoglobin 14.10 range 14.00- 16.00
hematocrit 41.10 range from 40.00-54.00
mcv: 99.52 range 80-94
mch 34.14 range 26.00-33.00
mpv: 11.20 range 7.40-10.40

GGT: U/L 51
TIBC 267.00 250.00-450.00


GLUCOSE: MG/DL 79.00 FROM 70.00-99.00

BUN 25.90 FROM 6.00-20.00
SODIUM 144 FROM 136.00-145.00
AST: 53.00 FROM 10.00- 38.00
ALT 53.00 FROM 10-43.00
ALBUMIN 5.30 FROM 3.40-4.80
TOTAL PROTEIN 7.20 FROM 6.40-8.30

CHOLESTEROL MG/DL 163.00 FROM 50.00-200.00
TRYGLYCERIDES 55.00 FROM 35.00-200.00
HDL 80.00 80 FROM 37-71
LDL 72 FROM 0-130.00

VLDL MG/DL 11.00
LDL/HDL 0.90



SED RATE MM/HR 1.00 FROM 0.00-15.00

PT SECONDS 11.50 FROM 9.00-15.00
INR 1.13 FROM .83-1.40


FERRITIN NG/ML 228.30 FROM 30.00-400.00



25- HYDROXY VIT D 44.17

CORTISOL 18 FROM 6.20-29.00


ACTH: 47.30 FROM 0.00-46.00

All im asking is, i need advice/help ;/.

symptoms: feeling cold all of a sudden, no morning wood, ed, no libido, no energy, recovery takes too long, depressed, anxiety, stress, insomnia, constantly urinating, can’t think straight, short term memory, lose strenght/weight fast, no motivation or desire to continue even living, no sperm when ejaculating, etc.

whats worst is fighting against my family who believes in numbers when it comes to labs. if its 1 point below normal range or high they say"dude its only one point chill out you’re normal" so if my lh is 1.1 and it ranges from 1.2-9.0 normal they will say its normal.



@highpull @charlie12 @systemlord @alphagunner


Is this the first you learned of this?
This certainly can affect hormones keeping LH and FSH low and you need pituitary to respond efficiently yo push out the LH for testes to make t.

Neurologist hopefully will shed more light on if the microadenoma is affecting pituitary function.

Dude your T and e2 are way low. and this is making you suffer.

Keep up with the dr appointments and am sure you will get treatment.

read about ACTH and DHEA and CORTISOL. how they work together.




According to the Free T3 ranges, you are hypothyroid and thyroid treatment may very well raise SHBG even higher. Hypothyroidism may explain the chronic sinus problems.

Some relatively common symptoms of hypothyroidism include nasal stuffiness, sinus congestion, and impaired hearing. These are explained by accumulation of glycosaminoglycans, the same chemical substance that causes puffiness of the face. Hence, if a patient has nasal and sinus congestion and impaired hearing and is not responding to anti-allergy medications, one should think of the possibility of hypothyroidism.

Doctors are like robots with these goddamn ranges, 1 point defines whether you are normal is insanity. Medical school brainwashes these doctors much like boot camp brainwashes soldiers, independent thought and critical reasoning go right out the window and is replaced with reference ranges.

You become as cash paying customer and the doctors will change his tune because his hands were just release from the handcuffs the insurance placed there since they are paying the bills.

Insurance was the death of medicine.


I Don’t agree with this. Not off of one lab esp since his TSH less than 2.

Thyroid I think should not be the first thing you look at.
OP has other base - root issues to address first.
Then other numbers may improve.


You should point out to them that “healthy” people with normal lab values drop dead every day. I know it is not unusual for some to have symptoms “in their head”, but low libido does not seem to be one of the in the head complaints. Guys don’t imagine that, or admit to it if it isn’t real.

You have a lot going on and my guess is that pituitary function is behind most of it. I am surprised prolactin is not higher. You’ll need a neurologist to start, not sure if you would be a candidate for medication or if there is a chance it could/ would help with pituitary function, and therefore fix your hormones. I would not think surgery is an option, yet. At the very least, it needs to be monitored regularly, probably yearly MRI.

If there is nothing you can do with pituitary, I’d start with testosterone, maybe DHEA. Get test and E2 straightened out. Go from there if you need to do so. Good luck and please inform us of your results.


hello sir! first of all thanks for replying. i went first to a psychologist who told me to look at my hormones first before treating me psychologically because in the dsm5 it says to treat biological stuff first before anything and yeah thats how i knew of my hormones. after that i went to the end and she said without knowing about prolactin to do mri because she did not know why my low t and mri showed that. but its small and probably non functional because i have normal acth low prolactin and low lh fsh. meaning i might be secundary?

well damn. my neuro appointment got cancelled because he haves surgery (emergency) tomorrow and i dont know when he can re schedule appointment. i had to cancel endos appointment which was today and now its on january 27 :confused: i need help because the symptoms are killing me and whats worst is my family does not jnderstand. how can i make them understand? not even telling my granma who is like my real mother understand me. i even tell her i dont have erection or eyaculation and its like nothing. how on earth is my estadiol 5 wtf! i know i can increase it with trt but what about naturally? my shbg must be high too.

i will keep up but worst case is they (especially endo) knows nothing about trt, igf1 shbg or believes in clomid or hcg saying its useless and illegal. o and i had to ask for estradiol from another doc because she wasnt willing to give most labs. yeah i read about acth and cortisol. cushing disease


thanks for your time for replying my friend.
wow i didnt know about the sinus! thats why im always with muccus after eating especially and allergies. i knew i had to take t3 from another doc since endo isnt willing to give me most of my labs.

yeah man doctors and people are all into numbers! wtf am i suppost to tell them? they say especially my mother “dude your testosterone is 251 and normal range is 250 youre fine” yeah no. but my test says low on paper so its fine to them. my igf1 is at 84 low af and my family says”dude youre 6’3” “ thats fake” how can i combat this -.- whats worst is that they say i dont accept treatment or what am i gonna do? yeah wtf am i going to do if doctors wont accept hcg with testosterone at my age or trt once every two week and wont test estrogen shbg or most labs!