T Nation

I Was Desperate!


#1

On Thursday, 5/28, I started TRT and am concerned I might have jumped the gun. I went to a hormone replacement clinic and they only did labs that would support their treatment options. Makes sense since they make their money off of treatment. Since my symptoms were so bad, I was ready to sign up for any option that would make me feel better. I do feel better since starting, but now I'm concerned that I don't have enough baseline info.

My main question, is should I take a break and get labs before my HPTA shuts down or do I have enough information to continue treatment? I am grateful for your advice and look forward to becoming more involved with the forum.

Personal Info

I'm 39 years old, 6'5", 235 lbs, 40" waist. I have thin body hair and I can grow a so-so beard. Much of my fat is around my waist--I've put on 15 lbs in the last 2 years. My diet has been poor--not much fresh fruits/veggies. I don't exercise much because I can't get the motivation and I'm sore for days. Never had testes ache, sex drive has been lower, but usually have morning wood.

The last few years have been stressful. My wife had undiagnosed depression and it really wore on me, never knowing how she would react on any given day. She has started treatment and is improving, but still a difficult circumstance.

I have family history of enlarged prostate--no cancer, but enlarged enough to need surgery. No pre-existing conditions. I've never been very high energy and I've always had a hard time building muscle. My wife and I are still interested in having kids.

Symptoms

Tired all the time/fatigue
Lack of motivation
Depression
Decreased memory/brain fog
Inability to concentrate
Fat gain
Poor recovery
Cold hands/feet
Sugar/caffeine cravings

Labs

The "Doc" ordered the following (test, result, ref range):
DHEA SO4, 75, 100-432 ug/dL
Free T, 3.8, 4.3-30.4 pg/mL
PSA, 0.67, 0.00-4.00 ng/mL
Ferritin, 104, 26-388 ng/mL
TSH, 1.40, 0.34-4.82 uIU/mL
fT3, 3.1, 1.8-4.2 pg/mL
Insulin, 14.80, 3.0-25.0 mcIU/mL
Glucose, 80, 70-110 mg/dL
Cortisol AM, 14.99, 4.3-22.4 mcg/dL

I found a walk-in lab and had a few other tests done before starting TRT. At this point I hadn't done much research and was grasping at straws:
Total T, 430, 348-1197 ng/dL
Free T, 6.6, 8.7-25.1 pg/mL
LH, 3.1, 1.7-8.6 mIU/mL
FSH, 4.1, 1.5-12.4 mIU-mL
fT4, 1.41, 0.82-1.77 ng/dL
Prolactin, 7.4, 4.0-15.2 ng/mL
IGF-1, 175, 83-233 ng/mL
GH, <0.1, 0.0-10.0 ng/mL

I am still awaiting results on DHT, Lipid Panel, Vit D, and Total Estrogen (I know now I should have ordered E2, but didn't know at the time and was very symptomatic). I will post once I receive them.

Treatment

Here is what I've been prescribed. I started Thursday, but based on what I've learned this weekend I will talk with the Doc on Monday.

T cyp 160mg IM 1x week
hCG 1000IU SC 2x week
DHEA 50mg pill daily (for one month, then 25mg)
Nature-Throid 32.5mg daily

I also take fish oil and vit D3.

I have been feeling better since Thursday--not great, but better. I know the hCG is too high and plan on cutting back to 500IU 2x week. The T cyp also seems a bit high for starting. He didn't start any AIs, but I don't have an E2 baseline. I also want to talk to him about SC T instead of IM--at 39 years old, that's over 2,000 holes I'll be poking in my muscles if I live to 80.

I really wish I had CBC, SHBG, E2, and bioavailable T to get a more complete picture of my HPTA prior to starting treatment. Now is the opportunity to stop and get the labs if I need them. If I should get the labs, how long should I wait from my last injection?

I'm educating myself as rapidly as I can. Thank you again for your help!


#2

Your set of labs is decent. What E2 does on TRT is more useful than a baseline in some ways, but if E2 was high that could have been driving down LH/FSH and T levels.

Read the thyroid basics sticky. Too bad that you did not check body temps before starting thyroid meds. fT3 was not bad, could be better, but if temps were quite low, that suggests that rT3 might be blocking fT3. You have the repeated stress and crisis events that could lead to adrenal fatigue and elevated rT3. Low DHEA can also be a sign of adrenal issues, you need DHEA for DHEA–>T inside your testes.

Have you both been using iodized salt long term. Iodine deficiency can affect a household if not using iodized salt. Check your wife’s temperatures as well; waking and mid-afternoon. She may need a thyroid panel as well; does she get cold easily?

Many of your symptoms could be be thyroid related.


#3

Thanks KSman!

I’ve been through the thyroid sticky and concur that there are issues there. I’ve been taking my temps for a couple days and have attached an image with my results. Yesterday I think I was running a bit of a fever. Based on my morning temps, I have ordered an iodine supplement.

My wife is also on Nature Throid–her TSH and T3 are similar to mine. Yes, she gets cold easily. I’ve been encouraging her to track her temps as well.

Dr Wilson’s Adrenal Fatigue book and the STTM books should be arriving soon. We’re working on getting healthier!


#4

I got a few more labs from before starting treatment (on the Lipid panel, I recently changed my diet to be more testosterone friendly, including more eggs, so the high LDL is not a surprise):

Total Cholesterol, 181 mg/dL, 100-199
Triglycerides, 106 mg/dL, 0-149
HDL, 51 mg/dL, >39
VLDL, 21 mg/dL, 5-40
LDL, 109 mg/dL, 0-99

DHT, 40 ng/dL, 30-85

Vit D, 39.3 ng/mL, 30-100

Total Estrogens, 141 pg/mL, 40-115

I know I should have ordered E2 instead of total estrogens, but I didn’t know at the time.

I also leaned that my Doctor bases his treatment on Dr Rouzier’s protocols. He is unconcerned about estrogen levels saying teenager boys have high testosterone and high estrogen and it’s not a concern unless there are symptoms. I think it’s a false analogy, especially based on the cases I’ve read here and elsewhere. I’m pushing him to follow protocols closer to Dr Shippen or Dr Crisler (or possibly find a new doctor).

Thanks again for your help!


#5

There is nothing wrong at all with your cholesterol numbers and LDL will improve when you resolve issues with thyroid and sex hormones.

“Dr Rouzier’s protocols” he is running a seminar business, but the attendees have no basis to know if his work and understanding is deeply flawed.


#6

After 6 months, I’m finally finding a balance. The biggest thing was finding out I’m an adex over-responder, which made finding my ideal dose difficult. Its amazing to have testosterone labs come back perfect but feel like crap because E2 is too high or too low.

Here’s my current regimen:
44 mg T-cyp SQ E3D
250 IU HCG SQ EOD
0.024 mg Adex ED (in liquid)

I’m feeling the best I have in a while, but it seems like my E2 level is on a knife’s edge. I take Adex every day because a larger dose every other day kills my E2. My adex levels are reasonably stable, but my testosterone levels tend to vary, and since E2 follows T, I can feel my good and bad estrogen days and am trying to decide how to level E2 out.

I tried to find my peak/trough testosterone levels and have attached my lab results. Overall I’m happy with the levels, but is that the difference most people experience over three days? I’m trying to decide if I want to go to T-cyp EOD to even out the peak/trough or take a different adex dose each day depending on where I am in my peak/trough (which I think will be more difficult, but fewer injections is a plus). Any experience from other over-responders?

On a side-note, I stopped taking nature-throid while trying to find my ideal adex dose. It was masking some of my E2 symptoms. It’s much easier to focus on one system at a time!

Thank you again to everyone on this site. I would have given up months ago without you all.


#7

I had a revelation today. I typed up all my lab histories and the protocol I was on at the time and did some comparisons. The most interesting one I have attached.

I had two very similar lab results, but one was with Adex and on without. Basically after 24-hours the Adex no longer has any affect. No wonder I’m waking up so sluggish. On a similar dose, my afternoon E2 is in the low 20s, so increasing my dose is not an option. This also explains how I kept crashing my E2 when I was using morning labs to adjust my doses.

I had assumed that an Adex over-responder would still experience the 48-50 hour typically half-life for Adex. However, it looks like I metabolize Adex quicker (and would explain why I over-respond).

Based on these results, I’m splitting my Adex dose to twice a day. I’m curious if anyone has created Adex troches from liquid Adex to make it easier to travel with? I found some recipes for making herbal troches that I think will work (they don’t use heat, just various thickeners to create a paste that dries into tablets).


#8

I am confused by this thread. E2=38 is quite high. Maybe the adex wears out so fast is because the dose is so very small.


#9

I decided to do an experiment and have an E2 lab before and after my Adex dose.

First thing in the morning, before any meds, my E2 was 46.9 (range 7.6-42.6)

After taking Adex and waiting an hour, my E2 was 38.8.

The Adex dropped my E2 8 points (this is the dose I take twice a day). I went to a higher dose of E2 to get my overall numbers down. However a larger dose means it will be a greater E2 drop. I’ll try the two E2 labs again once I get stable, but a larger dose will likely cause a larger drop. If I can get my low point to be around 21, I’ll likely be in the low 30’s before my Adex dose.

I agree the Adex dose is tiny and wears out quickly. I wish I could go to a larger Adex dose, but anything much larger than my current dose drives my E2 way too low. I feel much worse with low E2 than high, so I have tended to err on the high side.


#10

I takes 5-7 days for a given dose or dose change to result in a steady state serum level of the drug. This may be a flaw in your approach. And you are changing the T–>E2 production rate, not eliminating E2 with the drug. E2 is mainly cleared by the liver and that has its own half life.


#11

Thanks KSMan! While I agree that’s how it should work, I’m trying to figure out why my reaction to Adex is so different. Every time I take Adex, I get an immediate reaction. When I start to feel bad because I think my E2 is getting high, I take a small dose of Adex and 30-60 minutes later am feeling better.

When I did these labs, I had been on a stable dose of T-cyp, HCG, and Adex for 4 weeks. I’ve been on TRT for 8 months. The first month, I didn’t have Adex and was pretty miserable. For two months I tried larger doses of Adex and was even worse. The last 5 months have been better as I’ve been trying to get my doses dialed in (for a while I tried lower T-cyp doses to try to keep my hemoglobin down, but I’d rather just give blood).

I am obviously an adex over-responder. There’s something physiologically different that makes me over-respond. It seems possible that over-responders bypass the typical process. I agree with the small dose I take, that I never really have a serum level of Adex, so it’s like starting from scratch each dose. However, any larger dose makes me miserable.

What else could cause my E2 to go from 46 to 38 in one hour? I did eat breakfast between labs and I usually take Adex with meals–could eating cause E2 to decrease? Or do E2 levels naturally drop throughout the morning? I’m just trying to figure out what else could have caused the decrease. I don’t think it was lab variation, because I did feel better for the second lab.