T Nation

Just Diagnosed & Starting TRT, Questions

I’m a 31, 6’1" and 170 lbs. I’ve been having symptoms like brain fog, muscle weakness, can’t gain any muscle/muscle loss and low libido for 4 years now. My new doctor asked if my T had ever been tested, and I said yes and told her what my previous results were. When I told her my last results (270 ng/dl, then 407 ng/dl after retest), she shook her head and said, “That’s too low for your age. I’d like to retest.” So I had my level checked again before I left the doctor’s office.

I got a call about 4 days later saying my T was low and they wanted me to come in as soon as possible to get it checked again to “confirm” that it was low. Went in again, had it rechecked, and the doctor said “I’d like you to come in in a couple of weeks to discuss treatment options.” I was never told what my levels were.

So here’s my problem. My T has been consistently around 250-400 for the last year, so I’m assuming that’s what my levels were when the doctor checked. If so, that doesn’t seem all that low compared to a lot of the guys I’ve known who had to have TRT. Besides that, my testosterone was tested at 537 ng/dl shortly after my symptoms started. Is it even possible to be symptomatic with a T that high?

So what do you guys think? Should I go ahead and go through with the TRT like my doctor wants, or should I look elsewhere for the cause?

Sorry for the lengthy post and thanks for any help.

Symptoms -

-Brain fog
-Social withdrawal
-Rarely have morning wood
-Why do really hot looking women and girls now look like art instead of lust? <- This.
-I get cold easily
-Why do really stressful situations leave me feeling physically beat up. Adrenal fatigue. <- Also this.
-Dry skin, brittle hair and nails
-I am not depressed, I just don’t care about anything, no joy, no motivation, no reward
-Muscle weakness.
-Normal physical activity (taking out trash, cleaning house, working on car) leaves me exhausted
-Sleep doesn’t help. 6 hours, 10 hours, 3 hours, it’s all the same. I feel tired from the moment I wake up til i go to bed.
-Non-existent libido. Can still get erections, but not in the mood. Just kind of going through the motions with sex.

LABS -

(7/25/12)

  • Total T - 270 ng/dL (range 240 - 950)
  • Free T - 7.4 ng/dL (range 9 - 30)
  • Prolactin - 12 ng/mL (range 3 - 13)
  • LH - 3.7 IU/L (range 1.8 - 8.6)
  • FSH - 5.4 IU/L (range 1.0 - 18.0)

(9/11/12)

  • Total T - 407 ng/dL (range 240 - 950)
  • Bioavailable T - 147 ng/dL (range 72 - 235)
  • LH - 3.9 IU/L (range 1.8 - 8.6)
  • FSH 4.0 IU/L (range 1.0 - 18.0)
  • S Estradiol - 18 pg/mL (range 10 - 40)

UPDATE - May 26

Been on Androgel for only 6 days now and I haven’t noticed any positive changes (expected), but have noticed that I’m much more tired during the day than normal (totally unexpected). I have no idea why that is. I’m sticking it out until I see my doctor again in a month. Really curious as to why I feel more tired on TRT than I did before I started though.

BEFORE you start TRT, have your doctor test LH, FSH, Prolactin, SHBG, E2, etc. Read the Labs sticky.

Personally, I wish my doctor checked these before starting me on TRT.

Thanks HouKN98. I should probably edit my OP and post all the labs I have. I realized today that I didn’t do what the sticky said at all even though I’ve been lurking here for months and should’ve remembered to. I’m editing the OP to add results. I still don’t have the results from both tests my new doctor ran, but I’ll get them at my next appointment when I go to talk about TRT with her.

Yeah, your T is too low for your age.

You get cold easily? That’s a tell tale for sluggish thyroid. Please have your thyroid levels checked:

TSH
Free T4
Free T3
Reverse T3

Your doctor might complain and say these tests aren’t needed, but insist on getting running the BW. Say you just want to “rule it out”, and then get a copy of your lab results and post em here. Don’t let your doctor just say “your tests came back normal, you’re fine, and have a good day.”

I’ve already had to change doctors because some wouldn’t work with me to optimize my health.

It’s been checked a few times, but I don’t have the results around me at the moment. I know my TSH has been anywhere between 1.5 and 5.0 at any given test. The average has been about 3.3. Free T4 always looks good (mid to high end of the range), and Free T3 always looks good (usually mid range). I’ve never had rT3 checked though since most of the doctors have said it’s “pointless” and “doesn’t help diagnose anything”. Wtf.

I’ll ask this new doctor about retesting and post the results as soon as I get them. She seems completely different than all the other doctors I’ve seen. I’m surprised she wants to treat my T since other doctors have said it’s perfectly fine even at 270.

Read the thyroid sticky and google “Stop the thyroid madness” and read through their site. Excellent info on thyroid. They say TSH should be 1.0-1.5, not at 3.3. Mine is at 3.6. Even if fT3 and fT4 appear normal, a high TSH means your pituitary gland is working overtime trying to tell the thryoid gland to produce! produce! produce! That means your thyroid is slower than it should be. If you can find tincture iodine from a store, brush some on your forearm near the elbow fold. If the patch fades or disappears within 24 hours, you are deficient in iodine and should supplement with iodine (which I just started doing myself).

Thanks man! I’ll definitely look for some of that. There’s a health food store down the road so I’ll see if they have that there.

I wondered about thyroid problems since my dad’s thyroid started acting up around my age, and he went full-blown hypo around age 45 after around 15 years of subclinical hypo, feeling like total crap.

SO they haven’t done anything about your thyroid? How are you feeling?

My doc dismissed my thyroid concerns, but my iodine patch test proved that I have a deficiency, so I am supplementing with iodoral. 3 days so far, too early to tell.

I don’t get that about doctors. If you feel terrible and your labs are “normal” but bordering on abnormal, why not at least try something? What can it hurt to supplement a small dose of T3 or something to see if it helps?

[quote]TVorn wrote:
I don’t get that about doctors. If you feel terrible and your labs are “normal” but bordering on abnormal, why not at least try something? What can it hurt to supplement a small dose of T3 or something to see if it helps?[/quote]

Because most doctors are either morons that believe “within normal range” indicates no problem, or they just don’t care about you. The normal ranges is a terrible gauge of most health indicators. The key is finding a doctor that believes in optimal ranges. These doctors are very hard to find, but worth every penny you invest in seeing them as they are willing to treat you until you are well and happy.

I’m still getting dialed in to my TRT, but am very happy with my doctor because she listens to me and at least is willing to try things.

Quick update - just got back from the doctor and she went over my lab work with me.

First T result - 285 ng/dL (300 - 1157)
Second - 366 ng/dL (300 - 1157)

She went over treatment options with me and I opted for Androgel for now, and if it doesn’t help then she said we’ll switch to weekly shots. Instead of “treating to a number”, she told me she’ll see what level I feel good at and maintain that level as best as possible. I’m excited to hopefully start feeling a little better after all this time.