T Nation

JWilson Case Study

28
6 foot 2 inches
waist - 46 inches at the hips
330 lb
Limited body hair; small patch of hair on back; facial hair patchy and hard to fill out
Since 2003, fat gain has been abdominal mainly with some chest
Hashimoto’s disease for existing condition. Symptoms: brain fog, tired, depressed, limited focus, no sex drive, hard to get erections and even harder to maintain.
Armour Thyroid 90mg morning and 120mg afternoon
Lab results with ranges all listed below for what I have available.
Don’t have a strict diet. I try to eat whole foods as often as possible and limit simple carbs.
Have worked out on and off since 2000, but nothing strict. Currently only doing some cardio trying to drop weight before adding weights again.
Never and testes pains
Erections were non-existent. Once TRT started, erections are back and libido has increased but it fluctuates.

Backstory: I am already taking Armour Thyroid due to Hashimoto’s disease which was diagnosed a few years ago. Which was somewhat expected, as thyroid disease runs heavily on my mother’s side of the family. Once the thyroid was figured out we moved on to correcting my testosterone.

September 16, 2011:
Testosterone: 192 ng/dl (100-800); cannot find the free testosterone results but it was low, like in the 40’s on a scale of (30-150). Doc wouldn’t do anything for me since numbers were within range but did agree to reference a specialist.

August 15, 2012 (Last results)
Total Test: 564 (400-1080)
Free Test: 142 (47-244)

Follow up tests have been completed: after using .5mL per week (200mg/mL) the numbers just weren’t where either of us wanted them. Total came back as 564 (400-1080) and free test came back at 142 (47-244). He bumped it up just a smidge to .6mL per week, or an increase from 100mg to 120mg. He does not care what my total shows but wants my free to be around 220-225. I have been doing all shots subQ dosed at 25iu twice per week. I will now step up to 30 iu twice per week and test again in a couple months.

On a side note, the increased numbers are way better. I have energy, focus, and sex drive again!

January 8, 2013:
Total Testosterone - 396 (250-1100)
Free Testosterone - 50 (35-155)

He said that sometimes after using injectable testosterone for a while my natural production would completely shut down; whereas the first test it may have still been supplying some additional hormones to the system. They bumped me up to 1 mL per week (200mg).

March 7, 2013:
Total Testosterone - 390 (250-1100)
Free Testosterone - 81 (35-155)

He decided to keep the dosage the same and test again in 8 weeks. I think it may have been my fault though. Since the dosage is subq 2x a week I may have messed up the blood draw schedule. I do injections on Tuesday evening and Saturday morning. Normally, blood draw is done prior to the next injection. I took my Tuesday injection and didn’t do any more injections, then did blood draw the following Tuesday.

Thoughts on anything? I’m sure I need to get a full blood workup done and have in the past just don’t have the information in front of me. As far as the blood draw… should I do Tuesday injection, Saturday injection, and then blood draw Tuesday mornings?

Alkaline Phosphatase 63 38 - 126 U/L
AST - SGOT 62 0 - 37 U/L
ALT - SGPT 112 0 - 55 U/L
Bilirubin Total 0.8 0.2 - 1.3 mg/dL
Bilirubin Indirect 0.6 0.0 - 0.9 mg/dL
Bilirubin Direct 0.2 0.0 - 0.5 mg/dL
Albumin 4.6 3.4 - 4.8 g/dL
Protein Total 7.7 6.3 - 8.2 g/dL
Vitamin D 25 Hydroxy 12 30 - 100 ng/mL
T4 Free 1.3 0.7 - 1.5 ng/dL
T3 Free 3.0 1.7 - 3.7 pg/mL
FSH 3.4 1.5 - 12.4 mIU/ml
LH 2.9 1 - 20 IU/L
E2 22 10 - 45 pg/mL
PSA .25 0.00 - 4.00 ng/mL

Main tests to show Hashimoto:
TPOAb 345 0 - 35 IU/L
TgAb 190 0 - 9 IU/L

These are the test results I have handy…

Please read these stickies:

  • advice for new guys
  • protocol for injections
  • thyroid basics
    – report temperatures they are a guide to thyroid med dosing

Your liver markers are a problem.

  • as per the 1st sticky, list all of your meds, Rx or OTC and alcohol use

You are a hyper metabolizer of T or your T is bogus. Brand name drug?

Any effective TRT will shut down LH/FSH. Never “sometimes”.

Try injecting IM for a while.

For your weight, you may need more T. Hyper metabolizers often need 300mg/week. With your weight, you may need to inject 400mg. You need to find what works. When you get decent levels, your E2 will likely shoot up as you have a lot of fat for T–[aromatase]–>E2.