Hi, I’m Larry, and here’s my story.
I’m a 48 y/o male and I’ve been physically active for most of my life. I have never been on a prescription drug, have never had a surgical procedure and have a squeaky clean medical history. Last August I noticed that minor cuts and scratches were taking longer to heal than normal, you know how a scratch will scab up and heal in a week – mine starting taking 3 – 4 weeks. I also started feeling tired, worn down and fatigued, so, like most folks do, I turned to Google. Many of the symptoms I THOUGHT I was experiencing aligned with search results suggesting Diabetes.
My annual check-up was scheduled for early December and I decided to wait and discuss at that time.
I had lab work scheduled for 12/5 and the office visit for 12/13; I called ahead and left a message with my Dr. giving him a heads-up in the event he needed to expand tests to assist in diagnosing my symptoms.
Here are the results of the 12/5 lab (blood drawn @08:00 AM w/fasting @Quest Diagnostics):
CBC:
Component Value Standard Range
WBC 5.4 not provided
RBC 5.60 not provided
Hemoglobin 15.9 not provided
Hematocrit 48.0 not provided
MCV 85.6 not provided
MCH 28.3 not provided
MCHC 33.1 not provided
Platelet Count 207 not provided
MPV 9.0 not provided
RDW 14.0 not provided
Lipid Profile:
Component Value Standard Range
Cholesterol 198 not provided
Triglycerides 74 not provided
HDL 49 not provided
LDL 134 not provided
Non HDL Cholesterol 149 not provided
Cholesterol/HDL Ratio 4.0 not provided
COMPREHENSIVE METABOLIC PANEL:
Component Value Standard Range
Sodium 140 mmol/L 135 - 146 mmol/L
Potassium 4.3 mmol/L 3.5 - 5.3 mmol/L
Chloride 107 mmol/L 98 - 110 mmol/L
CO2 27 mmol/L 20 - 31 mmol/L
Blood Urea Nit 23 mg/dl 7 - 25 mg/dl
Creatinine 1.01 mg/dl 0.60 - 1.35 mg/dl
Glucose 100 65 - 99
Calcium 9.3 mg/dl 8.6 - 10.3 mg/dl
Total Protein 6.7 g/dl 6.1 - 8.1 g/dl
Total Bilirubin 0.5 mg/dl 0.2 - 1.2 mg/dl
Albumin 4.5 g/dl 3.6 - 5.1 g/dl
Alk Phosphatase 70 u/L 40 - 115 u/L
AST (SGOT) 47 u/l 10 - 40 u/l
ALT (SGPT) 45 u/l 9 - 45 u/l
TSH WITH FREE T4 REFLEX:
Component Value Standard Range
Thyroid Screen 2.58 mIU/L 0.40 - 4.50 mIU/L
TESTOSTERONE:
Component Value Standard Range
Testosterone 262 ng/dl 250 - 827 ng/dl
During our 12/13 lab review, my Dr. suggested that the symptoms were likely due to low test levels. I’m 5’ 8”, 215# with <20% BF, I have a lot of muscle mass and I was much leaner before all of this started. He felt I basically had more mass then the test levels could maintain and that the fatigue was probably a symptom of this. At this point, I had started to experience the fatigue, had been at a plateau in the gym since early October and was beginning to be less active than normal. He suggested we pursue TRT and in discussing the various options at our disposal, we agreed on an injection protocol. However, he first wanted to wait about a month and perform another lab looking at Total Test, LH and FSH.
We scheduled the lab for 1/16 and the next 4 weeks began a downward spiral in how I felt. By the time the next lab rolled around my fatigue was nearly unbearable, I had no energy, no motivation and no matter how much rest I got, I still didn’t feel rested. The fatigue was the worst part, I couldn’t handle sitting or lying still for more than a minute, and I started getting 3 – 4 hours of sleep/night because the fatigue was so damned persistent.
Here are the results of the 1/16 lab (blood drawn @09:00 AM no fasting @Quest Diagnostics):
Component Value Standard Range
FSH 10.3 mIU/mL 1.6 - 8.0 mIU/mL
LH 1.4 mIU/mL 1.5 - 9.3 mIU/mL
Prolactin 7.0 ng/ml 2.0 - 18.0 ng/ml
Testosterone, Total 163 ng/dl 250 - 827 ng/dl
When reviewing the results with my Dr. on 1/18 he was concerned about the FSH/LH levels and wanted me to see an Endo to identify the root cause, are we dealing with primary or secondary hypogonadism? I called the Endo’s office to schedule an appointment and they said their first opening was at the end of May – I kind of flipped out, because by this time the fatigue was ruining my life… Thankfully a patient cancelled while we were still on the phone and she said “Can you be here @08:00 in 2 days?” Yes I can!
So, I arrive at the Endo’s (University of Kansas Hospital in downtown KC), the nurse takes my vitals and in strolls the Endo. He has me strip down, gives me a complete physical, has me stand in front of him nude, and he’s just staring at me with an expression somewhere between curiosity and suspicion. After about a minute he tells me to get dressed, I’m thinking WTF is going on here!
We spent about 30 minutes together discussing how I felt and we reviewed the previous lab work my Dr. had ordered, and towards the end of the session he says “You are a mystery, most of the patients I see are obese and have diabetes. You appear perfectly healthy and have a substantial amount of lean body mass.” He wanted to order more labs to aid in determining if I have primary/secondary hypogonadism. He did not like that my last lab was @09:00 and wanted me there as soon as the lab opened.
Here are the results of the 2/20 lab (blood drawn @07:50 AM no fasting @University of Kansas Hospital):
Component Value Standard Range
Testosterone, Total 238 NG/DL 270 - 1070 NG/DL
Cortisol-AM 13.0 MCG/DL 6.7 - 22.6 MCG/DL
T4-Free 0.7 NG/DL 0.6 - 1.6 NG/DL
Estradiol (E2) 33 PG/ML 10- 44 PG/ML
Ferritin 67 NG/ML 30 - 300 NG/ML
Iron 98 MCG/DL 50 - 185 MCG/DL
Iron Binding-TIBC 468 MCG/DL 270 - 380 MCG/DL
% Saturation 21 % 28 - 42 %
On 2/22 the Endo reviewed the lab results with me, by this time, I had discovered T-Nation and came prepared with a few questions of my own. During our discussion I inquired about our initial consultation and why he was so pre-occupied with my physical appearance as compared to the lab results. I had told my wife I knew what he suspected, but I wanted to hear it from him. My hunch was correct, he thought I had done an AAS cycle and crashed post cycle. I reassured him that I’ve been lifting cleanly off and on for 30+ years and that this crash was sudden, extreme and that I was more confused than he because I document everything and I’m very anal about my routines.
He prescribes a protocol of administering one 200mg injection of Testosterone Cypionate every two weeks. Thanks to T-Nation, I knew this was a bad idea. I countered and suggested we do 100mg once weekly and he agreed. Nice, he seems open to working with me here!
Then I inquired about my E2 being in the upper third (33 PG/ML) and if I may need an AI. He said no. I pressed him again, and he firmly said no again and that it wasn’t going to be a problem. I guess we’ll see what the next labs have to say.
I started injecting on 2/27 and have been doing 100mg every Monday since. He wanted me to follow this protocol for ~90 days and my next lab work is scheduled for 5/15 (morning of an injection day) with follow-up office visit on 5/18. Once we establish my maintenance dosage, he just wants labs and a review once annually as long as I’m feeling fine.
On 3/31 I had an MRI performed so they could determine if the root cause was the pituitary. It is not, the MRI was clean!
So, how do I feel after 6 weekly injections?
So far, I feel no different than before I started TRT. My routine is to inject every Monday evening when I get home from work, about 6:00 PM. Some days the fatigue almost brings tears to my eyes, I can hardly maneuver under my own body weight, and I typically get ~ 4 hours of sleep a night and have zero energy, motivation or any semblance of well being.
What I have noticed is that on Tuesdays at about 4:00 – 6:00 PM I experience a reduction in the fatigue, it seems it takes Cypionate about 24 hours post injection for the spike to reach high-enough levels to knock the edge off. And that’s really all it does, the fatigue is still present but it reduces the peaks and makes it manageable. This experience is consistent through Wednesday, and begins to wear off every Thursday evening. I seem to get a 48 hour window of comfort, and then Friday – Sunday the fatigue has its ‘A’ game back on with a vengeance!
Perhaps I’m burning through it this fast, I dunno.
Since October I have cut back on my workouts considerably and I’m essentially just going through the motions at the gym – I have lost strength in some exercises (as much as 50% on dumbbell curls), I have lost lean muscle mass, and have gained 2” in my waste while maintaining the same body weight. Sad times for me gentlemen…
I’m going to stick it out for 4 more weeks and see what the next labs reveal, but in the spirit of transparency, I’m losing my patience, I’m beginning to feel desperate, and the daily battle with being discouraged is really bringing me down. Once I am able to establish my maintenance dose with the Endo (100mg/wk, 120mg/wk, whatever the script is) I do plan to inject every 3.5 days.
I’m working on a plan ‘B’ in the event my Endo isn’t willing to work with me; he’s previously made a comment about “not believing everything you read on the internet…”
I did as KSman suggested in the stickies and looked for compounding pharmacies in my area (KC Metro); I reached out to MCP (I believe this is who KSMan uses), and asked for their top N list. Last week I received 5 names and all of them appear to be clinics with monthly installments some of which are $300/month! If I have to use this path, it’s going to require more leg work to sort out viable professionals to work with.
Sorry for the lengthy post and I appreciate any feedback the community has to offer.
Larry