T Nation

Looking for Wisdom for What's Next

T Replacement
#1

Hello all,

Quick bio, male, 54yrs old, 3x survivor of Non Hodgkins with chemo and radiation, clean now about 17 years with last treatment 12 years ago.
Ht: 5’7"
Wt; 185
Fitness stuff: Cycling (mountain bike) 4x a week and supplemental lifting 2x a week, lift also when I can’t ride due to weather.

4 years ago TT 276 but FT was 10
on recheck from this value TT 310 and FT 9
The provider said all is okay you just need to lose weight (was about 200). Lost weight to 180 over the next couple of years.
2 years ago TT 320 and FT 8
Doc said you are in range so there’s not much I can do. I had been with this guy since 2007 so I trusted him.

So I recently searched and searched and hope I have found a new doc. I explained the issues I’m having.

  • increased belly fat on 2k diet, food tracked daily and working out 5x a week.

  • losing muscle mass in legs and overall strength though working out intensely with trainer (so frustrating).

  • non-existent libido

  • Gynocomastia (not diagnosed by a health care professional but definitely appearance-wise)

The new provider listened and we started the path down the road with blood work and a physical.

Lab results back today and I’m not sure where to go with this info. All lab work is done using Labcorp and their ref ranges. We ran CBC with Diff and Comp Metabolic. Also TSH and T4, lipid panel and A1C. Everything looks great overall with some elevated kidney function stuff and I was happy my lipids are now normal after fighting with them since chemo in 2005.

Some values I think are important to note here.
TT = 316
FT = 4.8
TSH = .862
T4 = 1.22
HbA1C = 5.2

So one question is what else should I be asking for in terms of lab values? I see things like
SBHG
E2
FSH
LH
Free t3
reverse t3

Specific questions I have and I realize I need to consult a doc as well and am doing so, but wisdom from the counsel of many is helpful:
Will the FT increase if the TT gets boosted?
Does the risk of hypertension increase with TRT? I am diagnosed but well-controlled.
Is there any increased risk of lymphoma with TRT? I wouldn’t think so but it’s always a concern for me given, well, you know the big “C” history.
Is gyno something that goes away or will I always have the increased breast tissue?

#2

I’ll answer what I think I can.

Yes free t will go up with increased total t.

I’m not sure about the risk of hypertension, I think it is more associated with a lowering of bp, but your mileage may vary. I had hypertension when I started trt and it hasnt affected mine appreciably.

I don’t know about the lymphoma, sounds unlikely, but I work with computers, so what do I know. If you still see your oncologist and want to know, shoot em a message or a quick call and ask.

You’ll want to keep an eye on the gyno. It may go away if you get your t levels up enough, it may not. You could try some Nolvadex and see if that reduces it, you probably don’t want to start an ai, estrogen is good. It might be the case that it won’t go down, and you’ll need to have surgery too remove the tissue if it bugs you. You can work out some options with your doc.

#3

Yes.

Maybe at high doses. Low e2 is terrible for heart health so there’s that side to consider too. I’m assuming yours may be low given T is pretty low. Wouldn’t hurt to get it checked.

That one I have no idea on and would not want to speculate. @highpull may know, he is a doctor

It can be reduce pretty significantly, if it truly is gyno. Is it fatty or like a hard lump?

#4

It looks like you need trt. But I would run the other labs you mention first.

Check igf 1 also before starting.

Trt may increase igf1 which can affect cancer growth. You may want to research that and speak to an oncologist. There may be other baselines oncologist wants to have to see if trt changes them.
TRt may also affect blood counts.

#5

That’s an oncology call. I’m not aware of any evidence in the literature that would contraindicate TRT, in fact, it should help with body composition, or maintaining it. This has been researched, though with younger subjects. I suppose they are not as concerned with low testosterone in older guys.