T Nation

Low T Since 19, Now 26. About to Start TRT?


#1

Hi all. I’ve checked in here before but thought it might be a good idea to finally post. I’ve been at a stably low TT since at least age 19, and my doc at that time had offered Androgel like nothing. I finally realized a few years later how badly it was affecting my life and decided to pursue it. My primary, who had been useful for his purpose up until then, was wanting to waste my time by sending me to an endo. FU, I thought, and I found a new doc. This new one was much more understanding of the issues low T has been causing me and was immediately open to starting TRT. He proposed biweekly then monthly injections, maintained by cream. This seems reasonable to me.

Vitals:
Age: 26
Height: 5’10.5"
Weight: ~350lbs
Waist: ~44-46" pants size; actual waist size may be much larger
Body and facial hair: Body hair light in color everywhere, average on legs and arms, light on chest/stomach and very little on back. Full beard and mustache (coarse and wiry but not thin).
Fat distribution: abdomen, waist, thighs. Largest around stomach to waist. This hasn’t changed except in amount since teens.
Rx drugs:

  • pantoprazole 40mg once/day
  • levothyroxine 75mcg once/day
  • bupropion XL 150mg once/day
  • modafinil 200mg once/day

Health conditions:

  • sleep apnea, high moderate, diagnosed by sleep study at 19. Untreated (I know I know) - CPAP was poorly tolerated at best when attempted. I do plan to seek alternate treatments. A deviated septum and misaligned jaw contribute to this and can potentially solve a great deal of it when surgically fixed. Modafinil was prescribed to counteract excessive daytime sleepiness (recommended by doc at 19, prescribed at 24 after rec from psychologist and Rx from MD)
  • somewhat mild hypothyroidism: have been taking levothyroxine since age 19, started at 50mcg, moved up to 75mcg about 4 years ago, have been stable at that dose since
  • generalized anxiety, largely treated via therapy and bupropion. Previously on low dose sertraline for ~6 mos, discontinued.
  • GERD since birth, 40mg pantoprazole has been treatment for well over a decade
  • low T since 19 - stable at 290s. Fluctuated higher at peak of health ~age 22-23; returned to 290s after

Diet: Kind of garbage. No sugary drinks, moderate sugar intake, but lots of fast food (more sandwiches than fries), pizza, etc. I’m aware this is suboptimal. I previously went keto, and over the course of a year and a couple months, dropped 110lbs (290 to 180) with training only started in the last few months. I maintained, staying strictly low carb, about a 190-200ish weight for a year or two after that. During that time I picked up a regular training regimen, settling on a three-day split (upper body/arms, lower body/legs, core/back) with sessions every other day. During this time my BP dropped to very healthy levels and my T elevated, but not super significantly and I don’t have the numbers any more.

Training: None currently. Energy and motivation is in the dumper. I am very aware that the sleep apnea, my sleep schedule, and way of eating all impact this.

A fair question would be “why the hell aren’t you doing more about your health” - the answer for better or worse is that a change in work in late 2015 first got me deep off the keto rocker, and as that’s continued, the low T and sleep apnea’s one-two punch have impacted me more. What really got me incredibly demotivated was attempting keto a second time, dropping 50lbs (280-230) and stalling for two months. Between this ridiculous stall (which in my mind really spoke to the ill effects low T was causing me) and a combination of work stress and relationship stress I was about done. Yeah, I gave up, real manly.

I have wanted for a while to tackle the low T, and it’s representing the first, and important, step in my plan to get back to the health, weight, and strength I previously had, but better (180 was a hard stall point for me; I’m fairly certain with my issues treated I could go lower, or at least easily maintain ~170-180 instead of 190-200). I have all the expected symptoms: weight issues, lack of motivation (this is a HUGE one for me, holding back my training and my work+income potential), anxiety, fickle sex drive, fatigue/lack of energy/big time brain fog… I know the apnea compounds this, but anything to start the process.

I had labs done a week ago. Not all the tests I might want to give you guys a full picture, but what I have is:

  • TT: 290 ng/dL
  • TSH: 2.50 mIU/mL
  • fT4: 1.08 ng/dL

and a complete blood count if any of those numbers help. About a year ago I had labs run (afternoon vs morning), and had:

  • fT4: 0.97 ng/dL
  • TSH: 3.29 mIU/mL
  • TT: 293 ng/dL
  • free T: 50.9 (missing unit, sorry - this struck me as high then)

Morning wood/nocturnal erections-wise… not great but no change. No aches generally, no fever since about a month ago when I caught a nasty infection that lasted about two weeks (unknown if viral or bacterial, since the idiots ran a WBC but not a differential… total was at 21k; has returned to 9.7k since), which is obviously unrelated.

The new doc’s office said the usual protocol with him is to get to 500+ and maintain, but he’s a reasonable guy and seemed to agree when I first said I should be at around 900 ng/dL TT. I do plan to remind him of this. Does this seem like a reasonable target (too high? too low?)?

As for my plan: once my T levels start to rise I’m going to feel more sure in that I won’t be completely wasting my time going back to what works for me. Low carb did wonders for my overall quality of life; it lifted some brain fog, virtually erased the GERD symptoms, helped me lose an incredible amount of weight and keep most of it off, and helped me strongly de-emphasize the importance of food in my life (making it much more utilitarian, as it should be - I was generally sticking to a one-meal-per-day, intermittent-fasting way of eating; this was easy on my wallet and I was never hungry during the day). I don’t want to hit that interminable stall again (which happened while both in caloric deficit overall, and actively training).

Thanks for reading.

EDIT: re: hCG, would it be worth trying simultaneously with the TRT?


#2

Partial response:

Find the ‘pencil’ edit icon below your post and edit to add lab ranges to lab results.

Thyroid: You appear to be under medicated.

fT3 is the active hormone and not tested.

TSH should be close to 1.0 with normal thyroid, often with thyroid meds, TSH needs to be pushed very low to get rid of hypo symptoms.

T3, T4, fT3, fT4 need to be near mid-range or a bit higher.

Thyroid normal ranges are stupid and misleading.

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#3

GERD since birth: But there are other factors that can make it worse…

GERD medications can lead to multiple mineral deficiencies and B-12 deficiencies.

If you get leg/foot cramps, that is a magnesium deficiency and may also show up as an ability to tighten up a muscle and make it lock up. Almost everyone has some degree of magnesium deficiency, you have a high risk factor for this. Low magnesium can affect sleep and increase BP.

GERD can be a hiatal hernia caused by abdominal fat lifting the stomach upward and fat lost is best outcome for that.

Starvation diets can be harmful, increasing SHBG, increasing rT3 that interferes with fT3 the active hormone.

Some FT rages go up to 25 and some with different methods product higher numbers about 5-6 times higher.

TRT makes snoring worse.

You have never tested LH/FSH to determine if pituitary or the testes are the problem? If LH/FSH are low, prolactin needs to be testes to see if a prolactin secreting pituitary adinoma is the cause. This is not rare!

You had a thyroid problem or thyroid hormone problems caused by not using iodized salt? I have never seen a doctor ask about iodine intake or iodized salt.

Can you provide more labs: CBC, hematocrit [HTC], hemoglobin, RBC, ferritin

Routine labs should be:
TT
FT
E2
CBC
hematocrit
ferritin
AST/ALT
TSH
fT3
fT4

Diagnostic labs:

  • above plus
    LH/FSH - both!
    prolactin - if high, lowers LH/FSH, T and dopamine with mood problems

Supplements:

  1. high potency B-complex multi-vit with trace elements including 150mcg iodine and 150-200mcg selenium
  2. magnesium, see this site’s biotest store for ‘ZMA’
  3. 5000iu Vit-D3

TRT suggested options after I see more lab data.
With thyroid issues, you may not be a transdermal T absorbed.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.