T Nation

Making Sense of Life, Labs, and TRT...


#1

I promise I'll try and be as brief as possible while giving as much background info as I can to help get some relevant answers.

-age : 33
-height : 5'11"
-waist : 34
-weight : 215
-describe body and facial hair : I can grow a mean red viking beard if work allowed it.
-describe where you carry fat and how changed : stomach, some chest, always been that way.
-health conditions, symptoms [history] : I honestly didn't know I had any until I had some wonky labs come back. Then some of the fatigue, tiredness, inadequate ratio of work going into the gym to aesthetics of physical appearance, decreased libido, etc.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever : Synthroid 50mg (part of the ongoing story) Multi, D3, ZMA, COQ10, Fish Oil, Bcomplex, Glucosomine/MSM/Condrointin
one brief exposure to adrosteintdione when it first came out, but it had saw palmetto and was guaranteed not to aromatize right? haha...
-lab results with ranges : Posted below in detail.
-describe diet [some create substantial damage with starvation diets] : Not the best, not the worst. I eat cleaner than the majority of the population, but am not afraid to eat.
-describe training [some ruin there hormones by over training] : I'm a firefighter so I train two days on 1 day off constantly. Presently doing 5/3/1 total body programming on second day off with a hybrid of dynamic effort lower and upper days with sprints and prowler on first day off.
-testes ache, ever, with a fever? : oddly enough, yes inexplicably and very few and far between.. no fever though
-how have morning wood and nocturnal erections changed : never a nocturnal emission guy.. morning wood really comes and goes. oddly enough this past week had it all the time, before that can't really remember it regularly...

With the introductions out of the way I'll get to the gist of the story. I'm a 33 y/o firefighter. Part of our department physical is a full body work over including ultrasound of organs and blood work. I went into this test for my second time expecting nothing out of the ordinary and was quite surprised to see the results of some of my labwork. The year prior yielded nothing out of the ordinary. Prior to this physical I had been feeling a bit more tired and run down with decreased libido (commented on extensively by my girlfriend), but I figured it was just part of a new assignment and par for the course for being up for 24 hours. The labwork showed as follows (parts of concern)

Quest Diagnostics 2/15/11
TSH 7.24 (0.4-4.5 MIU/L)
T4 free 1.5 (0.8-1.8 ng/dL)
Test Total 192 L (241-827 ng/mL)
PSA, Total 0.2 ( < or = 4.0 ng/mL)

Needless to say these came as quite a shock which lead to a follow up with my physciain whom which I had not visited in 5 years or so...

Physician of course wanted his own results before Tx and lead us to...

Unsure of Lab used 3/18/11
TSH 7.59 (0.34-5.6) uIu/mL)

Which lead to the following more complete panel

Unsure of Lab used 3/23/11
Ferritin 99.3 (23.9-336.2 ng/mL)
Free T4 0.8 (0.6-1.6 ng/dL)
T3 free 3.4 (2.5-3.9 pg/mL)
FSH 4.3 (1.3-19.3mIU/mL)
LH 2/8 (1.2-8.6 mIU/mL)
Prolactin 10.2 (2.6-13.1 ng/mL)
Test total 283 (249-836 ng/dL)
Test Free 9.54 (5.00-21.00 ng/dL)
% Free Test 3.37 (1.50-4.20)

At this point Dr. decided it would be best to focus on my thyroid first and see how that affected my other labs. He was very open with discussing TRT and mentioned having no problems starting me on it, but wanted to see how my thyroid responded first. 50mg of synthroid daily and fast forward to now...

Unsure of Lab used 9/20/11
TSH 4.2 (0.34-5.6) uIu/mL)
Test total 408 (249-836 ng/dL) as of Oct 17th per my lab sheet new ranges will be 348-1197
Test Free 12.44 (5.00-21.00 ng/dL)
% Free Test 3.05 (1.50-4.20)

So here's where we are and where my questions begin...

Thyroid therapy actually had a fairly profound initial effect on fatigue, mood, body comp etc. I do feel better most of the time than I do days prior, but this entire process has also made me more aware of when I feel bad, brain fog, unusal fatigue, slow recover from minor injury (wrist tweak, thumb sprain etc)... I know the new standard for TSH is 0.3-3.0 and will have my Dr. focus on adjusting my meds to reach that goal soon, but had questions regarding TRT first and wanted to get opinions on what is going on with me...

1) Did the synthroid have a positive effect on test? I.e. was I so out of whack hormonally this medication started this upward trend and will it continue without TRT or is that just a stretch.

2) At this point giving the way I feel and the fact that I am in the bottom basement of the new acceptable range I feel comfortable pushing for TRT. I plan on requesting the following protocol unless anyone has anything better to suggest..

  • 100mg test cypionate or ethanate injected per week with two or more injections per week.
  • 250iu hCG SC EOD [every other day]
  • 1.0mg Arimidex/anastrozole per week in divided doses.

Does this sound like the right move or do I need to give it more time and adjust TSH first?

3) I have yet to have my estradiol measured. I plan on doing this before starting TRT to get a baseline obviously, but meet with my Dr. in 2 days and wanted to somewhat hardball him into making a TRT decision... Is there any chance I could be having T suppressed do to excess E2 and is that something that management on it's own with an AI could take care of without TRT or does TRT look like it's the inevitable future

4) I work 1 day on 2 days off... Is there a huge issue with organizing injections around E3D which would be exponentially easier to program with my schedule for HCG/ Adex, and Test etc, or is the EOD method the best way to do things.

Thanks so much for any and all help coming my way. I do apologize for the last minute posting and requesting of help on short notice, but any advice and making sense of this mess would be greatly appreciated. I have decided that I have lived life in this fog for entirely too long and am willing to do what it takes to function happily and normally hormonally and hope I'm on the right path...


#2

Have you done an exam for testicular cancer? Google "testicular cancer self exam". This saved my life.

Any idea why your T4 may have fallen so considerably from the first test to this one?

Your Free T3 actually looks pretty good. T3 is the active form, and seems to be in abundance, so it does not make much sense that your TSH is so high.

Your high TSH combined with highish prolactin in the absence of anything else being noticeably screwed up would lead me to ask for an MRI of my pituitary to rule out an andenoma (non cancerous tumor secreting putitary hormones). Though this doesn't seem to be affecting your other pituitary hormones (LH/FSH). But good to rule out.

Did not test T3 or T4 after being on thyroid meds? Hrmmmm....

It would certainly appear so, and makes sense. Your body could not keep up with the High T metabolism demands due to your underactive thyroid (or possibly from the incorrect thyroid signals being sent by your pituitary, in the case of an andenoma).

There is a very good chance that if you get your thyroid issue lined out, you will see a dramatic increase in test.

Try to adjust TSH first before starting TRT. Rule out other causes (andenoma).

If you do start on TRT, I recommend starting at just 100 mg test/week (EOD or E3D injections).

I would not add in arimidex or hcg unless you determine later that they are needed (after 6 weeks or so on just test). Some people are able to do just fine on test only (at least initially).

Another option would be to try HCG monotherapy (without T cyp) to see how your balls react. I've read of some guys recently being able to achieve adequate test levels with hcg alone. Then they go about adding Test, if needed. Not sure which way I lean in this regard yet.

There are also some that seem to succeed on AI monotherapy, if there E2 was high enough. It's a complicated world we live in.

Let's cross this bridge when we come to it.

Get E2 checked ASAP! Definitely before starting TRT and track after 6 weeks on, but preferably now. You could be a candidate for AI monotherapy.

Its possible E2 is supressing your T, but your obviously screwed up thyroid/thyroid signaling is the most pressing issue currently.

Organize it however you can to get at least two doses/week. Your proposal sounds fine.


#3

Forgot to ask, did they do some sort of scan of your thyroid? MRI or ultrasound or something?

You also need to get your thyroid antibodies checked (can't remember the name off the top, but you can google them easily). This will rule out auto-immune disorders (Hashimotos, etc.).

Would also be beneficial to know your Reverse T3, though I can't think of good reasons right now.

www.stopthethyroidmadness.com has some good info, but take their conclusions with a grain of salt as it is run by a bunch of angry women who think everything is a thyroid disorder (not too dissimilar to our own forum with Test disorders :slightly_smiling:


#4

Yes I have and had it done at lifescan as well.. Definitel sound advice.

I honestly have no idea why any of it's going on, but it's definitely something I've been forced to deal with haha.

I think that's the approach I'm going to take now, try and get one thing ironed out before jumping on 3 more. Who knows...

That's definitely the plan. My dr. wants to see what happens with TSH before doing anything else so in the mean time I'll work on that E2 testing.

Thanks for all the help!


#5

I have had ultrasounds of my thyroid done yearly for the past two years and everything is good. I will look into those antibodies and see..

Went back to check with my Dr. and he had some different values for my test results that were somewhat perplexing to me.

Test total: 372 (249-846 ng/dL) new range oct 17th 348-1197
Free test: 16.11 (5.00-21.00 ng/dL)
% Free: 4.33 (1.50-4.20)

With these readings my Dr. is pulling the "Don't worry about your total test, your free test is great and you're out of range on your %, there's no way I can treat you for low test"

Not only that but when I mentioned an E2 test he somewhat blew it off saying i'm stretching at this point. He did offer to refer me to an Endo, but I'm not sure that's going to help much..

We agreed to work on my TSH after I brought in the research showing him the desired theraptuci values and he adjusted my synthroid. I go back in 10 weeks to get another TSH/Free T4 test. After that I need to make some decisions...

Is there any merit to what he's saying regarding the total T results? I've found mixed research honestly. While most point to Free T being what's truly important alot points out that loose bound T to albumin can be used and that Total T is needed for other functions so mine shoulnd't be so low.

Any advice again is greatly apprecaited.


#6

bump for some help/answers...


#7

I agree with your doc that your Free T is good. That means your SHBG is likely very low--I'm not sure if this can really affect you negatively as long as you have adequate T levels.

As I sai dbefore, you need to sort out your thyroid issues. Adjusting your meds is a good start. Did you ask him about the pituitary MRI? Definitely something a little screwey looking with your pituitary hormones.

How do you feel after adjusting?


#8

If the t-levels seem adequate then no need to persue any TRT correct even with absolute total being so low?

I am definitely working on the Thyroid issue first. I have a follow up 10 weeks after the change to 75 mcg to see if I am in the preferred 0.3-3.0 range.

Honestly I do find myself feeling better, having less fatigue, morning wood improved etc, but have no idea if any of it is related, psychosematic, or simply ups and downs...

My dr. has suggested he could refer me to an endo which might shed some more light on the subject, but in all honesty I haven't heard many things positive about that discipline as a hole. An MRI at this point seems a bit extreme and costly since I'd be paying out of pocket and things seem slightly isolated to my thyroid.

That being said I have another lifescan (full panel, ultrasound etc) coming up in March and will see if any trending is continuing before making that decision.

I really appreciate your help as well as anything else you might have to offer research wise or theory related. Thanks again...


#9

Right, Free T is what gets the job done. It could cause you some issues in the future if your SHBG elevates and corresponding Total T does not rise with it, but as long as your Free T is adequate you are good to go.

This is what you want to be cognizant of! It looks like you are getting to where you need to be. Getting your thyroid settled should get you on the right path.

Understand the cost issue and is probably overkill, especially if paying out of pocket. Keep it in your back pocket though in case things go south down the road. I see no need for you to go to an endo if your current doc works with you and fixes your thyroid.


#10

please read the stopthethyroidmadness.com site especially the information on T4 only medications. They might work for some, but they are definitely not for everyone.


#11

Still during the adjustment phase with the increased synthroid dose. Going back in Dec. to see where I'm at regarding that. So far so good on feeling a bit better, less fatigue etc. Not 100% sure what the labs will say or how long it will last but time will tell...

I definitely want to make sure it's in the right spot before working on any other hormonal fixes at the moment including TRT especially with my free test reading adequate.

As far as the thyroid medication and t4 only supplementation goes I will be doing some more research on it and requesting the corresponding labs as well and seeing what my Dr. says.. Good point on bringing that up and we'll see how that goes.

Thanks for all the help!