T Nation

My Health Case: Professional Firefighter, Low T/Adrenal Fatigue Symptoms

Age: 32
Height: 6’
Weight: 210lbs
Body fat: 16-20%
Describe body/facial hair: Eye brows seem full (possible thinning on edges, but subtle). Can grow a beard but have some patchy/bald/thin spots below chin and on neck. Thin, blonde hair on arms. Almost no upper body hair except around nipples, center of chest, and navel (sparse in those spots). Normal body hair below waist other than missing behind my knees and on the outsides of my shins and around ankles (very thin and missing).
Describe where you carry fat and how changed: 16-20% body fat that is carried in chest, lower abdomen, and in the form of “love handles.” I’ve carried fat in this way as long as I can remember. Very little body fat elsewhere.
Health Conditions/Supplements [history]: Born with jaundice and shoulder dysplasia. Allergies to pollen, mold/mildew, pet dander. Diagnosed with asthma at an early age, Rx albuterol for many years until 12-13yrs old. Sleep apnea/sleep disturbances for approximately 8yrs. Currently using CPAP. No Rx or OTC drugs currently. Current supplements: fish oil, zinc, magnesium, vitamin-d3, vitamin-c, b100 complex. Went through TRT clinic and followed TRT protocol 200mg Test-cyp E3D and 250u hCG EOD for 5 months before stopping cold-turkey with no PCT (see background below for further information).
Describe diet: Followed various diets over the years since 2009-2010 including zone diet, paleo diet, carb-backloading, ultimate diet 2.0, keto diet, intermittent fasting. Misapplied caloric restriction throughout the years with basically all of these diets, severely restricted the use of iodized salt. Demonized salt/carbs/fat. I did supplement with a multi-vitamin through this time. Currently following a balanced diet as described by Dr. Wilson in his book on adrenal fatigue. Salt liberally.
Describe training: Began very consistent training in 2008. First in the form of CrossFit/HIIT, then moved to a combination of HIIT and strength training, and now center around mainly strength training with some cardio. I’ve trained consistently 3-4 days per week 1-2hrs per day since 2012, with time off for some injuries. Currently following the “Daily Undulating Periodization” training protocol. I know for sure I have experienced over-training.
Testes ache ever, with fever?: Testes do ache from time to time, never noticed a fever. More prevelant since stopping TRT.
How have morning wood and nocturnal erections change?: I have both quite often, but morning wood isn’t every day.
Further, more complete background: I’ve been scouring the stickies and posts here for months. I’ve even read Dr. Wilson’s adrenal fatigue book. I’m coming here and posting now because I’m having a hard time piecing everything together for my particular situation. I’m trying to be as brief and concise as possible. I appreciate whoever takes the time to review this.

I am a 32 year old professional firefighter. I have been struggling with low T/adrenal fatigue symptoms for years (approximately 2010/2011, which was right before I started my career with the fire department). I’ve struggled with sleep disturbances (waking 3-4 times per night) and with sleep apnea (been using a CPAP for the past 2 years and noticed and improvement) since that time. My dieting hasn’t been the most healthy as I misapplied most principles of each diet and it resulted in caloric restriction and nutrient restriction. My approach to these aspects of my life have been to focus on sleeping more and follow a more balanced, complete diet. However, I always feel exhausted/fatigued, my libido fluctuates but is usually very low, my drive/motivation are low, my mood is almost always low, my performance in the gym is low compared to even 2 years ago. These symptoms led me to visit a TRT clinic in August of 2018. My total testosterone was approximately 292g/dL (bloodwork below) and I was then prescribed 100mg test-cup E3D and 250iu hCG EOD (both IM) and arimidex as needed. I followed this protocol for 5 months until I started having heart palpitations (approximately 8-10 per minute) an visited an ER. Testing and EKG’s with the ER, my GP, and a cardiologist all revealed benign PAC’s and nothing further. I stopped TRT cold-turkey the day I went to the ER and haven’t been back on any protocol since. The palpitations stopped approximately 30-45days after my last injection. I have bloodworm below for both before and after TRT.

I’m also concerned as a firefighter I have additional risks of extreme sleep deprivation (we work 24-48hr shifts with interrupted sleep and irregular sleeping patterns) and am exposed to fire retardants in my station clothes/gear on an almost daily basis.

So, I come here to ask if someone can help paint the picture of my current state of health and advise me in what steps to take and what direction(s) to head in for my situation. Some additional things to note about my bloodwork: the TRT clinic I used did not test LH/FSH levels prior to treatment. I’ve labeled where my testing was done and the date/time. Body temperatures are also listed after bloodwork.

TRT clinic (8/2018 - 11am) - Pre-TRT bloodwork
TT 292.10, 264-916
E2 17.0, no range given

TSH 2.18, 0.46-4.68

WBC 4.5, 3.8-10.7
RBC 4.33, 3.92-5.83
HGB 13.7, 12-17.5
HCT 41.6, 35.8-52.9
MCV 96.1, 81.2-99.8
MCH 31.7, 26.6-34.5
MCHC 33.0, 32.1-35.5
RDW 13.2, 12.6-15.7
PLT 199, 150-450
MPV 9.8, 6.8-10.7

IGF-1 216, 82-244

Cholesterol 152, <200
Triglyceride 41, <150
LDL 73, <110
HDL 71, >39

B12 815, 180-914
Vitamin-D 44.0, 30-100

ALT 36, 7-52
AST 31, 13-39

TRT clinic (10/2018 - 11am) - after 10wks TRT protocol
TT 850, 264-916
E2 44, no range given

TRT clinic (2/2019 - 12pm) - after stopping TRT for 2 months
TT 300.84, 264-916
E2 23.0, no range given
FSH 2.40, 1.27-19.26
LH 2.82, 1.24-8.62
SHBG 30.00, 13.3-89.5
Prolactin 5.62, 2.64-13.13

TSH 2.35, 0.46-4.68
TT4 8.78, 4.5-12.0
T3Uptake 40.6, 23.5-40.5
Free Thyroxine Index 3.6, no range given

PSA 0.47, 0-4

General Physician (2/2019 - 9am) - after stopping TRT for 2 months
TT 506, 250-1100
FT 73.4, 35-155
E2 31.0, no range given
FSH 1.7, no range given
LH 2.7, no range given

TSH 2.48, 0.35-4.94
FT3 2.76, 1.71-3.71
FT4 1.11, 0.7-1.48

Cholesterol 147, 0-200
HDL 59, 41-67
LDL 76, 0-129

HGBA1C% 4.9, 4.8-5.6

Ferritin 172.34, 22-275

AM CORTISOL (blood) 14.3, 3.7-19.4

Body Temperatures
Day 1
Wake 97.2
3hr later 97.7
3hr later 97.6
3hr later 98.1
Bedtime 97.8

Day 2
Wake 97.7
3hr later 96.8
3hr later 98.0
3hr later 98.1
Bedtime 97.5

Day 3
Wake 97.6
3hr later 97.2
3hr later 97.7
3hr later 98.7
Bedtime 97.3

Day 4
Wake 97.6
3hr later 97.3
3hr later 97.7
3hr later 98.1
Bedtime 97.2

Day 5
Wake 97.2
3hr later 97.7
3hr later 97.6
3hr later 98.1
Bedtime 97.8

Day 6
Wake 97.4
3hr later 96.8
3hr later 97.4
3hr later 98.5
Bedtime 97.8

Day 7
Wake 97.7
3hr later 97.8
3hr later 98.6
3hr later 98.1
Bedtime 97.7

You have got to start testing Free T, Total T is bound to SHBG and isn’t bioavailable. High estrogen can increase blood pressure, all you needed to do is lower your dosage to decrease estrogen.

Hey, thanks for replying. Yeah, the clinic I used didn’t test it when I clearly asked them to. My most recent bloodwork through my GP has that value. I’m not currently on any TRT protocol. Stopped 12/2018 cold turkey after my heart palpitations per the cardiologist.

I guess I’m wondering if I even need to truly take that route or if an HPTA restart is an option, my thyroid is causing problems, or adrenal fatigue. Feeling a bit overwhelmed.

HPTA restarts are fairy tales and I don’t think you realize your chances of going natural and having optimal levels when previously levels were under 300. If you’re hitting under 300 at age 32, something is broken and no amount of wishful thinking or magic pill will change your situation.

Low testosterone causes poor sleep, poor sleep causes low testosterone, you can’t pick yourself out of this hole, if your body was going to heal itself, it would have done so already and you wouldn’t need TRT.

These clinics tend to be behind in knowledge, having to inform them the importance of testing the free hormones circulating in the blood versus the hormone not available to the bodies tissues is telling me they must have gone through a short weekend crash course on TRT, dare I even call them doctors.

An E2 of 44 would give me palpitations, simply change your protocol to include more frequent injections to lower estrogen. You won’t find many men who can handle 200mg weekly without having problems.

Do you drink caffeine or any other stimulants?

Ok thanks again, @systemlord. There is a bit of wishful thinking in my thought process. But I’m also trying to get a better understanding of what exactly is going on with my body. My most recent labs showed a TT of 506 and FT of 73, obviously still on the low end. And I don’t feel good.

The only stimulant I use is caffeine. Drink coffee in the morning 10-16oz per day. Tobacco on occasion, but rarely.

I’d also love to hear anything @KSman has to say.

KSman isn’t here anymore he got beatup and chased away.
From the looks of your Feb 2019 bloods your HPTA restarted just fine and those blood numbers look pretty good. Having jacked up sleep really can reck all your hormones not just the ones for sex.
I would do waht you can to improve your sleep situation. Take a good look at your diet and don’t overdo the exersize but try to do something everyday. I think the supplements you are take are spot on.
Best of luck to you and thank you for choosing to be a fire fighter.

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If you even think you have adrenal fatigue, this has to stop.

TRT greatly increased what stimulants do to me. Could have been a combination of all the new dopamine causing some anxiety, on top of using the stimulant, that lead to your hear palps.

Hey bud, fellow ff here, 20 years. I also found Trt has given me some palpitations but am trying to grind through it.

Can anyone help me with the interpretation of my bloodwork results and body temps? Do I seem more primary/secondary? Need someone else’s eyes on the data. I’m actually kinda bummed ksman isn’t here anymore.

I’m not looking for a magic pill so much as just ways to improve my overall health and well-being. Sleep, diet, and exercise are always at the forefront of my mind. Should I attempt IR or an HPTA restart, or are those not going to improve anything at all?

Go to Pharma. There is a thread called “ask physiolojic anything” or something along those lines. His email is in his profile, he still might be taking people for free advice. Highly knowledgeable Endo Bodybuilder.

Restarts are a waste of time and only those who refuse to accept their diagnosis will attempt it, it will be in vain. You say you’re not looking for a magic pill, restarts are about as close you can get to a magic pill because restarts are fairy tales.

Once you stop clomid, your levels will fall right back down to baseline.

I’m just trying to discuss my situation here, that’s it. Feeling a little lost and overwhelmed as I’ve said.

You got dealt a bad hand. I got the diagnosis at 30. (TT of 71) probably 10 years into feeling like absolute shit. When i found out Trt was for life it didn’t make me hesitate at all, just basically told me that it’s proven to work long term and I could live out my days healthy. I’m low shbg (16)also and most likely going to end up going to every day injections. I guess for some it may be a hard pill to swallow but for me it was relief.

Yeah, if TRT is solely the route for me to go, I’ll gladly do it. I just don’t want to leave out steps before getting there. I jumped in last year without really educating myself about it. So I’m trying to go about this the healthiest, safest way.