T Nation

My Journey with Hypogonadism and TRT


#1

I am in Canada and it is difficult to find appropriate treatment at times for a number of health problems. We don’t pay for many things health related, but the flip side is that we don’t always get what we want. For example, I can’t just walk into a doctors office and ask for a bunch of blood work that i want. If they don’t want to give me a requisition that is up to them, I am not a paying customer so I don’t have the power to make them. I think there might be a TRT clinic in my city but it is my understanding that the costs are very significant, I am a student and I can’t afford it. Where this leaves me is to seek out doctors who want to and are capable of helping, this can be very tedious and time consuming.

STATS:
-33 y/o at start of story * 34 y/o now
-5’6
-body fat about 28% at start / about 14% now
-210 lbs April 2017 / 170 lbs as of Sept 2017
-I have more than average body and facial hair
-I carry fat around the gut
-greater than average muscularity

Health issues:
-Diagnosed with moderate to severe IBD September 2016
-Severe obstructive sleep apnea diagnosed in 2010
-Adult ADHD diagnosed in 2015
-Cervical spine degeneration the last three to four years, chronic pain and limitations with upper extremities and prolonged positions
-Chronic osteitis pubis the last few years, getting better now and able to do light to moderate controlled exercises.
-Primary Hypogonadism diagnosed November 2017

Medications:
-methylphenidate 54 mg per day
-Naproxen 1000 mg per day
-Omeprazole 20 mg per day
-Azathioprine 150 mg per day
-Adalimumab 40 mg bi weekly

lab results:
(only lab results I have at this time are total testosterone. It’s very difficult in Canada to get blood work for everything that we talk about here. I’ve just found a urologist whom seems receptive.)
October 2014 :
total test
1.0 nmol/l (7.6 nmol/l to 38 nmol/l)
29 ng/dl (219 ng/dl to 1096 ng/dl)

January 2015:
Total test
3 nmol/l (7.6 nmol/l to 38 nmol/l)
87 ng/dl (219 ng/dl to 1096 ng/dl)

March 2015:
Total test
7 nmol/l (7.6 nmol/l to 38 nmol/l)
202 ng/dl (219 ng/dl to 1096 ng/dl)

June 2015: (symptom free)
Total test
12 nmol/l (7.6 nmol/l to 38 nmol/l)
346 ng/dl (219 ng/dl to 1096 ng/dl)

December 2016:
Total test
4.5 nmol/l (7.6 nmol/l to 38 nmol/l)
130 ng/dl (219 ng/dl to 1096 ng/dl)

May 2017:
Total test
6.6 nmol/l (7.6 nmol/l to 38 nmol/l)
190 ng/dl (219 ng/dl to 1096 ng/dl)

September 2017:
Total test
9 nmol/l (7.6 nmol/l to 38 nmol/l)
260 ng/dl (219 ng/dl to 1096 ng/dl)

Last week I was given a requisition for blood work including:
red cell count
hemoglobin
hematocrit
RBC indices
HbA 1C
TSH
FSH
LH
Prolactin
SHBG
Testosterone
Free androgen index
Albumin

diet:
Diet consists of brown rice, chicken breast, green veggies, spinach, almond milk, banana, mixed berries, egg whites, whole eggs, oatmeal, mixed unsalted nuts.
Calories : 2000 during fat loss
Protein : 100 grams
Fat : 70 grams
Carbs : 250 grams

Exercise:
-Exercise was almost nonexistent between August 2014 and early 2016 due to chronic injuries.
-Since April 2016 I have been active almost daily with 30 to 90 minutes of body weight exercises (lower body only) and cardio (spin bike, jogging)

  • definitely have not been over training
    -weight training is not possible for me in the foreseeable future for anything involving my upper body, I’m at a point now where I can begin to reintroduce lower body resistance training but due to my chronic osteitis pubis it will be 6 months to a year before I can do anything remotely significant.

Testicle aches:
none

morning woods:
nonexistent for as long as I can remember, at least all of 2016 (until I started TRT in October 2017)

Hey guys

I have been having a journey with low T and in Canada our medical system can be quite difficult in terms of finding professional help. I now have found a urologist who agrees I suffer from primary hypogonadism and wrote me script for testosterone. I’m happy to find a doc who will acknowledge by situation, but I don’t think he is an expert in TRT and so I fear I will still need to continue quarterbacking my healthcare. Perhaps I still need to keep looking for another urologist or endocrinologist whom has more experience.
Okay, here’s my story. If I don’t specify lab values at times it’s because at the time I didn’t know I needed them, or the doctor would not give me a requisition for it. Most of my story will be subjective but I will share the objective when I can. I’ve done a lot of research the last few years and I’m also studying in the health care field.
I competed in bodybuilding between 2007 and 2014. I started using anabolics in 2009, and used progressively more and more along the way. Between 2012 and 2014 my steroid use was extreme including testosterone doses of 750 mg per week to 1000 mg per week, paired with GH, orals, tren, eq, deca yada yada. Due to chronic injuries I had to completely stop exercising in July 2014 and focus only on addressing the injuries because they were so bad I couldn’t continue. It was at that time I stopped steroids for the first time in a couple of years. I had severe low T symptoms within the same month and consulted my GP. My total testosterone came back in October 2014 as less than 1. I felt terrible as you guys know. We kept doing blood work every three months and each time it would double, by about 9 months I was feeling symptom free and my total test was in the normal range, albeit low normal. All was good.

Flash forward to 2016. I still can’t exercise due to my chronic osteitis pubis and a bad disc in my neck, I literally cannot do any exercise at all. I can barely put my socks on in the morning without throwing out my back, and use of my arms is extremely limited because I need cervical spine operation. I know that this lack of activity is not helping my cause. My diet is still quite good, although I was slowly putting on weight over the last couple of years since ceasing exercise. Summer of 2016 I was diagnosed with IBD and was very sick, that’s a whole different story I could write for hours about but I’m just sharing it to give an overall picture of my general health. It’s hard to say if I was having low T symptoms in 2016 because the IBD started to make me sick around March 2016 and by August 2016 I was in the emergency. I was diagnosed and started treatment with the most basic medications which settled things down to the point where I was okay to go to school and keep going about my business, although I was not in remission yet. In November 2016 I had my first very serious IBD flare up and ended up in the hospital and was very sick for a good month. That’s when they started me on prednisone at 40 mg per day. The prednisone worked and stopped the severe gastro bleeding within a week but the high dose of prednisone I was on caused me to gain another 25 pounds or so over the next few months. So, in November 2016 I was probably 20 pounds overweight and by March 2017 I was 40 or 50 pounds overweight. In March 2017 I started on one of the more expensive and serious last resort IBD drugs, Humira. If that didn’t work, we were going to have to consider surgery to remove my colon and rectum. Luckily it worked like magic and by May 2017 I was declared in remission.

Okay so now on to the real “low T” stuff. So, summer 0f 2017, I guess maybe because now my health was under control and that afforded me the opportunity to assess how I was really feeling, I noticed I wasn’t quite right. I couldn’t remember the last time I woke up with an erection, my libido was low, my erections were weak, and now that I’m over these symptoms I realize I was also irritable.

Oh, tangent. My osteitis pubis is much better now although not “normal”, my neck is still fucked and I’m waiting to meet a surgeon in March next year. Because my pelvis is much better I was able to start walking and low impact exercises (not resistance training) during the summer. I started with power walking, then moved to the spin bike coupled with my progressively challenging physio exercises such as one-legged quarter squats, bridging, etc. I dieted hard and was losing two to three pounds per week and increasing my fitness level fast. After I lost about 15 or 20 pounds I was able to start jogging. Between May 2017 and September 2017, I lost around 30 pounds and felt much better. I started at roughly 28% body fat and now I guess I’ve been around 15% or so the last couple of months, much healthier weight.

Back to the low T. I went to my GP in the summer and mentioned my symptoms and that I suspected low T. She looked up some of my past blood works from when I was extremely ill in 2016, we saw that my total test in December 2016 was a 4.5, we hadn’t noticed at the time. So we did another bloodwork in May 2017 and my total test was 6.5, still low. So, she referred me to a Urologist. I really wanted to just start myself on TRT but I restrained myself to see a specialist first. In September I met with the urologist whom said all my past blood work was invalid because he only cares about morning fasted total testosterone, and that I would require two low readings to be diagnosed as low T. So we did blood work and a month later I saw him again in October, my total test was a 9. He said you are normal and there is nothing to do, you are good. I said, “what about my symptoms?” to which he replied there could be many reasons. I agreed that my symptoms could be stress or psychological but that I did not think so in this case. He said if Cialis helps with the erections just keep using it. I told him I’m only 34 years old and shouldn’t need Cialis. He did not want to see me again.

I went back to my GP and explained that I was not happy with what happened, and could she please refer me elsewhere. She agreed with me that my libido problems were not likely psychological since I was not waking up with erections and simply having an issue with performance. She said she will refer me to another urologist but did not feel comfortable prescribing me TRT since she is not so experienced with it, my other health problems (IBD), and since a specialist already said I didn’t need it. I accepted her view but told her I was tired of waiting and I felt a trial of TRT would either prove or disprove my problem. So I told her I was going to start myself on TRT and would she please monitor me, she agreed. I started that same week on 125 mg every four days of Test E. After a week I was waking up with erections every day, strong erections. Within a couple of weeks my libido was WAY up and I felt less irritable.

Last week I met with the second urologist and explained everything as above. He agreed that it’s not unreasonable for a person to have low normal testosterone, be symptomatic, and benefit from TRT. He said my testicles were slightly atrophied and that I have primary hypogonadism, likely my steroid use contributed, and my testicles did not fully recover. He agreed to write me a prescription for test and filled out a requisition for:

red cell count
hemoglobin
hematocrit
RBC indices
HbA 1C
TSH
FSH
LH
Prolactin
SHBG
Testosterone
Free androgen index
Albumin

Finally!

We also talked about my concerns with fertility because I’m 34 and my wife is 33, we’d like to have a child in the next three or four years. He said TRT could cause problems with fertility but there are expensive ways around that. He also gave me two requisitions for semen analysis.

He told me to come back in six months and to have the blood work done before then. He wanted to put me on 100 mg test E per week, but I got him to write the script for 200 mg per week. I’m currently at 218 mg per week and I know that is a little high, so I’m going to do blood work now and see what that puts me at and then drop down to 175 mg per week.

I’ve been having a little bit of sensitive right nipple and the I already had a small nodule there from my bodybuilding days. It’s a little sensitive and swollen so I grabbed some anastrozole yesterday and took 1 mg tablet. I’m going to continue with the 0.5 mg of anastrozole per day for the next few days until it settles down, before reducing it to 0.25 mg EOD.

I’ve read that I should be using anastrozole while on my TRT and that possibly HCG as well to avoid shrinkage and maintain fertility. I need to go back to my urologist and discuss this because firstly I want to do everything in partnership with him, as well I don’t want to pay out of pocket for any of these drugs.


#2

any thoughts or feedback?


#3

If you want to maintain fertility you should add hcg. No guarantees you’ll be able to restart production at a later date.

Also you’re better off starting low and working up to ensure you don’t induce a bunch of unwanted side effects.

I jus started at 100mg a week and go for blood work in a month.

6 months is way too long to wait on bloodwork.

Go to a walkin and ask to get some blood work done in the interim or pay yourself. You can even go to the States if you’re close to a border and do it there cheaply to monitor yourself.

You should ask for free t to be tested too And E2

I’m in BC so I understand getting all the tests we require can be tough.

Especially with old school urologists.

You could ask to see an Endo too.

Or just look into paying for some tests yourself if needed.