T Nation

My Quest for Optimal Levels


#1

INTRODUCTION
Relatively healthy kid in my youth.
Never had issues with an erection.
I was highly sexually active until my late 30s.
I never had an issue with an erection.
Past 12-18 months none at all.
I got to a point recently where I could not get aroused at all.

I had a massive amount of stress in my 30s.
During this time my sex drive was still quite high, but I found it harder and harder to perform, I used herbs as a crutch, and they definitely helped a lot, but progressively over the past few years their effect has gone to zero.

It was practically impossible for me to maintain an erection, and when I could it was not very hard and I could not maintain it.
Every now and again I get a surprise visit from my libido, but its literally once in a blue moon.

age:
41

height:
5’8

weight:
173 Lbs

waist:
34 inches

describe body and facial hair:
medium density beard & thick hair.
medium to light density chest hair & medium thickness.
medium to light density leg hair * medium thickness

did to grow fast or slow and steady as a teen:
fast

testes ache or hurt? ever?:
not the testicles but once ever few months my lower abdomen aches intensely, but that could be from abdominal exercises too, which I do on and off.

mood:
feel like a grumpy old man a lot of the time.
OK sometimes, but never content

depression:
quite frequently

libido:
totally gone for the past 18 months

get cold easily?:
yes, frequently, often wear thermal leggings even when its warm. Feet & hands get cold easily too.
I have always become easily cold but it has become progressively worse over the years.

dry skin, brittle nails?:
dry skin

use iodized salt?:
no

eat much sea food?:
fish 2x /week

exposure to chemicals?:
use antibiotics on occasion when ill as a teenager

ever used hair loss drugs?:
no

Rx and OTC drugs:
no

additional recommended by PureChance

general energy levels:
quite poor, easily fatigued. Eg eating too much or doing anything physical or mental for more than a few hours

difficulty gaining muscle / recent muscle loss:
regular exercise regimen

weight gain (difficulty losing weight):
a little weight gain, but mainly because I’m trying to gain weight.

general diet:
healthy

concentration/focus/drive:
poor on all areas. It used to be very high, but has diminished progressively over the past 10 years.

confidence level/anxiety level:
fluctuating confidence and medium to very high anxiety.

general health + number of recent antibiotic treatments:
overall good

chest size/gyno?/chest sensitivity:
39 inch chest,

trouble urinating or awareness of prostate:
no trouble urinating, but I’m aware of my prostate sometimes.

morning erections/ability to maintain erections:
used to have daily until the last 18 months
morning erections for the past year have been practically nonexistent, unless I take zma (which I have currently stopped as I want to get my blood work done soon)

current supplement/vitamin regimen
creatine & zma

past medication/supplement history:
Regularly used (on & off) creatine & zma for most of my 20s & 30s.

normal sleep patterns:
sleep 8 hours per day, normally get up 1-2 times to go to the toilet, but I drink a lot of water in the evening.


#2

Do you have labs? We need labs with ranges.


#3

Hi,
Im waiting for my doc to contact me when my labs are ready.
As soon as I have them I will post them here.

Thanks for checking :slight_smile:


#4

Oh let me agree, you need a full set of labs. And it never hurt to hit our stickies. There a section on thyroid issues you need to read as well. And no it is really is not normal to get up to go pee at your age. Let alone twice. That plus low ejaculate in your prime. I think you will need a prostate exam, just to rule that out. But I am not a doctor. You will get right, you have come to a good place for info


#5

You have probably seen these before:
Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

You are describing hypothyroidism.
Are your outer eyebrows sparse?

To get better, you must get all of these right:
sex hormone levels and balance
thyroid function
adrenal function

Labs:
TT
FT
E2
LH/FSH
prolactin
CBC
hematocrit
TSH
fT3
fT4 [please not T3, T4]
PSA - baseline
fasting glucose
fasting cholesterol

Drinking water: Is this a habit or thirst driven? Are you drinking tap water, filtered or RO water. RO water can make you mineral deficient. If you get leg cramps, you are magnesium deficient. Drinking a lot of water can flush out water soluble minerals and vitamins.

When you introduce iodine supplements, you must have an identifiable source of selenium.

You need a good mix of healthy fats. Extreme low fat diets can wreck your hormones. Total cholesterol ~180 is ideal, <160 is health risk.


#6

Sorry for the delay.
My doctor refused to do several of the blood tests so I had to work around her.
I went to another doctor and she was even less helpful.
In the end I found a private option who did what I asked for.

I went for my bloodwork 2 hours after waking up, I did not eat anything that morning, I only drank some water.
Prior to getting my blood sample:
I stopped taking all supplements for approx 3 weeks, apart from creatine.
I did not ejaculate for at least 2 weeks.
I did not do an heavy exercise for a couple of days.

These are the results:

LAB 1 RESULTS
HAEMATOCRIT 0.459 L/L 0.40 - 050
SERUM Vitamin B12 397 ng/L 180.00 - 900.00
SERUM vitamin D 76 nmol/L >50 = vitD sufficiency. 30-50 = deficiency.
PLASMA MAGNESIUM 0.86 mmol/L 0.70 - 1.00

LAB 2 RESULTS
Red Blood Cells
HAEMOGLOBIN (G/L) 162 g/L 130.000 - 170.000
HCT 0.476 0.370 - 0.500
RED CELL COUNT 5.37 x10^12/L 4.400 - 5.800
MCV 89 fl 80.000 - 99.000
MCH 30.3 pg 26.000 - 33.500
MCHC (G/L) 341 g/L 300.000 - 350.000
RDW 13.0 11.500 - 15.000

White Blood Cells
WHITE CELL COUNT 4.9 x10^9/L 3.000 - 10.000
NEUTROPHILS 2.38 x10^9/L 2.000 - 7.500
LYMPHOCYTES 1.80 x10^9/L 1.200 - 3.650
MONOCYTES 0.60 x10^9/L 0.200 - 1.000
EOSINOPHILS 0.10 x10^9/L 0.000 - 0.400
BASOPHILS 0.03 x10^9/L 0.000 - 0.100

Clotting Cells
PLATELET COUNT 229 x10^9/L 150.000 - 400.000
MPV 9.6 fl 7.000 - 13.000

BIOCHEMISTRY
Kidney Function
CREATININE 103 umol/L 66.000 - 112.000

Liver Function
ALKALINE PHOSPHATASE 81 IU/L 40.000 - 129.000
ALANINE TRANSFERASE 18 IU/L 10.000 - 50.000
CK 211 IU/L 38.000 - 204.000
GAMMA GT 14 IU/L 10.000 - 71.000

Proteins
TOTAL PROTEIN 78.8 g/L 63.000 - 83.000
ALBUMIN 41.5 g/L 34.000 - 50.000
GLOBULIN 37.3 g/L 19.000 - 35.000

Iron Status
FERRITIN 56.71 ug/L 30.000 - 400.000

Lipid Profile
TRIGLYCERIDES 0.82 mmol/L 0.000 - 2.299
CHOLESTEROL 4.34 mmol/L 0.000 - 4.990
HDL CHOLESTEROL 1.45 mmol/L 0.900 - 1.500
LDL CHOLESTEROL 2.52 mmol/L 0.000 - 3.000

Heart Disease Risk
HDL % OF TOTAL 33.41 % 20.000 - 100.000

ENDOCRINOLOGY
Thyroid Function
TSH 1.59 mIU/L 0.270 - 4.200
FREE THYROXINE [T4] 16.82 pmol/L 12.000 - 22.000
FREE T3 5.19 pmol/L 3.100 - 6.800

Hormones
TESTOSTERONE 22.87 nmol/L 7.600 - 31.400
FREE-TESTOSTERONE 0.364 nmol/L 0.300 - 1.000 (CALCULATED)
17-BETA OESTRADIOL 207.2 pmol/L 44.000 - 156.000
SHBG 55.35 nmol/L 16.000 - 55.000
PROLACTIN 243.9 mIU/L 86.000 - 324.000

Prostate
PSA (TOTAL) 1.52 ug/L 0.000 - 2.000

I drink late at night normally because I eat late, and I like to have some tea after my meal.
I only drink distilled water and have been doing so for approx 6 years.


#7

That was a lot of work!

TESTOSTERONE 22.87 nmol/L 7.600 - 31.400
FREE-TESTOSTERONE 0.364 nmol/L 0.300 - 1.000 (CALCULATED)
17-BETA OESTRADIOL 207.2 pmol/L 44.000 - 156.000
SHBG 55.35 nmol/L 16.000 - 55.000

E2 is high!
That has elevated SHBG
Then lots of T+SHBG inflates TT, so your status is a lot worse than TT implies.
You are estrogen dominant, spoiling what T you have.
So why is E2 high?
With low FT, FT–>E2 is reduces, so we suspect impair E2 clearance in the liver.
AST/ALT are not indicating a liver prolbem.
But something, meds, herbs, that you take or eat could have that effect.

CBC and lipids look great.
But ferritin could be better? More red meat?
Ferritin ~80 would be better for some thyroid processes.

Thyroid numbers look quite good.
TSH indicates that your system is struggling a bit to get good body temps.
This can be from lack of iodine and/or elevated rT3.
As fT3 is a good mid-range number, low body temps point to elevated rT3.

Thinking that your body temperatures, never posted, may be low from higher rT3 induced by stress history.

I put a lot into this thread, please what points you have missed.

What have you done re iodine and selenium intake?

TESTOSTERONE 22.87 nmol/L 7.600 - 31.400
FREE-TESTOSTERONE 0.364 nmol/L 0.300 - 1.000 (CALCULATED)

With distilled water, minerals can be a problem as I pointed out earlier.
Blood tests for calcium will always be good, as calcium is taken from your bones as needed and that is also a problem for guys with low T. Serum magnesium also looks good, but blood may rob magnesium from elsewhere. Again, leg or foot cramps strongly suggests magnesium deficiency.

Blood proteins were high.

PSA could be lower if you were not estrogen dominant.

You need to be on TRT.
Suggest self injections for least E2 potential.
As E2 is a mess, you will need anastrozole from the get go and could benefit from anastrozole before TRT, if you wanted to try that route. You may be causing this high E2.
See the stickies I suggested re injections.


#8

This is great::smiley:
I’m so excited to think there is a possibility to resolve this!!
(I think I sound a bit girlie…. must be all the E2 in my system XD )
Thank you so much for your support.

HIGH E2
I have been eating super clean for the past 15 years…
So I’m not sure what food / herbs / supplements could have caused the high E2…
All I can think is that, it has to be the extreme stress I went through for several years, causing adrenal fatigue, which in turn caused the high E2.

FERRETIN
You are right; I have cut down on the red meat for the past few weeks, replaced with more fish and eggs. I was thinking about supplementing with dessicated liver tablets, what do you think?

THYROID [bare with me on this one please… I’m having paralysis by over analysis D:
Once again you are correct; I have not added the thyroid supplements.
I’m stuck and I need your help please.

1. Thermometer type
I wanted to figure out my base temperature before adding the iodine.
Unfortunately I was confused about what oral fever thermometer to get.
Reading around some people say I need a mercury thermometer, however I checked on Amazon and they all have bad reviews regarding unreliable readings.
So I checked out digital thermometers on Amazon…
same again, they all have mixed reviews about accuracy…
So now I’m stuck…
I don’t know what type to buy as I’m paranoid I’m not going to get an accurate reading.
What do you suggest? Digital or mercury?
I’m thinking I might just get this one and see how it goes…

2. Taking readings
I was confused about taking readings too.
From what I understand, I should be taking the readings 3 times per day:
Immediately when I wake, in the afternoon and in the evening.

My confusion here is as follows:
-I sleep under a duvet, so in the morning I’m normally quite hot as the heat builds up,
Do you consider this an artificial environment and hence I would get a false temperature reading?
Should I sleep under a thin blanket instead?
My only concern is that I will be very cold like this.
-Also I have started wearing thermal underwear on certain days, should I not do that, as my temperature is artificial when I wear them?

3. Iodine
Regarding iodine supplementation is this correct?
Optimox Iodoral 50mg + 200mcg Selenium per day for 2 weeks.
Then after 2 weeks get labs again to determine maintenance protocol?

I was considering using SSKi Super Saturated Potassium Iodide Solution 50mg drops + selenium instead
of Optimox; putting into 1-2L of water and drinking it over the course of the day.
What do you prefer, Optimox or SSKi?

ADDITIONAL SUPPLEMENTS
I will add
Magnesium chloride & msm (to get around drinking distilled water)
Vitamin D
Fish oil
liv52 (liver support)
Is that OK?

TRT & AI
I’m thinking to just focus on fixing the E2 level first.
Then look into TRT after a few weeks of normal E2 levels.
How much anaztrozole should I be taking?
What do you think about taking aromasin instead?
And then get my labs done again after 6 weeks?
Do you think in time I can taper off this, or will I have to take indefinitely?
(I suppose it depends on the labs, and we have to take it one step at a time :confused:)


#9

This is a better choice, we need more accuracy than simply detecting a fever. 0.1C resolution is poor.

https://www.amazon.co.uk/Basal-Body-Thermometer-BBT-113-iProvèn/dp/B0148L84TK/ref=sr_1_6_s_it?s=drugstore&ie=UTF8&qid=1479061153&sr=1-6

I cannot sleep under a duvet, I would fry. Try a sheet and a light cotton blanket.

Thermal underwear? Are you spending a lot of time outside in the cold. Dressing warmly is a symptom!

Iodine: Your plan is good. But use a daily multi-vit that has 150-180mcg iodine and selenium to keep selenium intake.

After two weeks, iodine will inflate and negate value of TSH lab. Your body temperature response is more interesting than labs and not changes to energy, mood and clarity of thought.

Source of iodine not important. But I do not like the taste of iodine and having to drink 1-2L of that sounds nasty - to me.

Magnesium: Consider ZMA sold here.

Vit-D25 status did appear good at Lab 1.
You did not appear to need more. Levels change with seasons and sun exposure.

A little Iron supplement might be helpful, but you need very little I would expect and males need to typically avoid iron as the body hordes iron, different for cycling females. Watch RBC.

Anastrozole: Try 0.5mg/week in divided doses then see how E2 responds. Hesitate to start with higher dose than that in case you are an over-responder.


#10

Thermometer
Ordered

Iodine:
Good point about the taste.
I will stick with one 50mg Iodoral tablet per day then.