T Nation

My TRT Journey

I’m 50 years old, 6’ 1" and weigh 280 lbs at 18% body fat. I am low on thyroid, DHEA and VitD so I’m supplementing those and taking Armour Thyroid 90mg daily. My doc put me on T-cream for the last 3 months, but it made no difference in my labs and energy levels. Doc now recommends T-cyp injections 1 x weekly with no AI.

Here’s my labwork from Sep 2012 and Jan 2013 from two different labs:

[Test: Sep 2012 Lab Corp Result (ref range); Jan 2013 Intermountain Labs Result (ref range)]

Testosterone, Serum: 493 (348-1197); 302 (212-742)
Free Testosterone (Direct): 11.5 (6.8-21.5); 53.1 (47-244)
Estradiol: 36.7 (7.6-42.6); NA
SHBG: NA; 35 (13-71)
Testosterone, % Free: NA; 1.8 (1.6-2.9)
Testosterone, Bioavailable: NA; 144.9 (131-682)
Albumin: NA; 4.4 (3.3-4.8)
TSH: .987 (.450-4.50); .43 (.45-4.67)
T3: 2.8 (2.0-4.4); 3.5 (2.4-4.2)
T4: 1.29 (.82-1.77); .96 (.71-1.85)

I want to talk with my Doc about the initial recommendation on the TRT: Protocol for Injections stickie. Is that still recommended? What other recommendations do you have? What tests should I focus on?

LH and FSH?

Yes, LH/FSH is needed to determine where the problem is.

E2 is way too high. You need liver data, AST, ALT. Problem could be there.

  • how much DHEA are you taking?
  • did DHEA increase E2?

Read the advice for new guys sticky and be open minded about other pathologies.

  • age=50
  • height 6’1"
  • weight 280
  • waist size ???
  • need more info as per sticky
    – OTC and Rx meds

Please see the ‘thyroid basics’ sticky and come back with history of iodine intake from iodized salt and vitamins. Check waking and mid afternoon oral body temperatures. Did you review iodine intake as part of your thyroid diagnosis? The concern is treating iodine deficiency with thyroid drugs.

Inability to absorb T transdermals is very common with thyroid problems?

Thanks for the feedback, KSman and others. Here are my answers and follow-up questions:

---- LH/FSH is needed to determine where the problem is.

  • I have a blood draw scheduled for 3/13 with results back on 3/27.
  • I’ll ask for LH/FSH, DHEA-S, Estradiol, TT, FT, Free T3, and Free T4
  • I had PSA test in Jun 2012: .6 (0-4)
    Q: Any other tests that are a MUST HAVE this time?

---- E2 is way too high. You need liver data, AST, ALT. Problem could be there.

  • AST-SGOT Jun 2012: 28 (0-40)
  • ALT-SGPT Jun 2012: 32 (0-55)
    Q: Is there a problem here? Should I get these re-tested?

---- How much DHEA are you taking?

  • 50mg. Test results were Jun 2012: 117.2 (44-331) before supplementing, Sep 2012: 240 (44-331), Jan 2013: 480 (136-448). Dr wants me at 500-600.

---- Did DHEA increase E2?

  • I did not get a baseline. Only had one test for Estradiol in Sep 2012 (3 months after starting DHEA sups).
  • Will test on 3/13 and get report back on 3/27.

---- Read the advice for new guys sticky and be open minded about other pathologies.

  • age: 50
  • height: 73 inches
  • weight: 280
  • waist size: 42 inches
  • more info as per sticky: I will provide in my next post

---- OTC and Rx Medications:

  • DHEA 50mg daily
  • Armour Thyroid 90mg daily
  • Vitamin D3 10,000IU daily - Tests for Vitamin D, 25-Hydroxy on Jun 2012 before sup: 22 (30-100), Sep 2012: 36 (30-100), Jan 2013: 51 (30-80)

---- Please see the ‘thyroid basics’ sticky and come back with history of iodine intake from iodized salt and vitamins. Check waking and mid afternoon oral body temperatures.

  • Will buy thermometer tomorrow and report back. (See history of iodine intake below.)

---- Did you review iodine intake as part of your thyroid diagnosis? The concern is treating iodine deficiency with thyroid drugs.

  • My doc did not discuss iodine before prescribing Armour Thyroid. I add salt to nothing. I have no salt in the house. The only salt I get is in the processed food I eat or what is added by restaurants.
    Q: Should I stop taking Armour Thyroid while I figure out iodine issues?

  • I have not been taking a multivitamin. A couple days ago I bought kelp tablets (225 mcg). I planned to start taking them after blood draw and talking with Doc next week about iodine dosage.
    Q: Should I start taking a multi-vitamin? How can I determine kelp/iodine dosage requirements?

---- Inability to absorb T transdermals is very common with thyroid problems?

  • The first stick/batch of T-cream applied to thigh each night (and sometimes mornings after showering) seemed to work (morning wood and increased drive) but the next stick (a different batch) of T-cream seemed completely ineffective. No physical indication and labs showed a decrease in T. Doc was perplexed. Stopped cream Jan 22 2013.

  • I will hold off on T injections until I learn more about TRT and thyroid. But it definitely seems like I would need an AI.
    Q: What else should I be considering?

Some guys freely convert DHEA–>E2 in there adrenals. Doc’s target is has speculative benefits and doc does not know about the DHEA–>E2 issue. Stop DHEA for two weeks and not any changes. You may need an AI.

Go with the injections. Suggest 150 mg, based on your weight, inject 75mg twice a week.

You will need to use an AI to get E2 in the lower 20’s to facilitate fat loss. This will also have good mental effects.

Read the protocol for injections sticky.

There is some iodine in Armour.

Supplements:

  • fish oil
  • high potency B-complex multi-vit with trace minerals and iodine
  • vit-C, natural source vit-E
  • CoQ10 ubiquinol type if using a statin drug or blood pressure becoming an issue

Why no salt? Doctor directed that?
There is no iodized salt in processed foods and most often not in restaurant meals.