T Nation

Need Advice on Treatment Routes

Hi everyone, this is my first post and I was hoping someone could point me in the right direction with TRT.

Background: I’m a 27 year old male. I’ve done oral on PH/DS/dbol cycles in the past. I probably did 3 or 4 cycles from the time I was 22 to 25. Most of these were just 4-6 weeks. I did not however, use proper pct. I only used OTC aromatase inhibitors and OTC ptc crap. I did have clomid and nolvadex somewhere but I can’t find them. I’ve had symptoms that may have been low testosterone from about the time I was 16or17.

I was always extremely tired even in my teen years. I feel like my nuts have always been small and my sack tight (which is another sign). I’ve also been dealing with depression and anxiety from around the same time. There was definitely a noticeable change in my high school years. I never had the proper blood work before taking orals, but I felt freaking great while on them.

I’ve been dealing with different types of doctors on this fatigue issue. I’ve done tons of tests for asthma, sleep apnea, etc. My doctor just wasn’t cutting it so I switch. My new doc ran the blood work and told my test levels were extremely low. He put me on androgel and set me up with an endo. The gel worked at first but it doesn’t do anything now. I have recent blood work from when I was taking adrogel. My insurance quit paying for it, so it gave me the chance to switch.

I have blood work form a few weeks ago when I was on androgel.
Total Test: 148ng/dl (lab range 300-1080)
Free Test: 38 pg/ml (lab range 47-244)

It was over a year, almost 2 years, since I took dbol and finally went to this new doc and was put on gel. The numbers weren’t that much lower before the gel. So even with the gel it’s extremely low in my opinion. I finally convinced the doc to let me self inject cypionate, and I’m taking 200mg bi-weekly right now.

I feel like my GP is good but is somewhat uncomfortable with me self-injecting. I think that bi-weekly is not going to be enough so that will be the next battle. I was on injections before that the nurse had to give me. I would feel awesome for 3-4 days after the shot and then start to drop off.

I have another appointment with my endo in a few weeks and need to get some more labs done since I’ve switched to cypionate.

I have a couple questions I was hoping someone here could help me with.

  1. Is there really anyway to tell if these low levels are drug induced or if I may have just always had low T? I did get my pituitary and adrenal gland checked. No problems there.

  2. Should I pursue restarting my natural levels or continue the TRT route?

  3. How the hell do I find a doctor that really knows about this? Most endos seemed to be diabetic focused. Any suggestions in the Pittsburgh, PA area?

  4. If I find a specialist out of state, how often do you really need to make office visits. I’d be ok with driving ~8 hours but I couldn’t do it for each appointment. Do they ever just order labs and evaluate them remotely?

  5. Anything else I should discuss with my endo?

Any other suggestion would help to. Thanks a lot.

edit: The next labs my endo has me doing are: Comprehensive Metabolic Panel, Prolactin, Lipid Panel, Ceruloplasmin, Iron Panel, and Free + Total Test.

Testosterone tunnel vision - look deeper!

Please CAREFULLY read these stickies:

  • advice for new guys
    – provide a lot more data about you
    – post lab results with ranges <====================================================
    – be open minded about causes, where low-T is a symptom, not the cause
  • thyroid basics

Inability to absorb transdermal T is a symptom of [subclinical] hypothyroidism.

  • As per the thyroid basics sticky
    – provide waking and mid afternoon oral body temperatures
    – describe history of iodine intake via iodized salt and/or vitamins that list iodine
    – dry skin or brittle hair/nails?
    – get cold easily?

You really needed to have LH/FSH tested before any TRT do determine if you have primary or secondary hypogonadism.

Other labs:
TSH, fT3, fT4 [not T3 T4]
DHEA-S

Have you been taking a lot of zinc, possibly creating a copper deficiency? Doc knows that?

Do you have digestive problems, food allergies?

Thanks for the replay KSman. I think I had all of those labs except for DHEA-S. I’ll read those threads and double check my blood work and update later. I’m open to low t being a symptom but it also seems that it can lead to some of the other problems I have. I really just want to have some energy again and be able to focus. The not being able to focus thing is killing me since I am a computer programmer.

I think my GP was heading in this direction of diagnosing the root cause but I was so depressed (didn’t want to live) that I told him I needed something to hold me over (depression meds weren’t helping). He gave me some test and it helped my mood a ton. The endo has bee running more labs but seems somewhat content with leaving me on TRT. I’m trying to prepare some question for my next visit in a few weeks.

I’m curious about why you are asking about digestive problems because I do have GERD/acid reflux. I think possibly maybe could be celiacs or some type of gluten allergy (seems to be somewhat common now) but I’m not sure. I’ve tried eating very clean for awhile but I’m not sure how to get carbs without gluten. I usually stick to oatmeal, brown rice and veggies. From what I hear brown rice is gluten free but some types of oatmeal can be cross contaminated with gluten.

Another thing. What denotes a sticky on this forum? They all seem to look like normal threads to me even though I know some one the ones on the front page are stickies.

edit: ok I see the little notepad icon

Some digestive problems can have GI bleeds and that can affect CBC and measures of iron. When I saw that I suspected that doc may have had that in mind.

GERD/acid reflux: Can also be from a hiatal hernia. Need more info as already requested.

Are you eating meat, cheese, eggs?

Here is the last comprehensive test I have on hand. The last test was only for T levels since that’s all I asked for. I need to get print outs for the rest of my info.

Answers to some of the symptons I’ve found listed here:

Symptoms: Why are you here
-Brain fog, no one knows what that means but everyone knows if they have it!
- Yes. Lacking concentration and focus. Not feeling as “sharp” as I have in the past. Business and work suffers because of this.

-Social withdrawal - “I would rather not go out”
- Yes. Started in high school

-Why do I have boobs? This really is depressing if prolactin is the cause!
- I have a big chest and am pretty high in bf now. I don’t have any gyno like nipples.

-Why do I carry fat like a woman?
- stomach yes. legs and ass not so much

-Why am I a moody bitch?
- yes. noticed improvements on T but. Mood swings frequently before

-Can’t get it up?
- Can, but very low sex drive

-It is up, now it’s gone.
- Not as strong as when I’m younger but never lose an erection

-My penis is numb -your nerves love T too. Things to do with testosterone cream.
- no

-My testes are softer and smaller
- Always been small. Cyst on one of them.

-My testes ache 24x7
- no

-My scrotum is up-tight, gives “how are they hanging” a whole new meaning.
- yes. always has

-Nocturnal erections -necessary but not sufficient
- pretty much never

-“morning wood” -things are working
- never

-Why do really hot looking women and girls now look like art instead of lust?
- Now that I’m taking T I am getting this drive back

-I felt great when I started TRT, where did that go? Neural transmitters rule your life.
- started with gel but it stopped working. Switch to 200mg cypionate bi-weekly

-My TRT seems ineffective or never was. Things that crash in the night.
- i seem to crash later in the week on shots. Later in the day on gels.

-On TRT and still do not feel right, something else is wrong.

-Loss of hair on lower legs, skin below the knees is smooth and shiny.
- no

-Why do I feel cold easily or all of the time?
- actually usually feel hot

-Why do really stressful situations leave me feeling physically beat up. Adrenal fatigue.
- they used to. I had a very stressful job for 3 years. I quit and try to not worry so much now.

-Dry skin, brittle hair and nails
- skin is dry

-Skin on the back of hand is thin, crinkly. Pinched skin does not recover
- I have problems with elasticity and healing. Get strech marks from lifting or gaining weight very easy. Cuts don’t seem to heal unless I use some antibiotic ointment

-Gum disease, the ugly killer
- they did tell me I had gingevitis last time I had a cleaning. They did some pressure washer cleaning thing that hurt like a bitch

-Why do I have a chronic cough [when taking a statin drug]
- no

-I have visual field disturbances such as reduced peripheral vision
- my eye continue to get worse

-My joints have started to ache
- yes. never had problems with this, but now my left hip will ache a lot.

-TRT and now leg cramps
- no

-TRT and wife says I am snoring more
- I snored a ton to begin with

-I am not depressed, I just don’t care about anything, no joy, no motivation, no reward
- I was this plus wanted to die. I’m defenitly less motivated and can’t work and focus long hours like I could in the past

-I want sex twice a day and my wife/GF is freaking out. What do do about her.
- maybe twice a year

-We fixed my wife’s hormones and I can’t keep up with her needs. [Give me her phone number!]
- this is true, but you aren’t getting the number :slight_smile:

As for the nutrient questions, I take animal pak daily and have for years.

The things you mentioned are listed:
Iodine(from Kelp) 150mcg
Zinc(as Oxide) 30mg
Copper(as Sulfate) 600mcg

  • I used to use iodonized salt but I eat sea salt lately

Trama:
I was hit by a car going somewhere between 15-25mph when I was 12. Only realy issue is a fractured my toe and it hurts like a bitch all the time. As far as I know there where no internal injuries.
At least one concussion for sure from football. Probably suffered at least 1-2 more from ice hockey.

Activity level:
Used to play baseball, football, hockey. Also used to rollerblade pretty much all day long when I was a teen.
Now pretty sedentary. Desk job. Try to lift 4-5 days per week. Fatigue and long working hours hindering this

Other things I’ve noticed:

  • Decrease in strength.

    • could bench 405, now maybe 350lb.
    • could squat >500, now maybe 350. 405 would be pushing it.
    • could deadlift >500, now 405.
  • Weightgain

    • I was 210 at my best shape, about 6 years ago
    • I stayed around 230-240 for a long time
    • Recently jumped to 280. Dieted back down to 240 and went back to 285-290 in a matter of months.
    • Goal is to hit 240 again by june
  • Lack of focus / lethargy

    • this really bothers me. I almost think I have ADD but I know it could be a symptom of something else
    • work 8-10 hours a day on the computer. Hard to stay focused, and think
    • drive 4 hours a day
    • run a business online which i suffering. I used to be able to do 18 hours of work no problem
  • Sleep about 5-6 hours per night.

    • no time for more
    • hard time falling asleep before 11-12 and have to be up at 5
    • sleep study showed no apnea but I didn’t feel like I slept at all
  • Hard to catch breath after walking up stairs. Things that would be nothing in the past

    • I know I put on weight but seriously?
    • Tested for asthma and other breathing problems and came out fine.
  • What seem to me as hypoglycemic episodes

    • Mostly occurs during physical activity
    • Lifting. Feel great. Then get hit with diziness and nausea
    • Blacked entirely out once
    • On the verge of blackout one other time. Symptoms seem to progress like this:
      • dizzy
      • nausea
      • in ability to speak or attempt to speak but other people can’t make out what I say
      • appear drunk/hungover to old gymrats
      • disoriented
      • ear ringing
      • can’t hear at all
      • eyes start to fade
      • blackness or waking up to someone
    • occured chopping firewood also.
    • seem to generally occur if I eat shit. IE pizza for breakfast and then physical activity
    • eating protein complex carbs seem to really relieve most of this
    • also if I’m at the gym and symptoms happen I pop a couple glucose tabs and will be fine in 5 minutes.

Diet
- My diet has been shitty lately to be honest. Lots of fast food and junk food
- oh, I’ve done ketogenic diets in the past. Not sure if this could cause anything else blood sugar related, etc.
- Goal is to get back on my standard diet which is something like
- meal 1: 1 cup egg whites 1/2 cup oats
- meal 2: protein shake
- meal 3: 6-8oz chicken 1 cup brown rice 1 cup brocolli or other veggies
- meal 4: 6-8oz chicken 1 cup brown rice 1 cup brocolli or other veggies
- meal 5: protein shake
- meal 6: steak, chicken, or fish 1 cup rice or 1/2 cup oatmeal

Diagnoses per Endo:
- Hypogonadism
- Hyperlipidemia (which no one has really discussed with me)
- GERD
- Syncope
- Elevated Liver Enzymes

My doctors don’t seem to have any problems ordering tests. I have good insurance that pretty much covers everything.

Oh one more thing. Since I’ve suspected blood sugar problems I test pretty frequently. I’m usually pretty low. If I start to feel a little sick my sugar is usually below 80. Generally I’m between 80-90 even during the day and within 2 hours of eating. I also noticed insulin was high and glucose was somewhat low on the blood work I posted.

Drugs I take:
nexium (40mg)
effexor (50mg 2x day)

caffiene (300-700mg day) Have cut this out for before months and then started again.

  • As per the thyroid basics sticky
    – provide waking and mid afternoon oral body temperatures <=========================

Your AM cortisol is low.

Are you thirsty, drinking a lot of water? With fasting lab work we often see slight signs of dehydration, not you.

You have some degree of primary hypogonadism. And your LH/FSH levels may be repressed by something as well. DHEA-S would be useful.

Need E2 lab data to complete the picture.

Temp this morning was 97.8. I took it before bed too and it was 97.6.

I drink stuff all day long pretty much. Lately it’s bee too much diet coke and some water. I generally drink a good bit of water each day.

Thirst and drinking a lot of water etc is symptom of diabetes.

[quote]KSman wrote:
Thirst and drinking a lot of water etc is symptom of diabetes. [/quote]

I’ve been through several tests for diabetes related symptoms but the docs always say I’m fine.

So far today, from 6am to bout 2pm I’ve had:
96oz of water
~30oz of diet coke
16oz rockstar energy drink

Although caffeine is a diuretic and I consume more of it than I should.

[quote]KSman wrote:

  • As per the thyroid basics sticky
    – provide waking and mid afternoon oral body temperatures <=========================

Your AM cortisol is low.

Are you thirsty, drinking a lot of water? With fasting lab work we often see slight signs of dehydration, not you.

You have some degree of primary hypogonadism. And your LH/FSH levels may be repressed by something as well. DHEA-S would be useful.

Need E2 lab data to complete the picture.

[/quote]

I forgot to take temps. I will check this tomorrow.

I had my doc add Estradiol and DHEA-S to the blood work I already have scheduled. Going to get it taken tomorrow morning.

Temps today:
6am - 97.6
11am - 98.8

I feel like I’m getting sick though so I may or may not end up with a fever.

Had labs done this morning. Should be back in a few days.

Edit: I’m running 100 now. I must have a fever. I’ll have to check my temp once I get over this.

Edit: Speaking of mental fog, I managed to leave my car in the driveway and running for 3-4 hours. wtf


KSMan thanks for helping me out. Here are my latest labs. Switch to 200mg of test cyp instead of androgel. I attempted to talk to my endo about the TRT protocol article. He doesn’t seem very receptive to my suggestions. I had E2 and DHES-S added to the lab and let him know. He said it doesn’t matter. I ask him if E increases with T and he said “yes, that’s why it doesn’t matter”. My E2 levels are pretty high. Total test is mid range, but Free test is much higher.

Free test is higher than my previous Total test levels! Ask my endo if there was any reason I couldn’t take 100mg of test 1 time a week instead of 200mg of test bi-weekly. He said I should stick with 200mg over two weeks as it is the high does that matters (blah). He seems to think I’m fine and scheduled my next visit for “sometime in the summer”. So i’m not very satisfied with this visit.

I’m going back to my PCP on Monday. He is a great doctor and will always listen to what I have to say and explain why a test or theory is right or wrong. I’m hoping I can get him on board for an AI. I also had a sperm count done with my PCP as I’d like to have children soon. Count came back with 0 swimmers. My PCP said if I had problems in this area there was something he could give me. I’m going to try to discuss the HcG and AI protocol. I’m going to try to get him to read the TRT protocols thread.

I printed out and plan on asking his opinion. If I can’t get him to by in to the plan I may need to go underground for AI and HcG, but hoping I don’t have to do this. Also going to see if he knows anyone who specializes in male hormal problems or even anti-aging.

edit: Also. I’m feeling much better than I did on androgel but not 100%. Mental focus is the worst symptom right now. I’ve noticed some positive changes in my ability to get out of bed in the AM and my general mood.

E2 is a major issue!!! UG anastrozole is easy, hCG is not.
High E2 and low SHBG is strange, in a good way.

HDL 29(H) should be 29(L)

Where are temps now? TSH is elevated and fT4 is well below mid range.

Why can’t you do you injections the way that you want?

[quote]KSman wrote:
E2 is a major issue!!! UG anastrozole is easy, hCG is not.
High E2 and low SHBG is strange, in a good way.

HDL 29(H) should be 29(L)

Where are temps now? TSH is elevated and fT4 is well below mid range.

Why can’t you do you injections the way that you want?[/quote]

I probably marked the HDL wrong in my spreadsheet. Basically good cholesterol was a little low and bad was a little high. Isn’t that somewhat normal on test?

I can give shots to myself the way I want but I need to get more pins. One way I was going to try to get the doc on board was having him give me a few orders for T that I can do every few days during the two weeks to show the changes.

I’ve gotten brandname clomid and nolvadex pills UG before but that source is dead. I’ve never been real sure about RC. They are usually liquid in my experience. I guess that would make anastrozole easier to dose. As for low SHBG, that makes for higher free test?

I know some local pro bodybuilders and some people involved in the IFBB as judges/trainers. I’m hoping one of them might be able to point to me a decent doc. I’m only concerned with feeling right not putting on mass but they might know the right people to talk to.

edit: Also, my wife is going through thyroid issues. Your thread on thryoid basics is great. She has TSH <0.0150 (Reference is 0.465-4.68)! But she seems to have HYPOthyroidism symtpoms.