T Nation

Need some expert advice urgently. extreme fatigue on TRT, randomly relieved by DHEA


#1

To start, I've been on TRT since 2011:

100 Ng Test-Cyp Weekly
250 IU HCG 2x weekly
.25 Arimidex every 4 days.

Before I started TRT, I had: No Libido, no energy, had not had morning erections in years, no motivation or drive, poor erection quality, no exercise recovery.

One day I got a bottle of DHEA to try it out, took a 50mg tablet and about an hour later it felt like I had taken the pill from the movie Limitless. My energy came surging back, felt like a 20yr old.

That lasted 4-5 hours, the next day I tried 50mg again, no effect. Tried 100mg, energy came flooding back. Next day it took 200mg to get that effect.

After that I went to see my Primary Care, he checked Testosterone, it was borderline low so he started me on TRT. I felt good for about a month.

Every since then I basically have gone back to all my old Low-T symptoms. Complete exhaustion, listless/no motivation, no libido, no morning erections, poor erection quality.

What is odd though, is that even now, if I don't take DHEA for a while and then take 50Mg, all my Low-T symptoms resolve for a few hours, and then the next day the DHEA does nothing and I am back to exhaustion.

7-Keto DHEA never provides relief, just regular DHEA, and only randomly.

I've talked to 3 docs about this, and all I get is a confused look and an "I don't know, your labs look good"

So I was hoping to get some of the knowledgeable folks here to see if they can provide insight. I am thinking that the DHEA is initially converting to another hormone that is the one I am really low in and providing temp relief, then converting to something else on subsequent doses.

Any help would be appreciated, I am at a loss and can't seem to make any progress, and am getting 0 help from doctors.

Labs below: (Note, the Total T, Free T, E2 was taken on the last day before my next dose to see the lowest that I drop)

Testosterone: 650 (Range: 292-1052)
Free T: 17.2 (Range: 4.8 - 25)
Estradiol: 19 (range <=63)
DHEA-S: 224 (Range: 104-446)
IGF-1: 207 (Range: 65-210)
DHT: 395 (Range: 106-719)
SHBG: 23 (Range: 16-94)
PSA: .6 (Range: <= 4.0)

TSH: 2.66 (Range: .4 - 4.5)
T4, Free: 1.5 (Range: .8 - 1.8)
T3, Free: 3.7 (Range: 2.3 - 4.2)
Reverse T3: 19.2 (Range: 9-27)

Cortisol AM: 13 (Range: 7-25)
ACTH Stim Test: Normal result

24Hr Saliva Cortisol:
Morning: 1.88 (Range: 5.1 - 40.2)
Noon: 1.65 (Range: 2.1 - 15.7)
Evening: < .33 (Range: 1.8 - 12)
Night: .35 (Range: 0.9 - 9.2)


#2

I wonder if TRT makes it more difficult to recover from adrenal fatigue

Also, licorice apparently boosts the half-life of cortisol. I imagine you drink a lot of coffee

Also, I just read in another thread advice was ‘eat moar and have some protein’. Due to increased metabolic rate and blood sugar lower. I’m going to try this ‘eating’ thing myself as this is my primary symptom, too


#3

I used to drink a lot of coffee, but have cut back to almost none a day. ussually 2-3 cups decaf. No soda’s.

I’ve tried licorice root, and the other adaptogenic herbs for Adrenal Fatigue (Eutheria, Ashwaganda, Rosia Rhadola) and they did not help. Adrenal Glandular’s did not help.

I just started a low dose supplemental cortisol a few days ago, but haven’t experienced anything from it yet either. Thats why I am curious as to what DHEA is converting into.

I had been off DHEA for a few weeks, and took 50mg this afternoon, hour later I’m bursting with energy. So even on supplemental cortisol, which should reduce adrenal fatigue, I was still fatigued until I took the DHEA. Tomorrow, if I take the DHEA again it will have no effect at the same dose.


#4

Well, I mean: http://www.paleoforwomen.com/wp-content/uploads/2012/04/resizedimage500372-steroidal-hormones1.jpg

Maybe 19 e2 is too low for you


#5

E2 is not the problem and its average level will be higher.

Please try this protocol:
50mg T cyp twice a week
.25 mg anastrozole at time of injection
250 iu hCG at same time

Do labs 1/2 way between injections.

Your T levels were dropping and the next AI dose would drive E2 low.

TSH=2.66 is too low, better near 1.0, lab ranges are stupid and docs are too
Are you using iodized salt or using sea salt and iodine deficient.

Low cortisol levels:
The raw material for making cortisol is progesterone and there is not much of that in males. You can get “KAL” brand progesterone [2%] cream at amazon and apply 1/2 - 1mk to forearms and note effects [experiment]. Please do not do DHEA at this time. If you apply at night and it keeps you awake, that is from increased cortisol. Some report better sleep. If it works for you, an AM dose makes more sense. Your wife/GF might benefit from the progesterone cream as well.

Check overall thyroid function by checking body temperatures:
Check oral body temperature when you first wake up AND mid-afternoon.
97.7 - 97.8 in AM is good, 97.3 is way to low. Need 98.6 in afternoon.

Your above mid range fT3, fT3 and elevated TSH suggest that rT3 is having an effect and all the more if body temps are low.

Feel cold easily?
Dry skin?
Outer eyebrows sparse?
Thyroid enlarged, asymmetrical, sore or lumpy?

Please read these stickies:

  • advice for new guys
  • thyroid basics
  • protocol for injections

TRT + low thyroid function can create further problems.


#6

Thanks for the response KSman.

I don’t have dry skin or feel cold, but my body temp is generally pretty low, and I don’t have any eyebrows outside of the first third. I also had a lot of hair fall out.

I have not had any form of iodized table salt in years. I use sea salt for any cooking. And for years I drank Mt. Dew, which has a high bromide content. Although I stopped that about 4 months ago, along with all other soda’s and caffeine.

So would a good test run for thryoid and adrenal support (outside of the injection protocol changes, which I will do) be:

Low dose Progesterone cream in the AM to help with Cortisol.
50Mg Iodine for 2 weeks to get built up, then maintenance dose of maybe 12.5Mg?

Should I supplement selenium? Should I divide up the Iodine into split doses throughout the day?

I tried Iodine supplementation a few years back, initially felt some improvement at 400mcg/day , then got super sick when I increased the dose to 12.5mg. But after reading through some of the articles linked in the Thyroid Basics post I may have been experiencing Bromide detox from all the Mt. Dew I had consumed over the years.


#7

You have a good grasp of things. I do not see any compelling reason to take selenium more than once per day. Get multi-vits that have iodine and selenium. Bill Robers here also suggests that 2mg iodine per day for two weeks might be enough, so you can pick your road.

You lack of iodized salt is the problem and doctors never ask about iodine. You should have a good response, but you will need to endure the bromine unloading. I suspect that large iodine doses are needed to displace bromines, another factor.


#8

Are you suspecting adrenal fatigue coupled with a thyroid issue due to iodine absorption being blocked by bromide?


#9

[quote]Davinci.v2 wrote:
Are you suspecting adrenal fatigue coupled with a thyroid issue due to iodine absorption being blocked by bromide?[/quote]

Yes, I think both adrenals and thyroid are lacking. My saliva cortisol numbers are extremely low.

After reading the thyroid basics post, I know that is an issue as well. I have difficulty losing any weight and lost almost all of my eyebrows. At one point there was only about 1cm of eyebrow left. I have noticed some regrowth after I stopped drinking mt dew. I’ve taken measurements and will check again after 2 weeks of iodine loading.

I’m addressing both now, with 50mg iodine and some progesterone cream in the am.

I think I’ll have thyroid fixed with a few weeks of iodine, but with how low my saliva cortisol is the adrenals may take a longer period of time to recover.


#10

VERY important to have selenium !!!