T Nation

New, Can Use Perspective I'm Not Getting From Doctors


#1

I am 41, 5’10" 245lbs, have been fairly fit in the past but getting more and more out of shape the past several years. Carrying all the weight in my gut it seems and my legs just get skinnier. Just to give an idea how I am now.

I’ve had Primary Hypogonadism since 18. At that age I was working 12 to 14 hour days plus lifting weights 2 hrs a day 4 days a week. I did not take steroids. The only supplements I took were those multi level marketing Shaklee supplements and shakes.

I was lifting more weight than ever and feeling great! One day my workouts didn’t work. Then I was feeling so bad I even stayed home from work thinking I must be sick. I never got better. I never lifted weights again. But I stayed in shape being super disciplined with diet and doing cardio and chopping wood and just staying fit but I would sometimes get very depressed and often felt like my body didn’t work. I would work all day but after work I had to go home and meditate and sleep while the other guys were inviting me to go out to the bars and parties and I just couldn’t physically handle it like they could. I went to psychotherapy and did every self help thing I could do because I didn’t know what was wrong with me. Doctors told me it was in my head.

Doctors would tell me I was the healthiest patient they had and there was nothing wrong with me. Until finally at age 34 I admitted I couldn’t get an erection. I was diagnosed with Primary Hypogonadism and the theory from multiple doctors was that my immune system attacked my testosterone factory when I was 18.

I took a “sample” the doctor gave me of Testim. A tube a day for 3 days. I felt like I was 18 again. In my mind I felt an emotional drive and caring for myself I haven’t felt since 18. Several months later I got on the replacement permanently taking Testim every day. The doctor also gave me a “booster shot” of testosterone. I grew some boobs that night. And unfortunately the therapy wasn’t making me feel great at all like the 3 day sample I took months before. I then changed to Androgel and then to Androgel 1.62. I never felt great. I usually felt bad. I was tired and muscle recovery was not good. I was very anxious and having depression symptoms. After a couple years I changed to Axiron. I felt much better. Not like that first 3 day sample, not totally normal. But I got in better shape, my muscles were recovering from physical work and I got stronger. I was not anxious and felt good and focused on doing whatever needed to be done at work and at home. Life was getting better. Then because of insurance I changed back to Androgel 1.62 and have been on that for 2 1/2 years now. I went back to feeling bad. My doctor tried doubling the dose. It didn’t help. Then to a 1 1/2 dose which is 3 pumps a day which is what I take now. I mentioned some stuff I had read about on the internet about estrogen and he actually laughed at me and told me I was wrong that Testosterone has nothing to do with estrogen.

So I finally got a new primary doctor in March and eventually an endocronologist for the 1st time too. Determined to get to the bottom of this I went to many appointments and did whatever they wanted me to and at home I tried my best to push through symptoms and be healthier and happier.

1st they put me on androderm patch because thats what insurance wants to try. It needed pre auth, I ran out of Androgel, so I paid $600 out of my pocket for 1 month of Axiron.

I also started going to psychotherapy for depression. I don’t have any depressive or mental disorder besides just the T symptoms and also lifes been tough the last decade.

Took Axiron for 1 month. Felt better, lost weight, got in better shape, was getting so much more work done at my job and at home after work. I was starting to be happy all the time for no reason thinking of happy memories and solving problems rather than worrying about them.

Started Androderm patch and took it for 5 days, 1 patch. I immediately felt horrible.Tested 60 for Total Testosterone on 5th day. I gained fat around my hips I think, like fats there that wasn’t before. I definitely grew some more boobs and they haven’t gone away. After 5th day doc had me double the patches. 3 days later that hadn’t helped and I switched to Generic Testim.

Took Generic Testim for 1 month. Felt better, had better muscle recovery. Felt happier but my mind was not working right. Couldn’t remember anything. Would get very confused very easily. For some reason the first 10 days I was on Testim I uncontrollably passed out early in the day for hours at a time. Sometimes like 6 to 8 hrs just dead to the world in the middle of the day. (I have a flexible work schedule and work from home a lot so no one to wake me up) It got better but sometimes would still fall asleep during the day once or twice a week.

Went back to Androgel 1.62, back to feeling exactly how I did months before. I feel bad. I feel depressed. Can’t get in better shape. Everything is a struggle all day. My mind is working a little better than on Generic Testim. For some reason I still fall asleep during the day uncontrollably about once or twice a week. That rarely happened before until I had tried the Generic Testim this last time.

I started reading some stuff on here and brought up estrogen at my last endo visit. The endo had nothing to say about my symptoms on all the T’s him and the primary put me on the past few months. He said what do you want me to do give you shots? Im like no how about looking into why I have good T levels on Androgel but have these symptoms? like maybe Estrogen?? He said yeah I can do that and just wrote a script for 1mg Armidex. He wasn’t even going to test my blood but I made him. Unfortunately it came back with what I think is a good level. The Estrogen test came back as 20 which was low end of normal.

So I’m at a loss. Why does Axiron almost work? By the way ED has gotten worse over these years and now my sex drive/ability is pretty much zero. It remained that on all the T meds, even when on Axiron it didnt get better. Why does Androgel give me normal T levels but I feel horrible and can’t get stronger. (I do physical work part of the week. As much as my body will let me which is not a lot these days.) I really thought the E levels would explain it. What do guys think? Sorry for the long story but I figured Id just get it all out there and maybe someone can help me can perspective because I have none at this point. Thank you so much.


#2

It sounds like your doctors aren’t even monitoring your blood work after starting the different treatments, transdermals suck plain and simple and are expensive. Injections are far more effective, but unless you have a good doctor treatment is pointless. Some absorb better under the armpit while some on the skin, that’s why you noticed a difference. I don’t absorb anything under my arms or skin on my shoulders, so imagine how I felt. Injections bypass all that bullshit and get directly into the bloodstream so you don’t have to worry about absorption rates. It sounds like you have doctors that don’t really understand male hormones. The only way you’re going to find out why one treatment works and the other doesn’t is blood work.


#3

You need to get your lab reports and post these here in list format with ranges.

Have you had thyroid tests: TSH, T3, T4, fT3, fT4?
Perform thyroid function evaluation via oral body temperatures - see below.

Where are you located?

Suggest:
self injected T cyp or eth self-injected 50mg twice a week subq, not IM, with #29 1/2" 0.5ml insulin syringes
0.5mg anastrozole at time of injections

hCG may have no benefits for you, you can get semen analysis to see if there is any sperm.

Primary means low-T and elevated LH/FSH.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#4

Thanks for your instructions and help! I have found all of the blood tests I have and put them into a spreadsheet so I can find them readily. I read a lot of your advice for new guys. I will be buying a thermometer tomorrow to take morning and afternoon readings.

I am posting a revised more to the point intro in response to my 1st intro that has more info you asked for.

I’m not totally sure what blood test readings to post so I’m going to post them separately in total in case they are needed. Ofcourse I don’t expect you to scour them but feel free to or ask me specifics if you’d like me to respond with specific tests results.

I have had TSH tested. It doesn’t look like they tested T3 or T4.

5/22/17 TSH 0.40-4.50 - 1.36
6/29/17 TSH 0.20-5.60 - 1.45


#5

Revised intro:

Question: Androgel 1.62 is giving me 573 TT and 122 FT. Yet I feel like shit. Can’t get stronger, can’t get through my day, can’t get an erection, feel very depressed. Whenever TRT scripts change in Type or dose I grow boobs. Except if I take Axiron. On Axiron I feel good and get strong though still problems with ED.

I am trying to figure out why, what is causing side effects, and what to do to take control of this process and be proactive from here.

Age 41, 5’10" size 38 jeans but tape I just used says waist 43", 245lbs
Live an hour north of Detroit, MI

Have hair loss on head, but have been gaining hair in my ears, nose, cheeks, arms, back, front, etc the past 10 years. I am Italian though…

Always have carried fat in belly and have had skinny legs, that has gotten more pronounced the past 10 years

Health Concerns: Primary Hypogonadism. LH/FSH was tested to make sure I was Primary before I was willing to start TRT.
Pinched nerve in lower back that causes only minor problems. No other diagnosed conditions ever.

Primary Hypogonadism happened when I was 18. Was not diagnosed until 33. Total T at age 33 was 190. Started TRT at age 34.

Have never had any discomfort in my Testes and have had physical exams with no issues found.

I have had little to no morning wood in 10 years. The past few years my ED has gotten to where it just plain don’t ever work and even on Cialis its 70%.

Currently Taking Androgel 1.62, have also taken Axiron and Generic Testim
No other drugs or medications. Taking B12 and D3 supplements from doctors advice from blood tests.

Diet is mostly food I cook at home. I don’t drink milk, I get sinus probs from it. I eat cheese sometimes. I don’t diet. I try to eat real food and healthiest I can come up with. Roasted vegetables, eggs, potatoes, chicken, beef, sauteed kale, sauteed cabbage, some white pasta, brown rice. I don’t like sweets and avoid sugar to some degree. Rarely eat fruit or anything sweet. I don’t use much salt except a bit while cooking.

I will be buying a thermometer tomorrow to start taking readings.

Exercise is coming only from work. At my job I get a couple hours a day of hard physical labor.


#6

3/14/17 Primary Physician

Testost SerPl-mCnc 250-1100 573
Testost Free SerPl-mCnc 35.0-155.0 122.1
SHBG SerPl-sCnc 10-50 20
DHEA-S SerPl-mCnc 106-464 169
Cortis AM peak SerPl-mCnc 11.6
FSH SerPl-aCnc1.6-8.0 <0.7
PSA SerPl-mCnc< OR = 4.0 0.6
Glucose SerPl-mCnc65-99 94
BUN/Creat SerPl6-22 NOT APPLICABLE
Potassium SerPl-sCnc3.5-5.3 4
CO2 SerPl-sCnc20-31 28
ALT SerPl-cCnc9-46 24
AST SerPl-cCnc10-40 16
ALP SerPl-cCnc40-115 78
Bilirub SerPl-mCnc0.2-1.2 0.7
Albumin/Glob SerPl1.0-2.5 1.7
Globulin Ser Calc-mCnc1.9-3.7 2.8
Albumin SerPl-mCnc3.6-5.1 4.7
Prot SerPl-mCnc6.1-8.1 7.5
Calcium SerPl-mCnc8.6-10.3 9.9
Chloride SerPl-sCnc98-110 102
Sodium SerPl-sCnc135-146 140
GFR/BSA pred.black SerPl MDRD-vRate> OR = 60 111
BUN SerPl-mCnc7-25 11
Creat SerPl-mCnc0.60-1.35 0.98
GFR/BSA.pred SerPl MDRD-vRate> OR = 60 96
IGF-I SerPl-mCnc52-328 137
IGF-I Z-score SerPl-2.0 - +2.0 -0.1
25(OH)D3 SerPl-mCnc30-100 21
ACTH Plas-mCnc6-50 54
ANA Ser Ql IFNEGATIVE NEGATIVE
Color UrYELLOW DARK YELLOW
pH Ur Strip5.0-8.0 7
Glucose Ur Ql StripNEGATIVE NEGATIVE
Sp Gr Ur Strip1.001-1.035 1.023
Appearance UrCLEAR CLEAR
Ketones Ur Ql StripNEGATIVE NEGATIVE
Hyaline Casts #/area UrnS LPFNONE SEEN NONE SEEN
Bacteria #/area UrnS HPFNONE SEEN NONE SEEN
Squamous #/area UrnS HPF< OR = 5 NONE SEEN
RBC #/area UrnS HPF< OR = 2 NONE SEEN
WBC #/area UrnS HPF< OR = 5 NONE SEEN
Leukocyte esterase Ur Ql StripNEGATIVE NEGATIVE
Nitrite Ur Ql StripNEGATIVE NEGATIVE
Prot Ur Ql StripNEGATIVE TRACE
Hgb Ur Ql StripNEGATIVE NEGATIVE
Bilirub Ur Ql StripNEGATIVE NEGATIVE
LH SerPl-aCnc1.5-9.3 <0.2
WBC # Bld Auto3.8-10.8 7.5
Hct VFr Bld Auto38.5-50.0 49.1
MCV RBC Auto80.0-100.0 89.8
Hgb Bld-mCnc13.2-17.1 16.7
RBC # Bld Auto4.20-5.80 5.47
MCH RBC Qn Auto27.0-33.0 30.6
RDW RBC Auto-Rto11.0-15.0 13.4
Basophils/leuk NFr Bld Auto 0.3
Eosinophil/leuk NFr Bld Auto 2.8
Monocytes/leuk NFr Bld Auto 11
Lymphocytes/leuk NFr Bld Auto 35.7
Monocytes # Bld Auto200-950 825
Lymphocytes # Bld Auto850-3900 2678
Neutrophils # Bld Auto1500-7800 3765
PMV Bld Rees-Ecker7.5-12.5 8
Platelet # Bld Auto140-400 210
Neutrophils/leuk NFr Bld Auto 50.2
Basophils # Bld Auto0-200 23
Eosinophil # Bld Auto15-500 210
MCHC RBC Auto-mCnc32.0-36.0 34.1
Prolactin SerPl-mCnc2.0-18.0 7.8
LDLc SerPl Calc-mCnc<130 120
NonHDLc SerPl-mCnc 187
Cholest/HDLc SerPl< OR = 5.0 5.9
Vit B12 SerPl-mCnc200-1100 526
Cholest SerPl-mCnc125-200 225
HDLc SerPl-mCnc> OR = 40 38
Trigl SerPl-mCnc<150 334


#7

5/22/17 Primary Physician

PTH, INTACT WITHOUT CALCIUM 24-May-17
PTH-Intact SerPl-mCnc14-64 36
WBC # Bld Auto3.8-10.8 7.2
RBC # Bld Auto4.20-5.80 5.56
Hgb Bld-mCnc13.2-17.1 16.5
Hct VFr Bld Auto38.5-50.0 50.9
MCV RBC Auto80.0-100.0 91.5
MCH RBC Qn Auto27.0-33.0 29.7
MCHC RBC Auto-mCnc32.0-36.0 32.4
RDW RBC Auto-Rto11.0-15.0 13.3
Platelet # Bld Auto140-400 238
PMV Bld Rees-Ecker7.5-12.5 8.1
Neutrophils # Bld Auto1500-7800 4450
Lymphocytes # Bld Auto850-3900 2160
Monocytes # Bld Auto200-950 454
Eosinophil # Bld Auto15-500 108
Basophils # Bld Auto0-200 29
Neutrophils/leuk NFr Bld Auto 61.8
Lymphocytes/leuk NFr Bld Auto 30
Monocytes/leuk NFr Bld Auto 6.3
Eosinophil/leuk NFr Bld Auto 1.5
Basophils/leuk NFr Bld Auto 0.4
Testost SerPl-mCnc250-827 61
TSH SerPl-aCnc0.40-4.50 1.36
Vit B12 SerPl-mCnc200-1100 389


#8

6/29/17 Endocronologist

Glucose 86.00
HGB A1C 3.5 - 6% Diabetic 5.70
Urea Nitrogen (BUN) 12.00
Creatinine w/EGFR 0.90
GFR 99.00
AST (Aspartate Aminotransferase) SGOT 17.00
ALT (Alanine Aminotransferase) SGPT 33.00
Calcium 8.70
TSH 1.45
Albumin 4.60
BILI-T (Bilirubin Total) 0.60
ALK PHOS (Alkaline Phosphatase) ALP 86.00
Lytes - NA+ 141.00
Lytes - K+ 4.40
Lytes - CL + 106.00
Lytes - CO2 30.00
Uric Acid 7.80
Total Protein 7.10


#9

7/10/17 Endo

Estradiol Ref Range: <53 pg/mL, (under column labeled normal) <20

Honestly it wasn’t clear to me what the result was but after looking up what Ref Range means I assume <20 is my score.

This test was done after 30 days on Generic Testim


#10

Temperature readings are 97.7 morning, 99 afternoon