T Nation

New to TRT Need Help with Labs

Hi guys, I have been reading the stickies and such for a couple months to learn more about TRT and feel fortunate to finally have a doctors office that cares (we use a local compounding pharmacy to provide the HCG, Test Cyp, and Armidex. I would appreciate any and all advice on how to continue to improve my health.

Age, 38 , 5’11 -height, 38 -waist, 240 -weight
Hairy Chest, limited back hair, hairy legs, arms, full facial hair
Fat around waist and hips, not out front but like a donut, very little body fat outside of the midsection. Always carried weight this way.

ED problems for 8 years (viagra helped), felt like crap since, however 3 years ago, began waking up at 3am, hair thinning (have no receding issues prior or now, did have thick hair, now thin, dry), cannot lose weight for the life of me. The poor sleep, ringing in ears, and weight gain all showed up at same time 3 years ago. Since the 3 years ago part, viagra does not help since this occurrence, almost too tired to think about it. Go to sleep at 1030, wake up at 3 like clockwork, try to go back to sleep, and doze in and out until the alarm goes off at 615. Feel Like crap everyday.

No drugs or OTC drugs. Nor any vitamins

Diet is solid, intake of protein (balanced between red meat, chicken, pork), and fruit vegetable carbs, limited grains (such as a whole wheat sandwich once a week and italian food once every two weeks in moderation) plenty of water daily, no soda, no tobacco, maybe 2 beers per week.

Training has been weight lifting and cardio, big problem with the cardio and lifting
is always out of breath. I have lifted on and off for 20 years, and for the past 6 years would lift light weights, and I was treadmill running 3 miles per day 2 to 3 times per week for nearly a year and never felt like I had any VO2. Also same applies to elliptical machine. I can gain strength. Trying to simplify the workouts, into 3 times per week, I switched to Crossfit in January, to find a happy medium, but don’t follow the Crossfit for time, rather just to complete the workout, as I have no recovery, drained, after a workout if i tried to handle the cardio. My heart rate is high during even weightlifting parts, it takes very little to get it elevated. When doing cross fit or treadmill running (5.0 miles per hour, flat) I can hold the heart rate at 160-165 basically 80% max. However here is my crossfit weight lifting stats. Bench 235 3 times, Max Squat 315, max Deadlift 405, Max Clean and Jerk 185.

No testicle problems

No nocturnal, and maybe occasional morning erection (once every couple weeks, but don’t
know if its because I have to pee).

Biggest problems are:
ED, No Libido ringing in both ears (very loud), poor sleep (wake up at 3), no deep sleep, tired in afternoon, no focus, brain fog.

After years and years of doctors, primary care, urologists, and endocrinologist, who thought I was crazy I finally found a doctors office that cared to test and really find
out what is causing my symptoms. So in June of 2012 I went in to meet the doctor explained my symptoms, and blood work was drawn up. Beginning July 2012, I began TRT with Test Cyp, HcG and Arimidex.

However one problem was that the filling pharmacy (who shipped me directly the meds) improperly labeled the test cup for dosage. Which was .25 ml every two weeks. I didn’t question as I had no idea what was correct, as the HCG was 250 iu 2x per week, with Arimidex at 1 mg weekly.

Needless to say I was not feeling any better and as scheduled went back 4 weeks later for
more blood work. That is where I learned the mislabeling. Upon return of my bloodworm, my Test only went from 208 to 224. However, compared to where I started I was just glad to
have professionals wanting to help. And my doctors office expressed complete regret this happened, and held the pharmacy accountable for what that is worth.

Therefore 4 weeks later at the end of August 2012, more blood work, and this results were much better.

However, all my symptoms still apply from above. I know that all these blood panels are not exactly correct every time because the paperwork order seems to get screwed up between the doc and nurse or office and quest? So please give me your opinions on where we need to go with dosage, additional treatment, etc as the office will work with my recommendations. I am scheduled to go back to the doctors office on Tuesday, so we can draw more blood then if needed.

In August to current day, I dose the following:

100 mg Test Cyp total per week, administered 33 mg EOD via SubQ injections
250iU HCG EOD
.25 Armidex EOD (on day I take HCG shot)

Thank you again for all your contributions, I know eventually I can feel better with your help!

All Labs are via Quest Diagnostics:

This link below is to my labs for June, July, Aug 2012 via google docs. I tried and tried to format in the post but it just wasnt working. Let me
know if I need to provide these another way.

Just want to make sure I’m understanding your question correctly: You’re wondering what could be going wrong with your treatment/biology because you are still having all of the symptoms you had before starting TRT? Am I in the ballpark? Or is it something else?

*EDIT: Quick thought - Do you have any more info on your Cortisol? All the first lab says is “.2” and it doesn’t have a reference range or measurement, i.e. ng/ml, ug/dl, nmol/L, etc.

**EDIT x2: Also, how long had you been on your current regiment before the 8/28 labs were taken?

***EDIT x3: Sorry! Last one! Did you have your LH and FSH tested before starting TRT? I didn’t see them in the June set. Did you get a diagnosis of Primary or Secondary?

Sorry. That cortisol is deleted. That was incorrect. The July labs are correct.

Yes, please tell me what I need to do to feel better, what other tests to take, etc.
I know there is hope on the horizon, we just need the right direction to go.

Edit: From the August labs, I had been on this treatment for 30 days.

Thanks

From the August labs, I had been on this treatment for 30 days.

No LH or FSH testing. Nor was there a diagnosis.

I’d like to start off by saying that the way you posted your labs is great! It is really clear and easy to read, and I think you were on there editing stuff while I was looking at it which is pretty cool.

Okay, well it wasn’t good to get on TRT without having had LH and FSH tested. This would indicate Primary or Secondary Hypogonadism, and would let you know whether you need testosterone supplementation or if you can try to “kick start” your system with a SERM Challenge or trying out hCG monotherapy first. I’m not sure if it’s best to stay the course and continue TRT, or to taper off the stuff, let your system return to “normal”, and then get the proper labs before proceeding.

I can’t make that call for you, but it’s something to ponder. Having your LH tested now (on August labs) is superfluous since TRT shuts down LH and FSH production. Further testing isn’t needed now unless you just want to confirm that your production is shutting down, which serves no purpose.

ED can be caused by a lot of things, and having high cholesterol is one potential cause. If you think you can bring those levels down on your own fairly quickly then go that route, otherwise medication may be necessary in the interim. Some guys on this site have a distaste for cholesterol meds for reasons that I don’t know. Maybe someone will chime in on that. I was on Lipitor (LOL spell-check wants that word to be “Clitoral”!) for a couple of months while I watched my diet and increased my exercise regiment to bring my levels down. But again, that’s something you and your doc should decide.

Have you ever been diagnosed with diabetes? I’m sure you’re aware that the fasting glucose of 100 is high, and you should keep an eye on that. Diabetes can cause ED issues.

Your Cortisol level is probably low (especially if you did the 8am test). Fatigue coupled with insomnia and anxiety and unrefreshing sleep are symptoms of adrenal problems. Getting the 24hr Saliva Cortisol test could be useful in order to get a total picture of your daily Cortisol cycle. Getting this done will also rule out the possibility of Addison’s disease. Link: http://en.wikipedia.org/wiki/Addison’s_disease. Something to look into, especially since you may have diabetes issues, and (as I’ll get to in a second) possibly some thyroid problems - both of which are components of Addison’s.

Another thing that could be causing sleep troubles is Sleep Apnea. Have you been tested? Has your sleep gotten worse since starting TRT? Testosterone therapy can exacerbate Apnea problems. Couldn’t hurt to get tested. It’s a two-part process: First they send you home with a machine you strap to your head, a strap around your chest and midsection, and tubes for your nose. That test shows whether you need to have the in-depth test. The full test involves spending the night in a sleep study center with a bunch of shit taped to your head and body to confirm any presence of sleep disturbances. If you test negative on the first test you won’t need the second, so it’s an easy thing to knock off the list of things that could be causing your sleep problems.

Obviously, cut out caffeine (and any other stimulants) late in the day if you have a habit of evening/night-time caffeine consumption.

I don’t really know a ton about thyroid stuff, though hopefully someone else will contribute. Sorry I won’t be able to give you a thorough break-down of your thyroid results! I do know that having a TSH over 2 indicates that something is going wrong (hypothyroidism), and it looks like your TSH has been getting progressively higher. I hope someone else can chime in on your thyroid scores because I know that having a high TSH isn’t the be-all-end-all, and your other scores will shed some light on what is happening there. For all I know, you could be fine! Thyroid problems can cause libido and ED issues.

You’re going to want to bring your Vitamin D level up a little. 60-plus is the sweet zone, though some say 80+ is optimal. Either way, just make sure you’re getting enough D3, and keep your level somewhere above 60. Don’t expect to see some amazing result from bringing it up from 38 to 60+, though it’s still a good thing to do anyway - give your body what it needs.

Your E2 is probably good, but every “body” is different. Opinions will vary, but most agree that somewhere between the low 20s and the low 30s is good. I keep mine around 23 just for reference. I don’t think you are high, but if you have any/many of the symptoms of high E2 (google it) then it may be worth your while to bring it down a tad. While we’re on the subject, Arimidex can cause some guys to have sexual dysfunction. If, after narrowing down the likely suspects, you feel that it is potentially the Adex causing your ED/libido problems, then it may be something you’ll want to change. Right now you have a ton of shit going on, and attacking the problems one by one is the best thing to do right now. Switching your AI is very low on the priority list at this point as other things demand your attention. That said, keep an eye on your E2 levels, and make sure you are getting it tested at the same interval in your cycle so that you have consistent data.

Someone else will need to expound on this for us: DHEA is directly linked to erectile problems. This is another item that I am not an expert on and hopefully either someone else can say something about it, or maybe your doc knows something about it. I know that DHEA levels can drop as you continue testosterone supplementation and, since you are having ED troubles, I would recommend keeping an eye on it. DHEA is also produced in the adrenal glands, so something may be going hand-in-hand with your Cortisol, but that is just speculation on my part! Progesterone is another thing to look at when assessing ED problems, so you should get that checked out in your next round of testing as well.

Are you sure you have the right range for Hematocrit? My last test had my level at 46.4% with a range of 39-51%, which would have your value of 47% well within range. As would your 49% result you have lower down on the list - which that time it was found to be in range.

Tinnitus (ringing in the ears), huh? There are literally thousands of things that can cause it, but I don’t see anything that jumps out at me that would be the culprit. I’d go see an ENT doctor. I had pretty bad tinnitus a few weeks ago. Turned out to be caused by one of the anti-inflammatory medications I was taking. I stopped taking it and the ringing cleared up about two days later. Since your’s has gone on so long I’m guessing that it isn’t simply a case of something in your medication causing it, so you’ll need a specialist who would know what to test/check.

In short, you’ve just stabilized your therapy at the correct doses and it needs some time to settle. At about a month out you should be seeing most, if not all, of the benefits of TRT. So, at this point you should be seeing a marked improvement in the issues that your low testosterone level was causing, though it can take a little longer in some instances. Any lingering issues are likely being caused by something besides testosterone deficiency. This is a process most of us go through when starting our TRT journeys: We get the testosterone issue fixed, then some other problem comes to light. We fix that and then something else pops its head up. Lather, rinse, repeat! At least you are on the right track and working to figure stuff out. Keep knocking things down, one by one, until you’ve fixed everything that ails you.

If you aren’t going to be getting off TRT in order to see what your “normal” LH and FSH levels are, then I would recommend the following, in no particular order: 1) Labs: 24hr Saliva Cortisol Test, Progesterone, Pregnenolone, maybe DHEA again (and keep tabs on your E2); 2) Follow-up on diabetes; 3) Consider getting a Sleep Study done; 4) Figure out if you have DHEA issues, either here on the forums or with your doctor (if he is competent); 5) Find an ENT doctor for tinnitus; 6) Follow-up on cholesterol; 7) Find out more about your Thyroid; 8) Work on bringing up your D3 levels if you haven’t been doing so; 9) Keep reading and researching other guys’ experiences with figuring out their ED/Libido problems.

Best of luck to ya! Make sure to keep us posted on what’s going on. And, of course, make sure to ask any and all questions you have!

Thyroid labs are mostly good, but TSH is higher than ideal. Are you iodine deficient? Iodized salt?

Your hair losses and dry skin suggest hypothyroidism which the labs do not support. Low T can make skin dry and more.

However, rT3 is a concern and it blocks your fT3 can create symptoms when fT3 is good. You can check your waking body temp and during the afternoon. If temps are low, you probably have functional hypothyroidism. Check the advice for new guys sticky for details.

Your cortisol seems low.

Adrenal fatigue involves lower cortisol levels and increased rT3. See the sticky suggested above.

Start taking 5000iu vit-D3 and a high potency B vitamin multi-vit. Take 500-1000mg vit-C. Take fish oil and/or ground flax seed. You need anti-oxidants too. Take 3mg melatonin in a time release formula. If that is not enough for sleep, Rx 50mg trazodone and expect to need to increase to 75 in a few weeks.

Do not test DHEA, test DHEA-S. DHEA output is variable and it has a short half life, so lab numbers are not truly re presentable. DHEA-S levels are quite steady.

How are your guts? Get a good probiotic from a health food store, preferably one that is in a refrigerate case. The product should include many different bacteria types.

Additional labs: Homocysteine and CRP, concerned about inflammation because of ringing in the ears.

Avoid smoked foods or heavily roasted. Thyme and rosemary on roasted meat can also make ringing of the ears worse.

Thanks to both of you for your insight.

Regarding LH and FSH, the doc office explained that since I was on HCG and very little test (label problem) in July, that I may be primary, as the HCG did not raise up my test numbers. For what it’s worth that is what I was told. I took 250 iu 2x plus per week during that time, so I guess it makes sense. 1 year ago I was sitting at 400 on the test level with a free test of 72 while going to a urologist, after being referred from my third PCP in three years. So at least now I am getting some help.

The office is concerned about cholesterol only because they think the thyroid is causing that and my other issues. They are not statin happy or other drug happy, they try hard to treat the symptoms and take feedback well.

As for the Thyroid, I asked them to review the thyroid tests, and they looked at the T3 Free and Total vs the Reverse T3 ratio and said it is out of whack and I was put on T3 only. That has been for 1 week now. So we will see what happens with the blood work in a few weeks.

Also, taking the minerals suggested and iodine salt, etc.

When new labs are done I will post results.

Thank you again.