T Nation

New to TRT

Ptownmike,
I’ll keep those sites in mind, but really hoping I can talk my doctor into ordering them. Work has a pretty sweet medical center, where all doctor visits, blood draws, most prescriptions, etc are 100% covered, and no co-pay or anything. I have to buy my test from a pharmacy, but injections are free.

Thanks KSman, I’ll check my body temps and post back.

Took my temp when I woke up this morning, and it was 96.1. Took it four times, and it ranged from 95.8 to 96.4, so 96.1 is pretty much in the middle. Will continue taking every 3 hrs, and do this for the next few days.

edit: Here’s how day 1 broke down
8am–96.1
11am–96.8
2pm–96.9
5pm–96.8

First 4 were taken with same thermometer, fourth was with a different one. I’ll post up my temps tomorrow.

Day 2
7am–95.9
10am–96.4
1pm–96.7
5pm–97.2

Based on the above, you have a real problem to investigate.

Now, are you iodine deficient? Iodine in vitamins? Using iodized salt?

There are two points of action, increased iodine intake [iodine replenishment]

and thyroid lab work: TSH, fT3, fT4 maybe rT3

What are your stress levels and major stress events and reactions to those.

Read the advice for new guys sticky and note thyroid and adrenal issues.

This is informative: http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/ksman_has_a_thryoid_problem

Yeah, that’s what I was thinking. Going to set up an appointment with my normal doc (not the one who put me on shots that I’ll be seeing again in December). I don’t take vitamins, and not sure if my salt is iodized or not. Will check tonight. My TSH was tested back when I first went to this doc, and it was 1.4 (Sep 2012). I’ve got some old lab work, and see that TSH was 1.97 in June 2010. I do not have any blood work for the other things you mentioned.

Stress levels aren’t bad (I don’t think). Kids/wife at home, work in IT so job can be stressful at times. I think I handle stress well, and work better under pressure. If I have a really stressful day, I’ll be tired when I leave, but its mostly mental exhaustion. From a physical stress stand point, I generally try to lift at night. I find that I just don’t have the energy to lift, and will be completely exhausted within 20 minutes or so. Not sure if its just because I’m out of shape, or something else. But even when I lift consistently, it didn’t get better. I don’t lift anymore, because I just don’t have the energy it seems.

Read the threads, and think I’ll hold off a bit on the iodine until I can talk to my doc, and see what he says. Would the iodine deficiency cause the low test? So you don’t have to re-read, my numbers were 164 total, 6.2 free in Sept, and 473 total, 16.5 free after 5 weekly 200mg injections.

[quote]KSman wrote:
Based on the above, you have a real problem to investigate.

Now, are you iodine deficient? Iodine in vitamins? Using iodized salt?

There are two points of action, increased iodine intake [iodine replenishment]

and thyroid lab work: TSH, fT3, fT4 maybe rT3

What are your stress levels and major stress events and reactions to those.

Read the advice for new guys sticky and note thyroid and adrenal issues.

This is informative: http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/ksman_has_a_thryoid_problem

[/quote]

Yes, hypothyroidism can cause hypogonadism. In your case, your hypothyroidism is “sub clinical” which means that a doctor will not see a reason to put you on thyroid medications. However, there can be real health issues in the zone of medical inaction/ignorance.

Doctors just do not see iodine as a factor, so you are on your own. They know that lack of iodine causes goiter, but I have never see a report of a doctor been iodine aware. Doctors are drug aware, not iodine aware.

Everyone is using sea salt and sea salt does not contain iodine. A few sea salt products are iodized. There used to be iodine in bread, in the dough conditioners, gone. Restaurants do not cook with iodized salt, perhaps a few do. Do they put iodized salt on there tables? Unknown. Prepared [factory] food is not prepared with iodized salt. So as we eat less food prepared at home and many use sea salt, iodine deficiency [IR] is becoming common.

If iodine was a drug that was patented, drug reps would be promoting it and doctors would learn about it on conferences etc. There is no money in the medical community taking notice.

Iodone is a dietary item, I do not see why you would think that you should ask your doc about this single mineral/nutrient issue.

Iodine can really improve QOL is one is low and the thyroid hormones fall below optimal. What is optimal? The consensus is mid range. Your body can store a lot of iodine and will safely dump the excess. Iodine replenishment [IR] is quite risk free. ID is not.

Thanks for the info. I checked, and our salt does not contain iodine. Sounds like there isn’t much risk to taking it, and my doc probably won’t do anything. I’ll look for some iodine supplements today, and see if it helps. Thanks!

Adults can store 1.0 - 1.5 GRAMS of iodine. Iodine replenishment with 1mg amounts is not very effective. That is where Iodoral can be useful.

Thanks, I’ll start looking for that, and hopefully find some locally.

Edit-Quick search makes me think I won’t find it locally. Amazon sells it in 12.5mg tabs, and 50mg tabs. I see you started at 50mg, then dropped to 25mg. I assume the 12.5mg is what I want, then just take a few per day?

Yes. I started at 50mg because I saw that others did well with that. And I knew that one needs to be prepared to cut back when their body says too. For me it was the disturbed gut function from the iodine killing off gut bacterial to some extent, at least the susceptible bacterial. It would really be wise to get a very good quality probiotic, try to find in a better health food store and the product will have many different types of bacteria. The product should be in a cooler, not the shelf.

One thing that has not been discussed for a while is bromine. The body can absorb bromine and that can block iodine function in various ways. When you take high dose iodine, that will displace bromine that can be excreted and on one’s breath. This increases free bromine in the body and that can may one feel unwell. You then have to tough it out or reduce the impact with a lower iodine dose then take that dose longer.

Might be better to take iodine in more than one dose per day, but for me, I did one dose a day for simplicity.

Thanks for all the help KSman. Ordered some on amazon last night, so hopefully will be able to post back with some initial results next week.

Got the pills in on Tuesday. Took 25mg that day, 50mg yesterday, and 25mg so far today. So far, not feeling any big difference, but will continue on and see. Took my am temperature yesterday, and body temp was in line with what it had been before (around 96).

Well after 3 months of shots, I’m still not convinced they are making any difference. Depression and libido may be better, but if they are, its not drastic. Energy levels are definitely no better, and might even be worse.

Got a bunch of blood drawn today, and have a visit with the doc again next Wednesday. Hoping she either has some other ideas, or will see if she can refer me to a specialist.

I’m starting to suspect sleep issues (as hardasnails called at the beginning). I sleep through the night, and that hasn’t changed, but my wife says I’ve been snoring more lately, and I’m wondering if that could be it. Will bring it up to the doc, and go from there. Just really hoping to get some improvement.

Did you ever get your estradiol (E2) tested? My TT was at 626 and my E2 was 110 and I felt terrible. I’ve been on adex for about two weeks now. I won’t know the actual numbers for a couple more weeks but I can tell it’s already made a difference.

No, when I first talked to the doc about starting the shots (after we got the blood tests back), I asked her and she was pretty against testing it. Said it wasn’t necessary, and if I wanted it tested she’d send me to an endocrinologist. They took a good amount of blood today, but I don’t know what all they’re testing. My main goal for the appointment next week is to get a referral for a new doctor.

Bumping this back up for some updates. Ended up having a sleep study done, and diagnosed with severe sleep apnea. Have been using a CPAP mask since February. I am feeling better, but still no where near feeling good. Not as tired as I used to be, but the rest of the symptoms are still there.

Current TRT is a 200mg shot every other week. Started at 200mg a week, and doc thought my levels were too high (around 800), and changed to every 2 weeks. Even when I was getting 200mg a week, I felt no real improvement. Have had a couple blood tests since changing to every 2 weeks. One time, we drew blood right before my shot was due (so had been 2 weeks since injection), and T levels werein the toilet (sub 200). Had more drawn last week (1 week after injection), and levels were around 340 (will get results tomorrow when I talk to doc).

I really suspect my E2 levels are elevated, as I’ve just never really felt like the shots made much difference. I’m going to ask if she has any other ideas tomorrow, and if not, see if she can refer me to someone else. Any one else have ideas? I’m really tempted to pick up some Anastrozole, and start at 1mg per week, just to see if it helps.

Talked with the doc a week or two ago, and not much change. She has adjusted my dosage to 120mg a week. Told her after 9 months of being on this, I still had 90% of my symptoms, and still felt like this wasn’t really working. She said one option was to stop the treatment, and see if things stay the same (which is crazy to me), and I asked if she could refer me to someone else.

She wanted me to start exercising again (I had quit months ago due to absolutely no energy), and if that doesn’t help, she’ll send me to an endocrinologist. I have follow up blood work on the 22nd, and talking to her on the 30th.

Started working out again last week, and so far, can’t tell any improvement (although I have noticed I’m more tired at the end of the day than I had been). I went ahead and ordered some liquid arimidex last week, and should get it tomorrow. Right now, I’m trying to decide if I should start dosing (1-1.2mg a week), and see if it helps, or if I should hold off until I meet with the endo. A big part of me says start dosing, as I’m really tired of this shit and would like to get better. But part of me also thinks maybe the endo won’t be a moron, and will do the right things and I can medicate legitimately. I just don’t want to start taking it, see improvement, then meet with the doc and if they do test E2, other things, my levels be artificially off.

Would I be able to dose arimidex for a week or two, see if it helps, then cut off it before blood work on the 22nd?

So no thyroid labs? Many of the symptoms of low T are common to [subclinical] hypothyroidism.

Need E2 labs.

You need to do some more reading:


This is standard advice maintained here:

There is a huge amount of knowledge in the stickies. Please study these. Start with the advice for new guys sticky.


There is a lot to read there, so read carefully. There are suggestions for things that are root causes of low testosterone [T]. Low T is a symptom, not a root cause itself. But low T itself is a root cause of many of the symptoms one experiences. Note that other things cause the same spectrum of symptoms, so do not have T tunnel vision. Many docs are guilty of that and they only treat the symptom [low T] and do not attempt to find the real problem. If you go to a clinic that specializes in low T, you will get T tunnel vision for sure.

Post info about yourself as suggested in the above sticky. We need labs, almost all of your labs, not just hormones. We also need the lab ranges.

We see a very high number of thyroid issues in the population of guys that show up here. So there is a strong focus on that. Most people are iodine deficient to some degree. Your history of iodine intake from iodized salt and vitamins that list iodine is important. If you become iodine deficient, the RDA [recommended daily allowance] is inadequate for recovery of iodine stores. Please see the thyroid basics sticky for more information.


You do not want to suffer from subclinical hypothyroidism or get Rx thyroid meds to treat iodine deficiency.

If you are injecting T or contemplating that, read the protocol for injections sticky.

There are stickies for finding a TRT doc, estradiol [E2] and lab work.

Do not place your history or treatment details in the stickies! That belongs in your thread. Keep all of your posts in your thread so we can have a clear picture of your situation and needs.

[quote]KSman wrote:
So no thyroid labs? Many of the symptoms of low T are common to [subclinical] hypothyroidism.

Need E2 labs.

[/quote]

Doc was insistent about not checking E2, as she didn’t think it was necessary. She did basic thyroid testing, pretty sure I posted the results earlier.

I started taking liquid arimidex last week. Taking .4 ml three times a week, so total of 1.2ml per week in conjuction with 120mg of testosterone a week. So far, have not noticed any difference. I have more blood work scheduled for the 22nd, then doc visit on the 30th. At that point, she’ll refer me to an endocrinologist, and I think I’ll stop taking the arimidex then, that way if the endo does an E2 test, the results should be accurate.

Little bit of an update, and asking for some help. Ended up finally seeing an endocrinologist at the beginning of last November (4 month wait to get in). He said since I had been diagnosed with sleep apnea after starting shots, there was a chance that just treating the sleep apnea would take care of the testosterone. If not, he would do more blood work.

Stopped taking the shots (and felt no difference not taking them as taking them), and about 6 weeks later got my levels tested again. Of course, they were still really low, so then he had me take a boat load of tests (of which I never have gotten the actual results to look at for myself). My IGF-1 levels were a bit elevated they said, so they had me take a glucose suppression test. Took that, and results came back perfectly normal. At this point, the endo just said to resume the shots (at 100mg a week), and they would test again in a month. Had that test last week, and my levels came back at 350. Nurse that called said that was normal, and that was it. Asked to talk to the doc, as my general practioner had sent me to him after a year of feeling no improvement in symptoms, and wanted to know what to do next (as staying the course wasn’t acceptable). Now I’m waiting for a call back to see if he has any next steps.

Feeling extremely frustrated by all of this obviously, and would like to find a new doc, preferably one who specializes in this. If I can get to talk to the endo, I’m going to ask again for an E2 test (during meeting in November, he said it wasn’t necessary). The CPAP machine has helped a little. When I started all this, I was exhausted by the time I left work (office job), and any physical activity completely drained me. Now, I’m just tired all the time (but not super exhausted like before). Minor physical activity is Ok, but when I tried lifting regularly, I never could recover and just ran myself into the ground.

Anyone know of a good doc in the Indianapolis, IN or Cincinnati, OH area?