T Nation

Newbie Help. Brain Fog, No Interest, Lethargic


#1

Hello, Im 33 yo male and I have had a rough time lately. In early November I was having testicular pain and in the general area. After many trips to the Doctors/ER all they could find was some minute varicose. By this time I was so worked up my PCP prescribed me with Ativan. I had several family issues come up during that time as well which were very stressful. The ativan did not seem to help. I was on it for 2.5 months with a 3 week taper. I have been off of it for 8 weeks now. I had many issues while on it and off of it.

I am still having issues with brainfog, insomnia, energy, drive to do things, anxiety/depression, appetite and poor sex drive. I have been using sleeping aides off and on a very low doses. I have not used them for a few weeks now and my sleep is still not what it used to be. I also saw a psychiatrist during that time and did not think i was a candidate for an anti-pyscotic which was good news to me. I have also been going to therapy once a week since this all started and it doesn’t seem to help but it is nice to talk to someone without criticism.

After being off the ativan and still feeling symptoms I started to find that my symptoms were symptoms of low-t. I then sought out an endocrinologist. I had all the proper blood work done as follows. My PCP did prescribed me Testim I have not used it yet due to the end saying hold off until the test results come back. The doctor gave me two choices of injections/w AI or climid. He prefers the injections because of all the problems he has had with the use of clomid. He even calls me daily to see how I’m doing and talk for 45 minutes. What should I do?

REE T4 1.33 ng/dL 0.82 - 1.77 ng/dL
HEMOGLOBIN A1C 5.7 % 4.8 - 5.6 %
Vitamin D,25-Hydroxy,Serum 49.8 ng/mL
TSH 2.690 uIU/mL 0.450 - 4.50 uIU/mL
FSH 3.1 mIU/mL 1.5 - 12.4 mIU/mL
LH 1.6 mIU/mL 1.7 - 8.6 mIU/mL
PROLACTIN 7.2 ng/mL 4.0 - 15.2 ng/mL
TESTOSTERONE, TOTAL 267 ng/dL 1st test
TESTOSTERONE, TOTAL 222 ng/dL 3 days later
VITAMIN B12 527 pg/mL 211 - 946 pg/mL
CORTISOL - AM 15.9 ug/dL
TSH PM 3.770 uIU/mL 0.450 - 4.50 uIU/mL
Estradiol 13.5NORMAL Reference Range: 7.6-42.6 pg/mL
Prostate Specific Ag, Serum 0.3NORMAL Reference Range: 0.0-4.0 ng/mL
Triglycerides 156HIGH Reference Range: 0-149 mg/dL
HDL Cholesterol 38LOW Reference Range: >39 mg/dL
LDL Cholesterol Calc 127HIGH

All my other blood work came back normal.


#2

Please provide with ranges if available:
hematocrit
RBC
hemoglobin
ferritin
serum iron
blood pressure

Your fT4 looks good, but TSH is high.
TSH should be nearer to 1.0, the ranges are bogus

FT not tested, but low E2=13.5 indicates low FT and/or low SHBG.

Many with symptoms of low-T are attacked with brain meds.

Low thyroid function is also depressing. Please see last paragraph in this post to self-eval.

You may be iodine deficient. Do you use iodized salt? Iodine is part of your thyroid hormones.

Stress can ruin your hormones, increase rT3 that interferes with fT3. Adrenals are stressed, cortisol gets high then falls later with adrenal fatigue. Your AM cortisol is currently good.

Ask for:

  • self inject 50mg T cyp/eth twice a week with #29 1/2" 0.5ml insulin syringe, inject SC/SQ not IM
  • 0.5mg anastrozole at time of injections
  • 250iu hCG SC/SQ EOD to preserver testes, also many find good for mood

Inject SC/SQ over top of upper legs where you can see and avoid veins. Pinch up skin and inject into end of fold, needle parallel to tissue underneath. After injecting, press on injection site for 10-15 seconds to allow

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

  • advice for new guys
  • 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.


#3

Thank you for your reply!

Hematocrit 43. 35-51
Rbc 4.56 4-6
Hemoglobin 14.2 12-17.7

Rbc and bp are perfect! I do use salt and I live in the us so that’s what we use here!

I was injected with 120 units of tc yesterday! Along with .33 of an ai!

Will tc help get my adrenal glands in check eventually?

I feel hot today and still a little spicy with no energy?

Any suggestions?


#4

Many in the U.S. use sea salt or discover that they purchased non-iodized salt from the same shelf in packaging very similar to iodized salt. In USA table salt does not need to be iodized. In Canada, table salt must be iodized, but specialty salts like sea salt do not.

Your TRT benefits can very easily have a heavy lid holding them done from thyroid issues.

HTC, RBC and hemoglobin are a bit low, but typical for a low T state. TRT will change this. Need to monitor as some TRT guys get problems with high numbers.

Thyroid health is more complex than TRT. Symptoms of thyroid issues are mostly the same as low-T.

120 units of T cyp? That would be 120mg and you should refer to that in mg’s and not volumes. If 120iu on an insulin syringe, that could be 240mg of 200mg/ml T cyp.

TRT may settle you done. But you really must attend to the thyroid issues that I presented to you. Get and post those body temperatures.


#5

What do mean by heavy lid? I do use iodized salt. Yes it was 120mg. Do the temps have to be under the arm pits or can it be oral? Is it too late to stop trt and start a clomid regimen? Would I have to use hcg at this point ?


#6

Heavy lid, as in holding you down, reducing energy/vitality, mood and libido. When guys are on TRT and feel great then develop thyroid issues, they really loose a lot of benefits. If you start TRT with thyroid problems your improvements are limited.

Please respond to other points/questions and post those oral body temps, AM and mid-afternoon.


#9

My temps are right around 98 throughout the day. I am going to get lab work done next week per the tests you suggested and some more. Should I not take the AI until I get the free E checked?


#10

@KSman ok I saw a different endo two days and and she suggested clomid instead of t replacement! I’ve had three injections so far at 140. She said that is too high of a dose to start out with. Is it too late to turn away from t injections and start on clomid she wants me to do it 3 times a weeks and week?!?! She also ordered iron tests and testosterone level tests as well. What should I do? I am very confused! Please advise!


#11

There is no point in checking T labs now if protocol is changing.

Clomid dose should be 12.5 or 25mg EOD, 3.5 times per week or three times per week.

On clomid, test:
TT
FT
E2
LH/FSH <-- the direct effects of clomid

If you feel horrible on clomid, can happen fast, you need to ask to switch to Nolvadex 20mg which does not do that. 20 or 10mg EOD or three times per week.

If clomid works, your fertility and testes are protected.

Temperatures near 98.0 are a problem.

One tests E2 - estradiol.
What is free E

You are not getting enough iodine or perhaps you should get thyroid auto immune panel, or double check your salt container.

You have to decide if you have a protocol problem or a doctor problem.


#12

@KSman I just got my iron panel back and they are:
Iron: 97. 65-175
Ferriton: 174. 20-274

Day after injection:
Ft: 31 3.50- 15.50
To: 1224 174-781

I will ask for thyroid immune panel. I am still very anxious and wake up way too early and do not feel well rested. The depression and brain fog have gone away the last few days. So that’s a plus! I feel that this level of t is making me super anxious and uneasy. Should I do the clomid since I believe low t came from a stressful event or just drop the injections down? If I drop the injections down how fast can I do it?


#13

Please provide more info re “right around 98”

Please keep your “case” in this one thread. Multiple threads will cause problems as your labs and other discussion will become unusable for context.

Please read the HPTA restart sticky.

You need to read the stickies suggested earlier to understand things better and make informed decisions. You cannot be passive with your hormone care.


#14

They are 98.6+ when ever no visit the doc! He agreed to a thryroid antibody panel today and had some blood drawn along with shbg and others! Should he be checking the estradiol every time I go in?


#15

Labs are often done every 3 months until doses are adjusted, then every 6 months can be adequate if there are no other issues.

Thyroid auto-immune problems can be from selenium deficiency.

Did you double check your salt container? Packaging is very similar.
Have you been checking body temperatures at home, when you wake up to get your low and mid-afternoon to get the high? Should be resting and calm, avoid drinking, eating or talking for a while.


#16

Yes the salt is iodized. I will need to invest in a better thermomenter I don’t think mine is accurate. My doc is also lowering my t injection dose to 120 weekly and then 100 next week. I was feeling too amped up. Does that sound feasible?


#17

If someone else hits 98.6F/37C on a thermometer, you have a level of confidence.


#18

@KSman The temps are good. I had a thyroid panel and autoimmune panel done and should get results tomorrow. I also had my lh and fsh tested as I am moving over to clomid after having second thoughts on T injections and the lifetime commitment of it and me being so young! Should I be ok switching over to clomid after three test c injections? How soon after my last injection can I start the Clomid? Do you think this is a smart move?


#19

You can do that and TRT is a future option if needed.

Please review my comments 7 days ago re clomid.


#20

Just had these checked. My system already almost shut down after 3 injections. I’m going to start clomid asap. ?!?
Test Name
Result
Flag
Reference
FSH
0.09 miU/ml
L
0.95-11.95
MALE 0.95 - 11.95 mIU/mL
NORMALLY MENSTRUATING FEMALES
FOLLICULAR PHASE 3.03 - 8.08 mIU/mL
MID-CYCLE PEAK 2.55 - 16.69 mIU/mL
LUTEAL PHASE 1.38 - 5.47 mIU/mL
POST-MENOPAUSAL FEMALES 26.72 - 133.41 mIU/mL

LH
10May2017 03:01PM
SURYADEVARA, SREENIJA
Fasting Status: …

Test Name
Result
Flag
Reference
LH
< or = 0.07 miU/ml
L
0.6-12.1
NORMAL RANGE
MALE: 0.57 - 12.07
NORMALLY MENSTRUATING FEMALES:
FOLLICULAR PHASE 1.80 - 11.78
MID-CYCLE PHASE 7.59 - 89.08
LUTEAL PHASE 0.56 - 14.00
POST MENOPAUSAL FEMALES (No HRT): 5.16 - 61.99


#21

I’ve done one week of clomid and my anxiety shot up like crazy! Do I really need to do a clomid restart with just 3 injections?