T Nation

NHS Follow up After T Gel First Month

Hello

I am new to this forum. I’ve been using T gel under NHS prescription as had low T calculated Free T but normal LH.

Initlally symptoms improved with better concentration and less fatigue. Now though I am tired all the time and have the old problems in thinking and concentration again.

Follow up appointment on Wednesday morning when I get the test results back for Vit D, Testorone and SHBG.

They didn’t test for E2 which is something mentioned on this forum - can they do this in the UK - I am in Winchester area?

Any advice as to what questions I should be asking or additional tests requesting. I privately did saliva Cortisol which came out normal on the profile and saliva testosterone which was very low before I started treatment.

One nipple is a bit tender in the shower. This could be from running abrasion but I’m not sure if something to do with hormones. Only one seems odd though.

Any help or advice hugely appreciated.

Might want to have them do a full thyroid panel- T3, rT3, T4, TSH next time as well since hypothyroid can mimic symptoms of low t. Wouldn’t hurt to check prolactin levels either since hyperprolactinemia makes some people fatigued and can cause nipple issues. You may have to order E2 test online out of pocket if the NHS won’t do it.

Thanks for the reply and help. Can you recommend a good place to get E2 tested? I will try and get what I can out of the NHS but will know more after the appointment tomorrow. Maybe I am not absorbing the gels.

You would just have to do a web search for “buying lab tests online in the UK” (if there are any?). Try to find one that has “doctors” on staff to order the tests, otherwise you would have to get your NHS doc to write a script for whichever tests you request and call/send it in to the online lab. As an example, here in the US there are several “online” labs to look at as a model for what you need there- PrivateMdlabs and LEF.org are two of the popular ones. You order whatever tests you want and their staff “doctors” authorize the lab work, which you have done at labs specified by them. However I have no knowledge if that’s something you can do in the UK or not. Good luck.

Please read the stickies. There is a lot of material there for you. Note issues with iodine and thyroid.

T gels create the largest amount of E2/estradiol of all of the T delivery methods, injections the least when done right.

Low cholesterol? Extreme low fat diet?

Hypothyroidism:
-many symptoms same as low T
-can reduce T levels
-blocks transdermal absorption of T

Some never absorb transdermal T, some do for a while, then that stops. So not viable for some at all.

What is normal LH? Post lab results with ranges.

Thank you all for the replies and advice. These forums are so useful for gathering information although the volume is a bit overwhelming. I am gradually improving my understanding. The advice from the Endocrinologist was that the T Gels looked like they were working but that my symptoms could take 6 months from start of treatment to improve. This sounds odd as I had fairly fast improvement but then a dip after a few weeks. Here I my blood results - the first number is before treatment, the second is after using the T gel for 4 weeks and the lab ref range in brackets.

A bit annoyed I didn’t get SHBG or Free T numbers as, although they were on the form, the lab didn’t test them - apparently they only do that if the T comes out low. Also I think Prolactin was on the form but didn’t get tested. The doctor did agree to an oestriodol test which I had yesterday and will get back in a week.

Also getting a bone density scan (DEX?) sometime. 4 month blood test done with Testosterone, Oestradiol, LH, FSH, renal, bone, hepatic and thyroid and follow up appointment.

Does this all sound and look as expected? Anything else I should do now other than be patient? I am going to try some nettle root and resveratrol supplement for a couple of weeks to see if that helps the symptoms. I really need my body to fire up again. It feels switched off.

All help and advice much appreciated.

Serum free T4 Level 9.3 10.5 pmol/L (7.5 - 21.1)
Serum TSH level 1.99 2.75 miu/L (0.345 - 5.6)
Serum Cholesterol/HDL rati 2.7 2.3
Serum Cholesterol 4 3.7 mmol/L (2.5 - 5.2)
HDL Cholesterol unknown 1.6 mmol/L
Triglycerides unknown 0.5 mmol/L ( - <1.95)
LDL Cholesterol unknown 1.9 mmol/L (2 - 5)
Serum inorganic phosphate 1.16 0.97 mmol/L (0.78 - 1.53)
Corrected serum calcium level 2.15 not tested mmol/L (1.8 - 3.5)
Serum calcium 2.25 2.32 mmol/L (2.15 - 2.6)
Serum bilirubin 18 20 umol/L ( - <20)
Serum globulin 24 25 g/L
Serum albumin 44 45 g/L (35 - 48)
Serum total protein 68 70 g/L (61 - 79)
ALT/SGPT serum level 17 22 iu/L ( - <45)
Serum alkaline phosphatase 46 49 iu/L (46 - 111)
Serum creatinine 73 69 umol/L (57 - 113)
Serum urea level 3.9 4.3 mmol/L (2.9 - 7.1)
Serum potassium 4.6 4.2 mmol/L (2.5 - 6.5)
Serum sodium 140 140 mmol/L (120 - 150)
Vitamin D 80 161.1 nmol/L (72 - 374) Supplementing 4000iu day
Testosterone 8.9 14.8 nmol/L (10 - 35)
LH 5.5 0.3 iu/L (2 - 9)
FSH 3.1 0.3 iu/L (1 - 18)
Prolactin 111 not tested
Free testosterone 189 not tested pmol/L (>220 - )
PSA 0.7 0.8 ug/L ( - <3)

Other info about me. Age 46, 177cm tall, 67kg and 14% body fat. Before getting ill last winter I was normally 62 - 63kg and around 12-13% body fat. I did run up to marathon, cycle, strength train and practice Tae Kwon Do 3 times a week.

If you have experienced some bone loss, the ‘fix’ would be TRT, sort of making the test of little value.

What are your waking and mid afternoon body temperatures? C&F please.
Using iodized salt?
Iodine in your vitamins?

fT4 midrange would be 14.3, your 9.3 is only 65% if midrange. So that is low and that is consistent with what your TSH=1.99/2.75 is saying. So there are two implications with that data. You are iodine deficient or your thyroid function is otherwise not what it should be. In the search box at the top of the screen, enter “KSman has a thyroid problem”.

It seems very odd, that so many of the guys here with low T have thyroid problems. Makes me sound like broken record.

Thyroid problems can lower T.

I would skip T-gels as guys with thyroid problems are famous fro not been able to absorb transdermal T. So much so that I wonder if it is universal. Your response is only mid range.

Thanks KS

I have ordered a new thermometer as the old one i have I don’t think is very accurate. It came out at 35.8 C (96.4F) on one underarm reading going up to 36.2C (97F).

My latest T4 was 10.5 the 9.3 was before starting T Gels. Looking back at a check up test from 2007 was 9.5 then so the latest reading is my best one yet.

My multivit has the RDA for iodine in it and I don’t use salt. The salt we have is not iodised. I didn’t even realise you could get it and our supermarket doesn’t sell it but other do in the UK. My diet would not include any other iodine.

Looking at the other thread you linked to I may try some kelp tablets at say a level that gives me 6-7 times the RDA rather than the massive amounts you took. I have to admit the farting is a concern!

Thanks again for your post. I’ll update when I get the new thermometer. BTW I do always feel cold especially hands and feet even when wearing twice as many clothes as other people.

Check and report oral temperatures. With lower level iodine doses, IR can take a long time.

Do not take iodine with a highly starchy meal.

People used to get goiter and mental retardation from low iodine intake, iodized salt has been introduced all over the world to prevent this.

Thanks again KSman. Will to the temp thing when the new thermometer arrives. INteresting advice not to take iodine with highly starchy meal. I could not find more info on this in the forum or web - do you have a source or link you could share with me.

It also got me thinking about other supplements. Maybe this has been discussed already but a sticky with a list of common supplements and how best to take them eg time of day, with or without food or types of food, with or avoiding other supplements at the same time would be useful. Prob done already in some way but I couldn’t find it.

Iodine binds to starches, and what I read suggested that the absorption of the iodine might be impaired. The mineral is still there. If the starches are completely broken down, then all of the iodine might be available for absorption. However, iodine bound to indigestible fiber may be another situation. There is not much data an internet searches hit a lot of major noise. There are some suggestions that iron and iodine do not play well together, but very few people take iron supplements.

New thermometer arrived and as it turns out the old one was not dodgy.
Took 6-7 times iodine RDA for a couple of days and today about 12 times from kelp tablets.
3pm temperature 36.4C (97.5F) which is about normal I think. Quite often is is under 36C though (96.8F) which sounds low.

Now have my oestradiol results telephoned through to me. I didn’t get the units which is a bit confusing based on looking at some other stuff.

My result 73 Range per doctor is anything under 172. I asked what the bottom end was but the doc said there wasn’t one.

Does this look ok with my testosterone at 14.8 nmol/L (range 10 - 35) ??

Currently using (but not at time of blood tests) nettle root 2 or 3 times a day at 500mg, resveratrol just started today at 200mg day.

Any advice appreciated.

http://www.unc.edu/~rowlett/units/scales/clinical_data.html

E2=20pg/ml, a good number! Your issues are not E2 related.

TT=426 mid range

How many mg’s of T are you applying to your skin. Normally we would see around 100mg, hoping to absorb 10%.

If you increase T dose, E2 will increase.

Thanks KSman. I already tried to reply to this the other day but something must have happened to the post as it has disappeared.

I am applying 50mg. The doctor is happy with that level. I wondered whether I could increase this very occasionally to 100mg on days where I felt bad or if that would have a detrimental effect eg lead to higher shbg or E2 which remained after the T got used up.

I don’t want to increase T then end up with higher SHBG because of that and be left with SHBG when reverting to the normal dose. I can’t find anything on that approach on these forums or web.

Does E2 hang around in the body longer than T? If so this could be another reason for not varying the dose.

From what we see with guys who inject one a week, it seems that T clears and E2 remains and that is accepted as the reason why some guys doing things that way feel worse off then before TRT. Everyone is different, so there results are very much a result of the individual.

Many will not do well on 50mg and that will deliver only about 1/2 of the testosterone that is needed.

T-gels increase E2 more than any other delivery method and thus will increase SHBG more than any other method.

Latest lab results showed T level at 1.1 (10-35 range). I made the mistake of getting blood test done before using gel that morning. Doc not happy with me I think. He is now talking about using Nebido injections every 12 weeks. I suggested getting another test done for T that afternoon and he agreed to that. My only worry is that will come back low as well.

I would prefer doubling the gel dose as my E2 does not seem to be a problem. That came out at less than 73 with anything under 172 being OK. Symptom wise I am improved but not back to normal activity levels without experiencing tiredness. My gut tells me a little bit more gel would be fine for me and injections every 12 weeks could be a problem with fluctuating levels.

I know people have problems with E2 with gels but it doesn’t look like is an issue for me.

Anyone else been in a similar situation. Any good arguments to present to the doctor against using Nebido?