No Difference Since Starting TRT

Pharma / TRT Testosterone Replacement
1

Age - 36
Height - 6 2
Waist - 40
Weight - 275
Describe body and facial hair. Very little body and facial hair. Cannot grow beard or goatee.
Describe where you carry fat and how changed. Have always carried fat in abdomen and love handle. Over past two years started gaining fat in chest.

Health conditions, symptoms. Diagnosed severe sleep apnea 8 years ago. Had tonsils, adenoids, and uvula removed, along with deviated septum to open airway. No CPAP. Past two years low energy especially in afternoon , no libido, weight gain , moody , irritability, mild depression, poor memory and concentration. Since starting Test in October 2012 I have noticed a small increase in libido though most of the other symptoms have not improved enough to make me think the Test has made a difference. See Doc again on 11/30/12 to go over Blood drawn on 11/12/12. Will post that data once available.

Rx and OTC drugs, any hair loss drugs or prostate drugs.No Hair loss or prostrate drugs. After 9/4/12 Rx
10% compounded cream I believe 30mg per day.

OTC
Been taking for several years.
Multivitamin (contains 150mcg Iodine)
1400mg Fish Oil

Started taking the following with TRT

3000IU Vitamin D
25mg DHEA
2500mg B-12
250mg Magnesium

Lab results with ranges ( before supplements)
Test Unit of Measure Range Result

9/4/12 @ 11:55 Am Non Fasting

E1(Estrone Serum) pg/mL 12.0-72.0 122
E2 (Estradiol) pg/mL 7.6-42.6 <5.1
LH mIU/mL 1.7-8.6 3.1
FSH mIU/mL 1.5-12.4 6
Testosterone Serum ng/dL 348-1197 262
Free Testosterone (Direct) Specimen Lipemic
Pregnenolone, MS ng/dL Adults <151 12
T4, Free (direct) ng/dL .82-1.77 1.07
DHEA Sulfate ug/dL 88.9-427 222.4
Cortisol ug/dL AM 6.2-19.4 11.7
PM 2.3-11.9
TSH uIU/mL .45-4.5 2.58
Prolactin ng/mL 4.0-15.2 6.1
Androstendione ng/dL 44-186 93
IGF-1 ng/mL 69-226 133
Vitamin D 25 Hydroxy 30.-100 21.5 L
Thyroid Stim Immunoglobulin 30.-100 32%
Thyroxine (T4) ug/dL 4.5-12 5.6
Triiodothyrine (T3) ng/dL 71-180 100
Vitamin B12 pg/mL 211-946 424
Thyroid Peroxidase (TPO) IU/mL 0-34 8
Antithyroglobulin 0-40 <20
Triiodothyrine (T3) Free Serum pg/mL 2.0-4.4 3
SBGH nmol/L 16.5-55.9 37.6
E1(Estrone Serum) pg/mL 12.0-72.0 122
E2 (Estradiol) pg/mL 7.6-42.6 <5.1
LH mIU/mL 1.7-8.6 3.1
5/21/12 @7:30AM Fasting
Cholesterol, Total mg/dL 100-199 172
Triglycerides mg/dL 0-149 349
HDL Cholesterol mg/dL >39 31
VLDL Cholesterol mg/dL 5.0-40 65
LDL Cholesterol mg/dL 0-99 76
Cholesterol, Total mg/dL 100-199 172

Describe diet. Normal diet. Meat and potatoes kind of guy. Very little veg and some fruit.
Describe training. Weight training 3-4 days a week. My work requires a couple mile a day walking and some manual labor.
Testes ache, ever, with a fever? No
How have morning wood and nocturnal erections changed - Occasional morning wood over the past two years.

2

Are the labs before you started the supplements?

Try to get 5,000 iu vit D next time and take it at night with a fat containing meal. On those labs your b-12 was below optimal, get a coenzyme b complex next time, B’s work in conjunction, 25 of magnesium is low, a full spectrum mineral supplement would help you more since it contains more things like zinc. No need estrone just E2 estradiol. You’re low on HGH and your TSH is nearly at 3 which means you may have a thyroid issue, if you do, you wont absorb creams very well. Creams are crap anyways switch to injections. what is your iodine intake like? check your body temps log them and post them.

3

Tuna,

All labs were done prior to supplements except a multivitamin and fish oil which I have been taking for several years now. I see doc again next week and we will go over recent blood work drawn last week. I will post those once available. Thanks for taking the time to look at things. I will also start taking temps and posting.

4

If you recently started the vitamins, you were not getting the iodine. We also need to know if you use iodized salt. Sea salts does not contain iodine and prepared foods and restaurant fool is rarely made with iodized salt.

Review issues in the advice for new guys sticky:
-body temps
-iodine
-TSH, fT3, fT4, rT3
-skin, hair, nails

Your T4 and fT4 are lowish, making sense with TSH, suggesting possible iodine deficiency.

Low T and low thyroid status both tend to make one fat. And that contributes strongly to apnea.

If you find that you are hungry at night, that can make you fat. A common cause for that is a hiatal hernia, which is quite common. Leading cause is pregnancy/delivery and being overweight. If you have heart burn, that is a sign of the hernia. Surgical correction is not something that you want to go near! If you loose weight, these two conditions can be improved. If your thyroid status is improved and you restore T to youthful levels, this will greatly facilitate weight loss.

You need to fix your diet and eat green veges.

E1 is rarely looked at with men. With low E2, high E1 does not make any sense.

Vitamins should be high potency B-complex, to compensate for diet and increase HDL.

AM cortisol is marginal, sort of at bottom of healthy range.

5

Ksman

Thank you for all that you do here to help others!!

I typically do not add salt to my meals. Whatever is contained in the good from processing is all that I will ingest. I will take temps four times daily for awl and post. I started taking supplements and TRT at the same time about 2 months now.

I find myself craving carbs in the evening more than anything. Don’t have any symptoms of hernia other than being overweight.

One thing I have notice is I seldom have energy to Complete a moderate workout and I don’t recover very quickly. This was never a problem before only the past couple of years. I know what is required be in better shape it just doesn’t seem to make a difference anymore.

6

The only symptom of a hiatal hernia for most is heart burn to a greater or lesser degree. The heart burn can be minor, but interpreted as hunger. This leads to eating in the evening. A ‘sliding hiatal hernial’ restricts the top of the stomach and there is not part of the stomach that is permanently above the diaphragm. But the function of the lower esophageal sphincter is compromised and acid gets where is should not be. You do not know that you have this hernia unless you have anesthesia and endoscopic examination. So you cannot say that you not have any symptoms. Eating in the evening is a symptom. I am only pointing out a possible factor in your feeding habits.

Processed foods do contain salt, but not iodized salt, so this is not an a source of iodine.

Your TSH is elevated. Your T4 and T3 are well below mid range.

Two months of 150mcg iodine will hardly have any effect on iodine deficiency. So at best, you would be treading water.

Test fasting glucose next time.

7

So I have taken for temp a couple of days now. Early morning temps are consistent at 96.1 over three days, slowly increasing to 97.9 by mid afternoon. I am starting to think a combination of adrenal fatigue and thyroid issue. One thing I didn’t mention as I did think it was related but may be. Past couple of years when I wake I have the feeling like mucus is stuck in my throat. I make a good effort to clear but nothing really comes up eventually after a shower it will subside.

When I joined the Corps during basic training I lost over 40 lbs in a three month period. I had been training to play college football when I choose to join at the last minute. I had excellent initial fitness scores though they got worse as time went on through basic which is typically not they case. I was very sick and run down when I came out. Felt better when I put on 15 during leave. Could I have Damaged my system to a point where I am now really feeling the effect?

8

Your adrenals may not have been able to keep up with the stress and a thyroid problem would certainly be a stress. Extreme weight loss is very stressful.

How do you react to major stress situations, mental or physical?

Is your thyroid gland enlarged, asymmetrical or lumpy? Does your neck look thick there?

9

I have not noticed anything abnormal in the neck. I have always had a large neck (18-19") in my adult years. Will definitely have Doc look at it Friday. I plan to start an iodine supplement this weekend. Any particular product that I should consider? I should have mentioned that the extreme weight loss was about 15 yrs ago not sure it relevant or not at this point. Just something that came to mind. I typically handle stress pretty well. Though past few yrs seems to make me tired. Don’t recover we’ll from serious workout. Can take 5-6 days to recover from a single body part workout. It wasn’t that way 4-5 years ago.

Life in general has been pretty stressful past three years. Job loss , baby, financial likely these things are starting to catch up with me?

10

Your AM cortisol is not great and you seem to be describing a situation where adrenal fatigue may be at play. If so, we could expect that rT3 is elevated which blocks fT3.

You may find this helpful: http://www.amazon.com/Adrenal-Fatigue-Century-Stress-Syndrome/dp/1890572152
And may find that it seems to be describing your situation.

Iodoral 12.5 mg. Most need to get that on the WWW. A good health food shop might have iodine drops that are potent. Note that the RDA 150mcg is .15mg

11

I went in to see Doc on 11/30/12 for follow up with blood work on 11/12. I could hardly get a word in as all he wanted to talk about was how high my Triglycerides and Cholesterol were. Admittedly they are high but nothing a revised diet and cardio canâ??t fix. He refused to consider thyroid or adrenal fatigue as a reason why I have not responded better to TRT. He did up my compounded Gel to 100mg/mL with sic clicks daily with a Topi Click, and said to come back in six months which seemed like a long time t me. Not sure if he is trying to blow me of or if he actually has a plan and just failed to communicate it. When I asked about injections he said I wasnâ??t a good candidate without any real explanation other than referring to the Trig and Cholesterol levels. He did indicate he has other patients on them.
My plan going forward is to increase my cardio and go back to a Protein based diet similar to South Beach to bring Cholesterol and Triglycerides back in line. Increase Fish Oil to 2800mg daily, add Iodine supplement,add another 2,000 iu Vit D and then ck Blood in 6 weeks. Should I consider a 4x saliva Cortisol Test? Am I missing anything here? I
New Supplements will be
â?¢ 2500 mg B 12
â?¢ 2800 mg Fish Oil
â?¢ 5,000 Iu Vit D
â?¢ 250 mg Magnesium
â?¢ 25 mg DHEA
â?¢ Iodoral
Labs taken on 11/12/12 Fasting @8:30am
DHEA Sulfate 88.9-427 ug/dL 324.9
Testosterone Serum 348-1197 ng/dL 489
Free Testosterone (Direct) 8.7 - 25.1 pg/mL 14.9
E1(Estrone Serum) 12.0-72.0 pg/mL 74
E2 (Estradiol) 7.6-42.6 pg/mL 32.2
FSH 1.5-12.4 mIU/mL 4.8
LH 1.7 - 8.6 mIU/mL 3.9
Cortisol AM 6.2-19.4 ug/dL 14.6
Vitamin D 25 Hydroxy 30.-100 ng/mL 35
Vitamin B12 211-946 pg/mL 859
Cholesterol, Total 100-199 mg/dL 223

12

Vitamin B12 211-946 pg/mL 859, why add 2500 mg B 12 and 2.5 grams is obviously wrong

E2 (Estradiol) 7.6-42.6 pg/mL 32.2, too high and increased T will increase E2. Did you discuss E2. You need to have printed talking points when you see the doctor. One copy for you and one for him. Keep him on track with your list. Many are forced to self medicate to control E2. E2 promotes endothelial cell dysfunction [aka heart disease, high BP]. E2 is thought, by those who bother to read medical research findings, to be the major cause of prostate problems. E2 rots your brain.

T gel or T cream? there is a difference

Are you going to read that book?

Your DHEA was good. Doc wants more?

Cholesterol is not bad. But really need to get HDL up. With more TRT, LDL can be expected to decrease.

Has doc palpated your thyroid?

There was something very wrong with your earlier TRT, your FSH 1.5-12.4 mIU/mL 4.8
LH 1.7 - 8.6 mIU/mL 3.9 should be driven down to zero. It is almost like you were not taking any T. There is some response, but we do expect LH/FSH shutdown with any effective TRT. Your dose was small and that may be part of it, and perhaps there is a lack of absorption from low thyroid hormones.

How much iodoral are you taking? Take 4 per day, 50mg, for 1-2 weeks if your guts tolerate that.

AM cortisol looks decent. But if it gets low in the afternoon, you may feel run down.

Repeating the warning: that the increased/restored metabolic demands from TRT can uncover adrenal and/or thyroid as weak links in your metabolism, and you can hit the wall.

13

Ksman,

Cant thank you enough for your counsel.I am not increasing or adding B-12 and DHEA. I started with T cream and now have been given Gel. am still waiting for it to be filled.

I have ordered the Book and Idoral.

I may see my primary Doc and get him to ck Thyroid. Hormone Doc blew me off on anything I brought up saying I needed to get Triglycerides down. Come back in 6 mos. May be time to play Docs against each other.

14

T cream is concentrated and applied to a smaller area. T-gel is 1-1.6% and applied to large skin areas. The effect with high T levels in the skin and the amount of aromatase exposed to T in larger skin areas leads to the situation where T-gels create a lot more E2 than T creams. This will increase your potential to create E2.

You can order your own E2 labs and self medicate with anastrozole if you cannot get effective medical care.

Blood work is available at LEF.org and they use LabCorp. See if there is a blood draw station that you can use:
Find Your Nearest Lab Location| Labcorp

15

I have several Lab Corp station near me. That is not an issue and my cost with Insurance is nearly nothing. Just need to find a progressive doc.

16

Past couple of days have been really irritable. Still waiting on Iodine supplement to be delivered. Have not had any blood work since 11/12/12. Have been doing to increased cream as Rx. Been applying to shoulder and groin alternating sides each day. I am in the process of seeking another Doc. Dont really want to go dark to get things if possible.

17

Found a product called Formeron had any body used this? I have gained about 15 lbs since starting TRT and I would not consider it muscle. I am think estrogen is climbing quickly. Am I missing something else?

18

See the other thread here - lots of guys are finding that fish oil takes away their libido. It might be worth stopping the fish oil and seeing if you feel any different.

19

[quote]seekonk wrote:
See the other thread here - lots of guys are finding that fish oil takes away their libido. It might be worth stopping the fish oil and seeing if you feel any different. [/quote

Please substantiate that or tear it down. You have a link?

20

Update:
Have been taking 50 mg iodine for two weeks and body temps have not really changed. I am not sure I have hit 98.6 more thana couple times the past month. I had wife take hers in am to test thermometer and she was consistently getting 97.9 and 98 .6 I can’t say that really notice any change mentally.

Biggest physical change is weight gain since starting TRT three months ago.i have put on about 15 all in the mid section. Kinda at a loss. Not sure what angle to after now was really hoping Iodine would help. Diet and exercise have stayed about the same. Now that holidays are over I will have more free time to train though I don’t want to get into a overtraining situation either. Anybody have any suggestions?