T Nation

On TRT for 2 Months


#1

Hi,

I am new to this forum and have been researching TRT. I have gone through stickies relating to TRT but would appreciate your input regarding my situation.

In 2011 I noticed an increase in body weight esp around the abdomen and inner thighs literally within 4 months. Along with this was bursts of anxiety, certainly bouts of depression and absolutely no appetite to hit the gym as I did before (at least five times per week). My weight jumped from 102kg to 120kg in these few months. I am 1metre 83 centimetres in height. I am now 36 years old.

To say the least my libido dropped considerably. I worked through these symptoms till 2013, my DOC prescribed Duromine 30mg which I would used daily. Just before starting the duromine, I requested labs and my TT was 5.27nmol (range 7.30 - 27.10). Still I had no clue of Low T. After two months of use, with the appetite suppressant, increase energy and training, I dropped 18kg. During this time I came across low T on he internet. Within the next month I requested labs again and my TT had increased to 11.26, so after discussing with my DOC about Low T he stated that my T has moved back into the normal range and I should continue with the Duromine.

After a few months I ceased with the suppressant and my weight came back within the next few months, my training regime fell apart as I felt completely exhausted most of the time. This also affected my mood. In August this year I again requested Labs and it came back.

S-SHBG 19.5nmol/L (13.0 - 71.0)
TT 3.54nmol/L (7.30 - 27.10)
Free T 87.2pmol/L (199.0 - 587.0)
S-TSH 2.59miu/L (0.47 - 4.68)

He prescribed Depo Test Cypionate 200mg ever two weeks. Literally within the next few hours of my first shot I felt alot change. Mood, libido and I trained that evening like I did prior to 2011. Within the next two days I noticed morning and evening wood, but I also noticed the difference in how my clothes felt on me (mega water retention), puffy face, chest and belly. I researched further and saw on this forum the use of AI. Three days before my next two week shot I had more labs done.

TT 16.14nmol/L (7.30 - 27.10)
E2 196.90pmol/L (28.0 - 156.0)
S-Prolactin 8.58ng/ml (4.04 - 15.20)

He prescribed Anastrozole for elevated E2 at 1mg per day. My research on this forum stated that this could drop me to low so I took .5mg EOD for two weeks. On week three I decided to pin 100mg per week .5mg for the next two days. On day four after pinning I started experiencing Halo Vision for about two hours, hot flushes, brain fog and pretty much alot associated with LOW E2, so I stopped the AI. I took my next shot the day after of 100mg and my symptoms kinda subsided but I was totally smashed for the next two days. I took labs on the third day after my shot and it came back as follows:

S-SHBG 15.6nmol/L (13.0 - 71.0)
TT 16.60nmol/L (7.30 - 27.10)
Free T 447.3pmol/L (199.0 - 587.0)
Free Androgen 106.6 (31.9 - 104.4)

I am now considering pinning every 3.5 day at 50mg per dose but how should I dose my AI. Is it possible that my symptoms was associated with LOW E caused by the AI and if it was, why after six days did my E2 still come in elevated on my Labs. I will be taking my next shot tomorrow, but have had mega water retention this whole week. Mood is still not great, not exhausted but have absolutely no desire to train. My concentration is still not where it should be.

If you could suggest any doses of an AI with shots 50mg twice a week, I would greatly appreciate this.

Please excuse my ignorance and I am sure you have answered this question thousands of times. I believe our symptoms are unique in some kind of way.


#2

Please try this:
50mg T twice per week
0.5mg anastrozole at time of injection
Do labs half way between injections always
From the stickies, read up on anastrozole over-responder so you know what to consider if E2 crashed doing the above.

TSH=2.59 is too high. The lab ranges are bogus. Better if near 1.0
How do you get iodine where you are? Iodized salt, added to bread or dairy products?

Check overall thyroid function by checking oral body temperatures:
- when you first wake up, should be 97.7-97.8, higher is OK, 97.3 is a problem
- also check for 98.6F/37C mid-afternoon

Low thyroid function can rob energy and make you fat while creating most of the same symptoms of low-T.

Please post all lab work, not just the above hormones.
LH/FSH was not tested so you never got a primary/secondary diagnosis.
You gave a severe metabolic imbalance.

Labs: - you have some now
TT
FT
E2
LH/FSH - too late, do not do now
prolactin
CBC
hematocrit
AST/ALT
Fasting cholesterol [can be too low]
Fasting glucose
A1C
TSH
IFG-1
DHEA-S
AM Cortisol
Vit-D25

[re] read these stickies:
- advice for new guys
- protocol for injections
- things that damage your hormones
- thyroid basics

List all medications and anything that might be a factor with when all of these problems seemed to start.


#3

Hi KSMAN

THanks for your response. Is there a method of me sending you my blood work via another method other than on this forum.

Regards


#4

No, private messages were killed off 2 years ago.


#5

Thanks KSman,

In 2011, I was diagnosed with anxiety and prescribed Cilift. This helped with mood and general wellbeing. Before the anxiety I felt exhausted and later that year after researching I booked myself in for a sleep study and was diagnosed with severe sleep apnea. I make use of a cpap machine for quality sleep. I have been well rested since then. I believe the anxiety was brought upon by sleep deprivation. I am still on Cilift and use .5mg every third day. All is going well, but weight and appetite to train is a problem. The weight gain started shortly after using the Cilift.
About my iodine intake, I use iodised salt and use quite a significant amount daily.

In 2010 my sodium measured at 140nmol/L to ranges 133 - 145
In 2013 my sodium measured at 132nmol/L to ranges 135 - 145
In 2013 my chloride measure at 95nmol/L to ranges 98 - 107

What could be lowering my salt?
My doc told me my salt intake is low.....this I could not understand this as I take in plenty of salt. Other than this my next set of labs I have taken was pre TRT, two weeks after my first pin and another shortly after. These I included in my first post. No other hormones were taken besides those I gave.

Please elaborate on the bogus ranges? In terms of thyroid ranges I have always measured in the middle of my ranges. I have never taken drugs, never smoked and don't drink. I have cycled sustanon 250 with Deca for a period of 2 months and during that year Winstrol for another two months. This in 2004. Also ECA stack during this period. Other than this nothing else.
You say I gave a severe metabolism imbalance?
I have followed you protocol of pinning 50mg every 3.5 days and I must admit the water is still there but not as much, mood is good and energy there. Next pin is tomorrow, where I will intro the anastrozole on the first day. Is there any avenues I can explore to determine why I am low T? I will draw full labs in the next two weeks and I will post this.
Over the past three days I have experienced serious lower back pain. Not the muscular kind. Can adrenal fatigue cause this? I will take temps as suggested.

THanks again for you help and responses.


#6

T3. T4 fT3 fT4 should be mid-range. The published ranges are bogus.
TSH should be closer to 1.0
TSH=2.59 is a real problem

Check overall thyroid function by checking oral body temperatures:
- when you first wake up, should be 97.7-97.8, higher is OK, 97.3 is a problem
- also check for 98.6F/37C mid-afternoon

Why did you miss the above?

Please verify labeling on your iodized salt package. Non-iodized packaging is very similar.

Sodium or chloride levels: Are you drinking excessive amounts of water?

Please provide more lab data that you have.

Have you looked at those stickies?


#7

Thanks KSMan,

Just thought I would catch up with you re my situation.

Changed my injecting protocol and AI as suggested by you. Man you were absolutely spot on the money and it has had a significant impact on mood and general feeling of well-being.

I know for sure that I am still carrying a bit of unnecessary water but no experience with peaks and valleys. This is very important for me. I would suggest this protocol from the get go. GP's have no understanding of this.

I have not had anytime to draw labs as I am way to busy especially this time of the year, but I will be pulling full labs in the second week of December.

My weight still has not changed except of picking up a considerable amount of muscle. I am still only on 50mg of test every 3.5 days. What is your take on t3 as you already said my thyroid reading was not where is should be. My doctor believes it is normal and I dont think i will get any further with him on the matter. I would really like to shed a few kilos.

Thanks again for your advice.......it has made a huge improvement on my well-being.


#8

You have missed some of my questions.


#9

Hi Ksman,

So I had labs pulled yesterday, midway thru my next pin.

S- Prolactin - 7.85ng/ml 4.04 - 15.20
S- SHGB - 14.4nmol/L 13.0 - 71.0
Total T - 22.44nmol/L 7.30 - 27.10
Free T - 621.04pmol/L 199.0 - 587.0
Free Androgen - 155.5 31.9 - 104.4
DHEA - S - 11.30 2.41 - 11.60
Cortisol AM - 206nmol/L 172 - 497
S-TSH - 4.09MIU/L 0.47 - 4.68
S-FT4 - 15.37pmol/L 9.10 - 23.80
S-FT3 - 4.79pmol/L 3.10 - 6.80
PSA - 0.92ng/ML .10 - 4.00
S-cholesterol - 5.56 <5.00
S-Triglyceride - 2.02 <1.70
S-HDL - .84 >1.00
S-LDL - 3.79 <3.00
Non HDL choles - 4.72 <3.80
E2 - 85.10 28.0 - 156.0
Thyroid antibodies - 166iu/ml <4.11
Thyroid peroxidase - 0.76iu/ml <5.61

No weight loss whatsoever.
Water quite significant 2nd day after shot
Increase in bodily hair especially back and chest
Mood certainly better than pre-trt
Fatigue and motivation still a huge problem
Morning temps 36.5
Afternoon 37.2
Evening 37

Iodised salt - have alot of it in bread dairy, salted meat etc
Taking selenium 10ug
Ester-C 1000mg
Kelp 350mg
rockweed 350mg
bioflavnoids 200mg

Dr. has now prescribed 30mcg daily of eltroxin for the next three months.

Don't think I have left out anything. Please peruse and provide your input.

Many thanks


#10

S-TSH - 4.09MIU/L 0.47 - 4.68
S-FT4 - 15.37pmol/L 9.10 - 23.80
S-FT3 - 4.79pmol/L 3.10 - 6.80

fT3 and fT4 are good, but TSH is very high.
Thyroid antibodies - 1.66iu/ml <4.11 [edit]
You DO NOT have thyroid auto immune disease.

eltroxin: https://en.wikipedia.org/wiki/Levothyroxine
This will lower TSH and reduce the over production of TSH.

Body temps suggest that rT3 is not an issue.
Please monitor body temps to see what the effect of the thyroid medication is.
Note if you feel warmer etc.

Doc thinks normal because the lab normal ranges are way to wide, but he did Rx T4 medication.

TT, FT, E2 look good. Do not know your source of lethargy.
But SHBG is lowish.
Did you get fasting glucose tested? Concern is insulin resistance.

You are still missing points in my posts!!!!!!!!!
Sodium or chloride levels: Are you drinking excessive amounts of water?

Have you looked at those stickies?


#11

Correction antibodies
1.66 vs range <4.11
Will your diagnoses on the auto immune disease stay the same

Are your suggesting that I take the eltroxin or do other tests before continuing with this.medication

I consume just over 1 litre of water per day at times 1.5 litres.

And yes Ksman I have read the stickies that you directed me too.

In terms of lethargy I do not know what the cause of this could be as I get at least 8 hours rest per day.


#12

They had missed the fasting glucose test at the lab so this I do not have this yet.


#13

With the correction of thyroid antibodies, I edited my prior post.
Your autoimmune thyroid is cured!

fT3 and ft4 should be supporting energy levels. fT3 could be a bit higher.
Its odd that your hypothalamus is calling on the pituitary to create those high TSH levels.
Low body temps are not doing this, but do keep an eye on body temps now and on the T4 medication.
If you feel better on the T4 med, that tells us that you have some kind of odd problem.
Cortisol is good.
You could check IGF-1 to eval GH.
T levels are adequate for good energy levels.

Your mitochondria produce ATP, the universal currency of energy in all of your cells.
Mitochondria need QoQ10, antioxidants, B vitamins, vit-E, r-lipoic acid, acetal-L-carnatine to work properly
You can try Ubiquinol form of C0Q10, 50mg and see if that does anything. Must be "Ubiqinol"

CoQ10 is made in the liver.

Some TRT guys are depressed and that can vary. When first starting TRT things can be great but there is that background problem. I suggest Wellbutrin, but in some commonwealth countries its only Rx for smoking cessation. Wellbutrin does not have the spectrum of problems found with SSRI family of AD meds.

Also get fish oil and vit-D3 [5000iu suggested].

Increase HDL with:
- fish oil
- DHEA if DHEA-S is lowish
- hi potency B-complex multi-vits
- healthy fats
- vitamin C
- natural source vit-E
- 5000iu vit-D3 [in tiny oil based caps here] [test Vit-D25]