T Nation

Ongoing Saga of TRT

First post here, but long-time lurker. Running out of ideas and hoping to lean on the experts here for advice or info… many thanks in advance.

Backstory:
The last six years have been a real journey. Had to do a year of chemo for liver disease, resulting in screwy hormones (thyroid, testosterone) and other autoimmune problems (Hashimoto’s, autoimmune hepatitis). Soon after chemo ended, the docs discovered thyroid problems (found to be Hashimoto’s), and began T4 meds. Things still didn’t iron out, and they eventually discovered low testosterone levels (Total of 230) and began HRT with Androgel. Unfortunately, no tests were ever run for the -why- question of low test.

From there it’s been a roller-coaster, with lots of docs, opinions, and egos. Finally, I’ve got some I can trust and that are open-minded. At this point, I’m in my mid-30s, trying to put the puzzle pieces back together. Had to learn a lot along the way, and am still learning.

TRT:
Began on 5g Androderm patches. Skin irritation like a mofo, so we switched to Androgel 1% @ 5g. Was on that for about five years. Total Testosterone numbers varied anywhere between 300s - 600s, typically in the 400s - 500s. Libido and E.D. was persistent most of the time. Naturopath even briefly tried sublingual compounded testosterone – but that didn’t pan out. So last summer we tried doing injectable T (testosterone enanthate) at home dosing 100mg/week. No A.I. at that point. Only problem was it felt like I had been hit by a truck after each injection, and had constant diarrhea (perhaps high E2 or reaction to sesame oil binder?). FYI, E2 Estradiol numbers before starting Test. Enan. were upper 20s/low 30s.

A few weeks in after starting Test E. injections, libido got much, much better and far less E.D. Starting sweating like crazy, too. It was like being a horny teenager for a few days. Shortly thereafter, things seem to get worse again quickly, almost like I missed the target – with minimal libido, E.D. back again, depressed/moody. Labs at the end of the weekly cycle were a Total T of upper 600s. Not great, but better than before. We continued on at 100mg/week dosing for the next few months. TRT lab numbers looked good on paper, except E2 crept into the low to mid-40s, and thyroid numbers took a dump (TSH went from 1.xx to 3.5x). Still had the crushing fatigue, no energy, minimal to no libido, and ongoing unexplained diarrhea.

So back I went to Androgel, although this time we went for 10g/day. Libido was still shot, E.D. returned. However, fatigue got better, less moody/depressed and diarrhea went away. Doc was okay with trying an A.I., so we did generic Anastrozole at 0.25mg twice a week. Irritability and moodiness got less, and I didn’t feel as bloated. But this dropped my E2 Estradiol down from mid-40s to 16. So we reduced dosage of A.I. to 0.25mg once a week. Still have E.D. and no libido at this point. My most recent Total Test. on the 10g Androgel was in the upper 500s.

Thyroid:
Started with just 50mcg of T4 years ago. Things briefly improved on the thyroid front, then got worse. Eventually it was discovered I have Hashimoto’s (autoimmune thyroid disease). I had no idea I was under-medicated. New docs increased T4 meds to 88mcg a couple of years ago, then eventually switched me over to Nature-Throid at 1 1/2 grains. So, unfortunately, my thyroid numbers are still bouncing around a bit and an ongoing work in progress. Not exactly sure how many of my issues are from thyroid vs. testosterone problems (or something else). Ultrasounds of thyroid show some enlargement and a few smaller nodules (all <1cm in size).

Adrenals:
Naturopath doc ran a couple of salivary adrenal tests. Past endocrinologist did a 24-hr urine collection for adrenals. None of these tests indicated adrenal problems. Interestingly, taking small amounts of Prednisone at various times for other autoimmune issues seemed to help here and there. Only conclusion I can come to with that is it was helping to keep thyroid antibodies and inflammation down. Presently on 5mg of Prednisone and doing a trial run of compounded Low Dose Naltrexone (LDN) to see if it helps fatigue and autoimmune problems.

Diet/Exercise:
Went from eating crap years ago to being gluten-free and adopting a more paleo approach. Naturopath discovered the bad gluten-sensistivity which helped somewhat overall. Not much exercise tolerance on my part, just walking around the block can be exhausting, depending on the day. Used to be very active with hiking, biking, gym, etc.

Current Issues:
Very low libido, E.D., bad brain fog, awful fatigue, poor stamina, anxiety (seems tied to hormone fluctuations).

Questions and Thinking Out Loud:

  • Is it possible to get testosterone enanthate with a different oil (no sesame, perhaps cottonseed instead)? Or is that only found in the cypionate offerings? Wondering if I had a reaction to it.

  • Has anyone heard of ongoing diarrhea as side effect or reaction from injectable T?

  • My goal has been to get E2 in the low 20s, now that I know a little more about it. How potent is Estradiol as far as blocking thyroid hormone absorption? My thyroid numbers seemed to get worse after starting TRT injections and having an E2 increase.

  • Would re-trying injectable Test. at a lower dose (say, 80mg/week instead of 100mg) and splitting that into twice-a-week dosing be a better way to ease back into things, keeping E2 sides minimized?

(Labs to follow in another post…)

This post reserved for labs… I have many years’ worth of data, but I’ll post up a selection from a few of the more recent ones for now… anything else needed, just ask.

*4/9/14 Labs:
TSH 1.30
Free T3 3.5
Free T4 1.02

*2/21/14 Labs:
Total Test. 560 (241-827 ng/dL)
Free Test. 165 (47-244 pg/mL)
% Free Test. 3.0 H (1.6-2.9)
SHBG 16.4 (15.0-87.0 nmol/L)
17-B Estradiol 16 (0-40 pg/mL)
PSA 0.48 (0.00-4.00 pg/mL)
Free PSA 0.3
Free PSA % 62
TSH 3.503 (0.4-4.0)
Free T3 3.7 (2.3-4.2)
T4 6.2 (4.5-10.9) lab mistake, supposed to run FT4
ALT 64 H (10-35)
AST 27 (14-50)
Albumin 4.8 (3.5-5.0)
Total Protein 7.8 (6.0-8.3)
Glucose 95 (74-100)

*12/18/13 Labs:
Total Test. 368 (241-827)
Free Test. 105 (47-244)
% Free Test. 2.9 (1.6-2.9)
SHBG 15.6 (15.0-87.0)
17-B Estradiol 24 (0-40)
TSH 1.335 (0.4-4.0)
Free T3 3.7 (2.3-4.2)
Free T4 1.04 (0.84-1.51)
TPO Ab 61.4 H (0.0-60.0)
ALT 54 H (10-35)
AST 28 (14-50)
Albumin 4.9 (3.5-5.0)
Total Protein 7.9 (6.0-8.3)

*10/19/13 Labs:
Total Test. 334 (241-827)
Free Test. 88 (47-244)
% Free Test. 2.6 (1.6-2.9)
SHBG 18.8 (15.0-87.0)
17-B Estradiol 39 (0-40)
TSH 1.367 (0.4-4.0)
Free T3 3.6 (2.3-4.2)
Free T4 0.98 (0.84-1.51)
ALT 55 H (10-35)
AST 27 (14-50)
Albumin 4.7 (3.5-5.0)
Total Protein 7.9 (6.0-8.3)

*9/2/13:
Switch back to Androgel due to injection side effects, increase from 5g to 10g/day.

*8/1/13 Labs:
Total Test. 654 (241-827)
Free Test. 185 (47-244)
% Free Test. 2.8 (1.6-2.9)
SHBG 19.6 (15.0-87.0)
17-B Estradiol 43 H (0-40)
TSH 3.346 (0.4-4.0)
Free T3 3.5 (2.3-4.2)
Free T4 0.87 (0.84-1.51)

*7/17/13 Labs:
Sed Rate 1.0 (0-15 mm/hr)
CRP 1.5 (0.0-10.0 mg/L)
Osmolality 297 (275-300 mOs/Kg)
Urine Osmolality 827 H (500-800 mOs/Kg)

*6/23/13:
Begin testosterone enanthate injections @ 100mg once a week.

*6/22/13 Labs:
Total Test. 345 (241-827)
Free Test. 88 (47-244)
% Free Test. 2.5 (1.6-2.9)
SHBG 20.7 (15.0-87.0)
17-B Estradiol 37 (0-40)
TSH 2.112 (0.4-4.0)
Free T3 4.2 (2.3-4.2)
Free T4 0.97 (0.84-1.51)
Reverse T3 10.0 (9.0-27.0)
TPO Ab 93.8 H (0.0-60.0)
RA Factor <10 (<=14)
ALT 39 H (10-35)
AST 24 (14-50)
Albumin 4.7 (3.5-5.0)
Total Protein 7.7 (6.0-8.3)
PTH-Intact 31 (12-88)
Calcium PTHI 9.8 (8.6-10.3)
Ferritin 112 (22-322)
Glucose 100 (74-100)

*5/11/13 Labs:
TSH 2.363 (0.4-4.0)
Free T3 3.3 (2.3-4.2)
Free T4 0.89 (0.84-1.51)

*3/27/13 Labs:
17-B Estradiol 32 (0-40)
PSA 0.51 (0.0-4.0)
TSH 3.071 (0.4-4.0)
Free T3 3.7 (2.3-4.2)
Free T4 0.83 L (0.84-1.51)
TPO Ab 90.4 H (0.0-60.0)
Thyroglobulin Ab <32.0 (0.0-60.0)

*2/28/13 Labs:
TSH 2.628 (0.4-4.0)
Free T3 3.3 (2.3-4.2)
Free T4 1.04 (0.84-1.51)

*2/18/13:
Re-start Androgel at 5g/day.

*2/6/13 Labs:
Cortisol 21.1 (3.1-22.4)
DHEA-Sulfate Serum 315 (106-464)
17-B Estradiol 29 (0-40)

*1/26/13 Labs:
Note - these labs reflect no TRT on board. Took break from Androgel from mid Dec. 2012- end Jan. 2013. Restarted Androgel on 2/18/13.
Total Test. 202 L (241-827)
Free Test. 48 (47-244)
% Free Test. 2.4 (1.6-2.9)
SHBG 21.6 (15.0-87.0)
TSH 3.675 (0.4-4.0)
Free T3 3.1 (2.3-4.2)
Free T4 0.85 (0.84-1.51)

*5/2010 - 12/2012
Apply Androgel @ 5g/day. Brief increase from old docs to 7.5g/day, then decreased me back to 5g/day.

I have the a similar problem like your just that I havent been put on trt yet.
I got put on hcg and clomid also anaztrozole.

One other thing – a peculiar side I’ve noticed since beginning Androgel years ago, is that for a few hours after applying it in the morning, I feel more exhausted than beforehand. By mid- to late-afternoon and into the evening I start feeling better and have a little more energy. Not sure if this is some sort of connection to the adrenals (or something else), but it’s a side effect I haven’t been able to get away from.

You can’t be on Prednisone longterm! There are HUGE side effects that covers every single system of the body. Why would your doctor have you taking it indefinitely? This could easily be your problem.

Been on the Prednisone since late last year. The idea was to trial it and try to control inflammation from autoimmune issues. (However, my libido/ED, thyroid, and other issues were present long before starting the Prednisone.) But you’re absolutely right – it’s not good long term whatsoever, and I’ve got a doc appt. next week where that is going to be a topic. My goal is to get tapered down and off the Pred.

[quote]pacificnw wrote:
Been on the Prednisone since late last year. The idea was to trial it and try to control inflammation from autoimmune issues. (However, my libido/ED, thyroid, and other issues were present long before starting the Prednisone.) But you’re absolutely right – it’s not good long term whatsoever, and I’ve got a doc appt. next week where that is going to be a topic. My goal is to get tapered down and off the Pred.[/quote]

Yeah it’s tricky to use for chronic conditions. I’m glad you’re all over it and know how to manage it. The tapering is absolutely critical good to see you know that. I’d be interested in what the Dr has you do.

Well, good news, doc agrees on trying to wean off of the Prednisone. Will taper down by 1mg/month and see how that goes. As far as re-trying injectable test., he is open to that if I am interested. (Definitely very lucky with this doc.) Pretty flexible, okay with me trying twice a week injections and continuing the Anastrozole for E2 blocking. Also asked for a sample of E.D. meds and was given a pack of “Stendra”. Have never taken anything like that, but I am curious (as is the wife). Thyroid labs from the other day look pretty good.