T Nation

Please Review My Case


#1

-age - 26
-height -5'9"
-waist â?? 28-30 Inches
-weight â?? 135 lbs
-describe body and facial hair
A small amount of hair on chest and stomach, average looking arms and legs, beard is on neck, sideburns, 'goatee' area and cheeks. My facial hair takes time to grow back. I was in the military (USMC) and we had to maintain a clean shaven face. I would be able to go almost a week without shaving before my stubble became noticeable. When I got out I let my facial hair grow for 2 months and one of my friends made fun of me because what I grew in 2 month, he said he could grow in 2 days lol. He was exaggerating, but he could have caught up to me in a week, so thatâ??s still bad for me.

My facial hair is not of an adult texture. My fatherâ??s facial hair as well as other males in my family and that I know have a different texture. My texture is kind of the next step up from peach fuzz. My under arm hair is also not of adult texture, still soft and curly, not coarse. I do not have a lot of under arm hair, though I have noticed some growth this year. Same thing with my pubic hair. My pubic hair comes out when I am in the shower. I do use a wash rag, but I gets everywhere. I donâ??t have patches missing or anything, but I did shave my pubic once and it took forever to grow back like a month and change. It was horrible because I have SMALL testicles ( I feel they are under developed)

-describe where you carry fat and how changed
I am very skin and do not have body fat. Well I would image its impossible not to have ANY body fat, but I am a very skinny, ectomorph, couldn't gain weigh if you paid me to, type of guy. 5â??9 135lbs soaking wet.

-health conditions, symptoms [history]
Depression, anxiety (possible), Chronic fatigue, Sleep Apnea, Insomnia, feeling cold all the time

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Zoloft, Wellbutrin, Prozac, < all for depression. Trazodone (for sleep issues) , This was all from 2008-2010. I also took some acne pills as a teenager, I donâ??t remember what it was. It was NOT Accutane. I tried multiple adrenal herbs/glandulars (all seem to be non effective). Herbs for depression (st. Johns Wort etcâ?¦) A bunch of super foods. Long story short nothing worked and I had all the issues I had before these products/meds and I still have them now.

-describe diet [some create substantial damage with starvation diets]
Currently a vegan, I could be doing better with my diet, but again, I had all the issues Iâ??m having back when I was a meat eater, eating the standard American diet. I never had much of sweet tooth back and I donâ??t have one now. I eat the same thing every week just about. I juice fruits and vegetables and do super foods every now and then. Again I had these issues before the diet. Also my appetite is horrible, sometimes I can get away with eating once a day. I donâ??t purposely do it, but sometimes Iâ??m not hungry and Iâ??ll only eat so I donâ??t get hungry when everything closes. I had some gut issues, but I fixed all of that as confirmed by a GI Profile. I donâ??t drink a lot of water either, I have frequent urination and drinking a bottle of water would keep me in the bathroom lol.

-describe training [some ruin their hormones by over training]
I do not current exercise and havenâ??t for about 5 years, mind you I am very skinny so I still look in shape, but I am too fatigue to work out. Hell I only sleep 2-4 hours, mostly 2 per night. I was in the Marines from 18-23 years old (2006-2011). I used to work out in the Military as a unit, never much on my own. I performed well. I always though I could do better, but I always felt fatigued. I tried lifting weights in the military, but I didn't work out. I tried lifting weights during my last year in HS, but that was a waste of time again, I was always to tired. I did pass my weightlifting class, but I did not gain any weight.

-testes ache, ever, with a fever?
I definitely get some achy balls now and then. Didn't think much of it. My left testicle aches as Iâ??m writing this. The right one never gives me a problem. My left testicle is smaller than my right. Again I have small testicles to begin with. They donâ??t hang much and are really close to my shaft. Its very uncomfortable. They do not hang like they should and Iâ??m pretty sure there are grapes bigger than my testicles. No BS. Like the big plump grapes. If I took my testicles out and replaced them with 1 golf ball (total, not each), my sack would be bigger than it normally is.

-how have morning wood and nocturnal erections changed.
I am currently on clomid, so that is affecting me on the negative side of thing as far as sex drive, but I will get to that later on. Normally I have a lot of erections and a lot of precum dripping. Its weird. I still feel Iâ??m in like tanner stage 3-4 in puberty. I shouldn't be that easily aroused. I know some guys here would like to be in my shoes in that regard, but itâ??s a hassle/problem. For instance if I see a girl I like and I hug her, Iâ??ll get an erection or come pretty close to getting one. I should not be that sensitive. As far as nocturnal erections, Iâ??m usually up most of my nights and yes I have erections.

All right Iâ??ll explain the whole thing below.
When I was younger say middle school. I used to love playing basketball. I could play all day, I took it very serious. I had some depressions issues back then, but I kept rolling with the punches. Then I went to HS and in 9th grade I had gym class. I would play basketball in there when they let us, other than that it was flag football or badminton (it was actually fun). I sprained my ankle twice that year in 9th grade. I sprained it playing basketball. It was healing pretty well then I jumped down a short flight of stairs and hurt it again lol. I knowâ?¦stupid. After that I healed, but that was the last time I was really physically active until I joined the Marines. Now I donâ??t know what happened, but when I was in HS, things just changed. The depressions started hitting me hard, I was always irritable and anxious. I used to sweat for no reason sometimes and I always had that pubescent body odor smell. Not quite a full grown manâ??s body odor, but that smell in between. Kind of hard to explain. But I never felt like I developed properly. My twin cousins had mustaches and I didn't, they had under hair and I didn't, however I was still taller and weigh more than they did. And Iâ??m still taller and weigh more if not the same and they still look older than me. These are my first cousins too. After I graduated HS, I joined the Marines. Boot camp was a killer because I was always tired and fatigued, but I pulled through. I did pretty good overall. I just felt like shit while doing it. Now I had sleep issues all through HS and possible middle school (I canâ??t remember exactly about middle school). I finally started complaining in the Marines and went to the doctors. At first I was just told to practice good sleep hygiene (total BS). Then I tried again and was given Ambien (didn't really work), Ambien CR (still didn't work), Lunesta (didn't work). I also tried any and everything over the counter that I could findâ?¦Still didn't work. I was taking antidepressants. Still didn't work. Fast forward 2 years. I am diagnosed with Mild Obstructive Sleep Apnea. I barely made the limit. I was given a CPAP machine. The machine didn't help. I could only tolerate for 4 hours. The thing is. I have severe insomnia. During the sleep study it took my 75 minutes to fall asleep. Anything after 10-15 minutes is insomnia. I tried to get the pressure increase for my CPAP thinking that would help me fall asleep. The doctor declined and stated that there is something else going on with me that I need to find out. By this time I googling any and everything. I come across testosterone. I always felt I was under developed for my age and I still feel that way. I honestly believe I will grow taller and my shoulders will broaden just a bit and I will gain weight. Im 27 call me crazy, but I just feel that way. Anyway I get my main doctor to check my testosterone levels. All she says is that they are normal. I NEVER got the actual results. I was stupid and I took her word for it, but still felt something was wrong. by the way this all done by military (Navy) doctors. Marines dont have their own doctors. She did a testicular exam as part of my final physical when I was leaving the military in 2011. She didnt mention anything about the size of my testiclesâ?¦neither did I (at least I donâ??t remember). When I got out of the military I found a naturopathic doctor and got some adrenal tests done. I will post all lab results. I will likely scan the documents.

The labs I have are from different dates and ranges so please look keep that in mind when you compare them.

Again my symptoms are: Fatigue, Chronic Major Depression (at least 8 years), Insomnia (bad), Inablity to stay sleep (I'm up by 2am), I have Mild Obstructive Sleep Apnea, Mood Swings, some Anxiety, Cant really gain weight/muscle (think ectomorph), Decrease Sex-Drive/Libido, Erection quality not bad, but could be better.

I am aware that I had/have low vitamin D and B12. My doctor states even though they are low she does not think that they are the reason for any of the symptoms above.

I tried Clomid for 3 weeks after my second to last results. My test went up through the roof and I didn't notice any positive changes, no extra facial hair, no increase in libido...Basically none of my symptoms mentioned above changes. I did notice my sex-drive slightly decrease and my orgasms are as sensational as before, but nothing to panic about. Well i did notice that my testicles felt a little fuller especially my left one. That one is smaller than the right and hurts sometimes. I stopped the Clomid and things went back to normal (Testicle still hurts and small without the clomid-it hurts off and on Clomid, both of my testicles are still small for my age). My estradiol went through the roof so I guess that's the problem. I was on 50mg for 3 weeks. Then got tested. Those are the last results. The doc say to take 25mg and get retest. I have been on 25mg for a number of weeks and waiting to get tested again.

Please help....

Another thing I thought I had adrenal fatigue, but I dont think thats really the case, but im open to your opinions.


#2

Labs


#3

If you restored decent T levels, it would take a few months to realize physical and mental/brain changes; not 3 weeks.

Some feel worse with clomid, nolvadex does not have that problem.

Do you get cold easily? Using sea salt or iodized salt long term?

We can’t do much unless you post your lab results WITH RANGES. Get and retain your lab results.

Labs:
CBC
cholesterol - a problem if too low
TT
FT
E2
LH/FSH <-- very important
TSH
fT3
fT4 [not T3, T4]
prolactin
DHEA-S
vitamin D25
DHT

Read the advice for new guys sticky. <-------- good info

You were never properly virilized. TRT would do that.

If LH/FSH are low and a correctable reason cannot be found, you might do well injecting 250iu hCG SC EOD

Any blows to the head before things became a problem?


#4

[quote]MysteryMan wrote:

-describe diet [some create substantial damage with starvation diets]
Currently a vegan, I could be doing better with my diet, but again, I had all the issues I�¢??m having back when I was a meat eater, eating the standard American diet.
[/quote]

Honestly, the vegan diet could be a big component of your problems. There is a huge difference between a vegan diet and a standard American diet. I wouldn’t consider either one of them particularly good.

Eat real food. Using the vegan template to start is not a bad thing. Vegan is a good thing in terms of encouraging you to eat ‘real’ food. Eat stuff that would come out of a theoretical garden in your back yard. Having said that, add some lean meats. Get some real protein in your diet. Soy or Seitan doesn’t count. Make it some sort of naturally raised farm animal (beef, lamb, etc), wild game or wild fish.

A vegan diet does work for some people, but I believe that it’s much more likely to not work. At the end of the day, you have to figure out what fuels you the best. Whatever your girlfriend does or whatever is in the latest book you’ve read really doesn’t matter. Experiment with you. What you’re doing right now is not working. You have be honest with yourself. Before you worry about any sort of pharmaceutical intervention, you need to get your food dialed in.


#5

Hey KSman i have my labs, but when i try to upload the pdf. It doesn’t go through. Is the moderator blocking it or is pdf files not allowed on this site. I have converted them to jpeg files with that work. I have a lot of labs so its easier for me to scan them. I have labs that are like before and after so you can compare them. Please let me know if its possible to upload the files or what format is best.

Thanks to everyone who responded. I hope to talk to you guys some more. I got really excite when I saw someone responded to my thread lol.


#6

Try to uploads labs as Jpeg


#7

No head injuries or trama that I remember lol. Cholesterol is good, will post below. I took body temps a few times, seemed fine to me. Will take them again if my below results suggest that its necessary.

The first test ever taken that convinced me of low T.

CORTISOL PANEL Collected: 03/31/13
Time Your Value Standard Range Units
8am 4.70 3.5-6.3 ng/ml
12pm 2.59 1.4-2.8 ng/ml
4pm 1.80 0.8-2.4 ng/ml
8pm 1.24 0.6-1.6 ng/ml
12am 1.06 0.3-1.2 ng/ml
4am 2.30 0.3-1.7 ng/ml ******

DHEA SULFATE PANEL Collected: 03/31/13
Time Your Value Standard Range Units
8am 6.60 2.8-12.7 ng/ml
8pm 5.20 2.7-9.0 ng/ml
12am 4.70 1.8-8.1 ng/ml

TESTOSTERONE-MALE RANDOM Collected: 03/31/13
Component Your Value Standard Range Units
TESTO… RANDOM 96.6 95.0-650.0 pg/ml***********
Estradiol-Male 1.26 0.5-3.0 pg/ml
Progesterone-Male 38 5-65 pg/ml


COMPREHENSIVE METABOLIC PANEL Collected: 5/16/2014 9:48 AM

Component Results
Component Your Value Standard Range Units
Sodium 141 135 - 146 mmol/L
Potassium 4.4 3.5 - 5.3 mmol/L
Chloride 103 98 - 110 mmol/L
CO2 26 19 - 30 mmol/L
Glucose 82 65 - 99 MG/DL
BUN 5 7 - 25 MG/DL
Creatinine 0.87 0.60 - 1.35 mg/dL
BUN/Creatinine Ratio 5.7 6 - 22
CALCIUM 9.6 8.6 - 10.3 MG/DL
Protein, Total 7.4 6.1 - 8.1 G/DL
Albumin 4.8 3.6 - 5.1 G/DL
Globulin 2.6 1.9 - 3.7 G/DL
Albumin/Globulin Ratio1.8 1.0 - 2.5
Bilirubin, Total 0.6 0.2 - 1.2 MG/DL
AST (SGOT) 17 10 - 40 U/L
ALT 13 9 - 46 U/L
Alkaline Phosphatase 59 40 - 115 U/L
EGFR 120 > OR = 60 mL/min/1.73m2
AFRICAN AMERICAN EGFR 139 > OR = 60 mL/min/1.73m2

TSH W-FREE T4, RFX Collected: 5/16/2014 9:48 AM
Component Your Value Standard Range Units
TSH 1.66 0.40 - 4.50 mIU/L

FERRITIN Collected: 5/16/2014 9:48 AM
Component Your Value Standard Range Units
Ferritin 52 20 - 345 ng/mL

IRON PROFILE Collected: 5/16/2014 9:48 AM **** (I FEEL COLD MOST OF THE TIME)
Component Your Value Standard Range Units
Iron 98 45 - 175 UG/DL
TIBC 412 250 - 425 ug/dl
Iron Saturation 24 20 - 50 %

CBC WITH DIFFERENTIAL Collected: 5/16/2014 9:48 AM
Component Your Value Standard Range Units
WBC 3.7 3.8 - 10.8 Thousand/uL
RBC 4.47 4.20 - 5.80 Million/uL
Hemoglobin 14.8 13.2 - 17.1 g/dL
Hematocrit 44.3 38.5 - 50.0 %
MCV 99 80 - 100 fL
MCH 33.0 27 - 33 pg
MCHC 33.3 32 - 36 g/dL
Platelets 197 140 - 400 Thousand/uL
RDW 12.5 11.0 - 15.0 %
MPV 8.6 7.5 - 11.5 fL
Neutrophils Absolute 1543 1500 - 7800 cells/uL
Bands Absolute CANCELED 0 - 750
Result canceled by the ancillary
Metamyelocytes Absolute CANCELED 0
Result canceled by the ancillary
Absolute Myelocyte CANCELED 0
Result canceled by the ancillary
Promyelocytes Absolute CANCELED 0
Result canceled by the ancillary
ABSOLUTE LYMPHOCYTES 1783 850 - 3900 cells/uL
Monocytes Absolute 318 200 - 950 cells/uL
Eosinophils Absolute 37 15 - 500 cells/uL
Baso(Absolute) 19 0 - 200 cells/uL
Blasts Absolute CANCELED 0
Result canceled by the ancillary
Absolute NRBC CANCELED 0
Result canceled by the ancillary
Neutrophils 41.7 %
Band Neutrophils CANCELED
Result canceled by the ancillary
Lymphocytes 48.2 %
Atypical Lymph % 0.0 %
Monocytes 8.6 %
Eosinophils 1.0 %
Basophils 0.5 %
Metamyelocytes CANCELED
Result canceled by the ancillary
Myelocytes CANCELED
Result canceled by the ancillary
Promyelocyte CANCELED
Result canceled by the ancillary
Blasts CANCELED
Result canceled by the ancillary
Nucleated RBC CANCELED 0
Result canceled by the ancillary


CHEMISTRY Collected: 8/2/2014 7:12 AM
Component Your Value Standard Range Units
Cholesterol 167 125-200 mg/dL
Triglyceride 85 <150 mg/dL
HDL Cholesterol 61 > or = 40 mg/dL
LDL Cholesterol, calculated 89 <130 mg/dL
Cholesterol/HDL ratio 2.7 0.0-5.0 ???
Non-HDL Cholesterol 106 ??? mg/dL

VITAMIN B12, Serum 447 200-1100 pg/mL
T3, Free 3.2 2.3-4.2 pg/mL
T4, Free, Non-Dialysis 1.1 0.8-1.8 pg/mL
TSH 1.61 0.4-4.5 mIU/L
***TESTOSTERONE (Total) 588 250-1100 ng/dL
***TESTOSTERONE (Free) 117.2 35-155 pg/mL
***VITAMIN D 12 30-100 ng/dL
VITAMIN D 25-OH, D3 12 30-100 ng/dL
VITAMIN D 25-OH, D2 <4 30-100 ng/dL

***TESTOSTERONE Collected: 8/7/2014 9:34 AM
Component Your Value Standard Range Units
Testosterone Total 347 241 - 827 ng/dL

***TESTOSTERONE Collected: 8/14/2014 8:05 AM
Component Your Value Standard Range Units
Testosterone Total 417 241 - 827 ng/dL


This is the same type of test as when I first found out my T was low. Its just an update with NEW RANGES, but a year and change later. I posted it down here to keep all of my test in sequential order as far as dates go.

CORTISOL PANEL Collected: 08/17/14
Time Your Value Standard Range Units
8am 13.60 5.50-24.80 nmol/L
12pm 4.37 3.80-13.20 nmol/L
4pm 6.27 2.20-9.40 nmol/L
8pm 2.38 1.60-4.40 nmol/L
12am 1.91 0.8-3.30 nmol/L
4am 1.89 1.10-9.40 nmol/L

DHEA SULFATE PANEL Collected: 08/17/14
Time Your Value Standard Range Units
8am 3.47 1.60-18.50 nmol/L
8pm 1.52 1.00-10.50 nmol/L
12am 1.82 0.80-8.30 nmol/L

TESTOSTERONE-MALE RANDOM Collected: 08/17/14
Component Your Value Standard Range Units
TESTO(LC/MS/MS) 206.7 95.0-650.0 pg/ml
Estradiol-Male 2.14 0.5-3.0 pg/ml
Progesterone-Male 64.7 29-110 pg/ml


FSH AND LH Collected: 9/2/2014 9:00 AM
Component Your Value Standard Range Units
LH 4.9 1.5 - 9.3 mIU/mL
FSH 6.4 1.6 - 8.0 mIU/mL

***TESTOSTERONE, TOTAL, BIO, FREE, S Collected: 9/2/2014 9:00 AM
Component Your Value Standard Range Units
Testosterone, Free 73.7 46.0 - 224.0 pg/mL
Testosterone, Bioavailable 154.8 110.0 - 575.0 ng/dL
Testosterone,Total,LC/MS/MS 507 250 - 1100 ng/dL
Sex Hormone Binding 30 10 - 50 nmol/L
Albumin 4.6 3.6 - 5.1 g/dL

After All of this I finally went to a UROLOGIST and he noticed my T-Levels were jumping all over the place. He told me all about TRT and I was still scared (lol) of injections, not that I fear needles, just the whole shutting down my natural production, fertility and the whole new life style that comes with TRT. We settled on CLOMID. I used CLOMID at 50mg a Day for 3 weeks and got tested again. Below are the results. My Testosterone is up above range as well as my Estradiol. I dont have any postive affects from the Testosterone and no major effects of the Estradiol being almost 2x the max range. Basically its like i never took the CLOMID. I do notice I’m not as horny as before the clomid and my orgasm sensation has diminished, but again nothing too crazy. I dont have any problems with my nipples, water retention or anything of that nature. I feel fatigue, but thats nothing new (maybe a little bit more so now, hard to tell).

***CHEMISTRY Collected: 9/2/2014 9:00 AM
Component Your Value Standard Range Units
Prolactin, Serum 8.8 2.0-18.0 ng/mL
Estradiol 72 < or = 39 pg/mL
Testosterone,Total,LC/MS/MS 1317 250 - 1100 ng/dL
Tesosterone, Free 268.7 35-155 pg/mL


#8

Classic SERM overdose, too much LH leads to high T–>E2 inside the testes and anastrozole would not control that. You need to cut clomid by 50% and then repeat labs. Still might be too much. If E2 levels become sane and T is good, then anastrozole would fine tune your E2 levels if needed.

See the stickies

Thyroid labs look somewhat decent.But your body temperatures are the best overall measure of thyroid function, often not the labs.


#9

KSman-So based on all of my testosterone levels do u see injections in my future? Also I have horrible sleep and I’m up all hours of the night. For example I can wake up at 2am and stay up the remainder of the morning. When would I check my temperature for thyroid? Should I just do 8am, even though by then i have been up for several hours or should I do it at 2am or whenever I find myself awake. I took it at 3am one time and got 96F, I did it a few more times and got the same result, to confirm. When I measure at 7am,8am,9am, my results are normal around 98.?F. I already ordered swansons version of idoral (same ingredients just cheaper) to be safe.

Oh and by the way my evening temps have been 98s and 99s even.

KSman-what did u think of my cortisol and Dhea-s labs? Adrenal fatigue?


#10

Correction the thermometer was too cold to function properly. I had it near a window, so it was giving off a temp of 96. I have to let it get room temperature and try again lol.


#11

Yes, DHEA is low, try 25mg every day.

Vit-D25 is low, 5000iu in tiny oil based caps every day, take 25,000iu for first 5 days.

I assume that your LH levels are changing and causing variable T levels. Your messed up sleep patterns may be in part a result of changing cortisol levels and perhaps that affects pituitary function.

Suggest 5-6mg TIME RELEASE [OTC] melatonin 1/2 before you are ready to try to get to sleep. See if you can get Rx trazodone 150mg. Start with 50mg and that might work well for a while and then you may need 100mg. When dosed appropriately, should not leave you groggy in the AM.

You have a serious sleeping disorder and hormone problems are associated with that. Because you don’t get good sleep, are you tired all of the time and using caffeine to compensate? That could make things worse. Your diet may not be working for you.

Some things calm the nervous system, such as fish oil and other EFAs such as flax seed oil/meal and nuts.

Neural transmitters: These look low(?) across the board. But I don’t know how to read that scan. You might try low dose Wellbutrin and judge it by its results. If you function better, it would seem that something was holding you back. Take early in the day, you don’t want much of that in your system when its time to be getting tired and going to bed. Selegiline https://en.wikipedia.org/wiki/Selegiline is very safe in low doses and will increase all mono-amine neural transmitters and you might consider this as an alternative to Wellbutrin. Selegiline is safe and effective, but many docs who don’t have a functional medicine understanding will balk at this. Again, try as a trial and see where this takes you.

“feeling cold all the time” really sounds like thyroid and some of your temperatures lean in that direction. Your T3 is not low, so rT3 is a good suspect, should get that tested next time you are doing follow up labs on lower dose clomid.

Did clomid make your depression worse? If so, replace with nolvadex.


#12

Clomid did not make my depression worse. I have already been taking vitamin d at 10,000iu, but now 50,000iu about 2x a week. I’ll get that retested soon. I tried melatonin before and it did not work. Nothing natural seems to work and the prescription drugs have failed me as well. I actually had my melatonin level checked before. I cant find the results, but it was a good level. As far as ssri’s, Wellbutrin gave me hives so thats a no go, no antidepressants helped not even natural stuff (st johns wort). I will try dhea supplements and iodine supplements.

Will the hcg virilized me? Im thinking about quitting clomid.