T Nation

Question Regarding Trial of TRT


#1

Hi everyone. I'm new to the forum and had a question regarding a trial of TRT. My total test and free test are very low and have been for a couple of years now. I'm pretty sure the reason for the issues is due to me taking propecia for about three years. Propecia was fine for the first 2 years and then the last year I started have all kinds of sexual side effects. I stopped and have not been the same since.

for the last year and a half i have had depression, anxiety, no sex drive and ive been to an endo and got a prescription for 100mg of test cyp weekly. I am only 35 years old and am really nervous to start taking something that i will have to take for the rest of my life. Right now I am extremely moody and taking an SSRI and Wellbutrin. That totally helps with the mental issues but just hinders the sex drive even further.

My question is, is there any harm to just taking the TRT for a month or so and see how I feel on it. If i stop taking it will I get back to where I am now or will I further harm my already low natural testosterone production. My psychiatrist is pushing me to take it as he thinks that all of my issues are related and I guess either I take anti depressants or test.

The other concern that i have is hair loss. Is it pretty assured that supplementing with test will further cause that?

Thanks for the responses so far. I read the stickies and here is the addl info.

-age 35
-height 6'1"
-waist 33inch
-weight 182

-describe body and facial hair: ive never had very thick facial hair or alot of body hair. just chest and stomach hair. nothing on back. i did have a patch of hair that grew on my upper left arm and when i started the propecia it went away. since stopping propecia it didnt come back.

-describe where you carry fat and how changed mostly in my mid section. I was about 15% bodyfat as of january 2010 and i cut down to 10% training for a marathon last year then cut down from 13% to 10% again from april to june of this year. been on maintenance ever since.

-health conditions, symptoms: no health issues other than low libido, anxiety/depression. never had any illness or anything. I do have trouble getting a good night sleep. can't remember the last time i slept 8 hours straight through the night.

-Rx and OTC drugs, any hair loss drugs or prostate drugs: right now taking 10mg Paxil and 300mg Wellbutrin XL daily and rogaine. Took Propecia and then generic finasteride for a period of about 3 years from july 2006 until the later part of 2009. i also take a multi and fish oil daily.

-describe diet: my diet is very healthy. when i was cutting i cut at between 2100 and 2200 calories a day. 220g protein/60g fat/195g carbs. right now i am maintaining on 2700-2800. 210g protein/80g fat/285g carbs. i realized that 60g fats was prob too little for me so i'm getting at least 80 now. somtimes i eat 90 and less carbs. i eat mostly whole foods, very little processed. lots of oats/sweet potatoes, veggies, lean beef, fish, chicken. most of my fats come from olive oil, nuts, almond/peanut butter, some beef/pork.

-describe training: right now lift weights 3x per week (Chest/Tris, legs/shoulders, back/bis split) and run 3x per week (3-4 miles 2 days and HIIT once)

-testes ache, ever, with a fever? never

-how have morning wood and nocturnal erections changed: when on propecia i never had them. a couple of days after i stopped taking it i had ridiculous high school type morning erections. they have since subsided but i still wake up with a semi erection most days.

LABS
11/2/04 (just for a baseline, 2yrs before propecia)
Total 814ng/dL (241-827)
T4, 9.1 UG/DL (4.5-12.5)
TSH 1.9 uIU/mL (.4-5.5)

7/20/10
Total T 225 (350-890ng/DL)

7/23/10
FSH/LH 4.0 1.4-18.1 mIU/mL
LH 2.2 1.5-9.3 mIU/mL
TSH 1.105 .35-4.5 uIU/mlSLN
Test total 189.55 350-890ng/dL

8/5/10
Iron Bind Cap 273 250-450ug/dL
UIBC 219 150-375ug/dL
Iron, Serum 54 40-155 ug/dL
Iron saturation 20 15-55%
Test serum 197 280-800ng/dL
Prolactin 6.3 4.0-15.2ng/mL
SHBG serum 49.6 14.5-48.4nmol/L

2/22/11
Test Serum 355 249-836ng/mL (this is best it had been)
Test Free 8.58 5-21ng/mL
%Free test 2.42 105-4.2%
TSH 1.79 .45-4.5uIU/mL
Cholesterol Total 131 100-199mg/dL
Triglycerides 36 0-149
HDL 77 >39mg/dL
VLDL 7 5-40
LDL 47 0-99mg/dL

6/15/11
TSH 1.340 uIU/mL 0.450-4.500
Testosterone, Serum 189 ng/dL 249-836
Testosterone,Free 4.01 ng/dL 5.00-21.00
% Free Testosterone 2.12 % 1.50-4.20

I stopped cutting june 1st and have been eating at maintenance since. i have surgery next week so will be out of the gym for 2 weeks. think i will get it checked after some time off from the gym and see how it looks then.


#2

The only thing I can recommend is that if you plan to do a test run, do it properly. Otherwise if you don't do it properly you will not be able to make a fair assessment.

Have a read here and if you have any questions after, be sure to ask.

http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/lab_work_and_blood_testing

Yes on the hair. Taking testosterone can accelerate your hair loss if you have a predisposition to it.

If you have lab results post them up. The answer to your problem might be elsewhere.


#3

Read the "advice for newbies" and "blood work" stickies. Post ALL bloodwork, and any additional symptoms mentioned in the stickies (fatigue, etc...). Come back with a full post and be ready for a 2-way conversation. This is YOUR health and you need to be informed, we can work with you but not for you.


#4

Get some labs done or this is all pure conjecture. In my opinion it doesn't really make sense to evaluate it for a month, especially with a demonstrated need. Being low-T is bad for your health and life expectancy. I didn't even feel any effects until my 3rd week, it takes some time to act. Not only that, but taking it for a month could be just enough to crash your natural T. If you come off, you will likely feel awful for a period while your HPTA rebounds (this can be mitigated with ancillaries like HCG, though.)

If your psych issues are related to low-T, which mine definitely were, it makes way more sense to fix the low-T than to take SSRI's. You have a psychiatrist trying to get you off psych meds, that is pretty amazing...kudos to him. I would listen!

If TRT made me lose my hair (because I was going to lose it at some point anyway) I would still take it. It's worth it for me. That's a decision you have to evaluate on your own.


#5

The good news is that you are like the first person in forever who doesn't appear to have subclinical hypothyroidism along with low T. I won't even waste your time telling you to get Free T3/T4 tested - your TSH is fine and you don't complain of fatigue, feeling cold, putting on weight, or any classic hypothyroid symptoms.

However, you DO need your adrenals tested. This could easily be causing your lack of sleep. Also, your body will not support additional testosterone without healthy adrenals. Often, people in this situation report brief periods of feeling great on TRT only to go right back in the dumps.

Get a 4-point saliva cortisol test if you can - otherwise, an 8am blood draw is the best bet. You want this value to be right near the top of the lab range.

Hair loss drugs do not directly interfere with the production of test. They prevent Test from being broken down into DHT - which is often villified as being responsible for hair loss and prostate cancer, but in fact is mission critical for libido and sexual function. Some (most) docs just want DHT as low as possible, in reality it should be neither above NOR below the lab range.

That being said... hair loss drugs may reduce the production of T through some secondary mechanism or feedback loop, I'm not sure about that. It would help to see your cholesterol/pregnenolone/DHEA-S/E2 levels just so we know what your production line looks like, and which link is the broken one.

Last thing... as far as your question about a temporary trial... maybe someone else can answer that. That's a bit out of my wheelhouse.

edit - In the future, make a new post when you have new info (instead of editing the first), so we know something new is in the thread


#6

The only thing that sticks out to me is your above range SHBG value from last year. Have you had that measure again? Have you had E2 measured by any chance also?

Maybe your High SHBG needs attention.


#7

Thanks for the replies.

I had my cholesterol checked recently. those numbers are in my post. as far as E2, DHEA, Pregnegnolone, cortisol I dont believe i have ever had those tested. I only had the SHBG tested the one time by the endo. I can ask my Dr. if he would mind running those tests for me.

i have never had any of those symptoms you mentioned (fatigue, feeling cold, putting on weight). I work out 6x a week and I never have any energy issues. I have a hard time putting on muscle/gaining strength but I'm not losing muscle.


#8

Your low CHOL is a bit concerning. What's your diet like? Total calories and macronutrient splits.


#9

Why would low cholesterol have anything to do with test levels? Since my first physical (10 years ago or so) my cholesterol has always been low. The highest it ever registered was 140 and lowest was 101. My dad has low cholesterol too. Even at 64yrs old (has a big belly), eating whatever he wants (tons of saturated fats) his is only around 170. My diet is below.

2700-2800 calories. 210g protein/80g fat/285g carbs

I eat a good balance of food. I eat probably 80-90% clean and the rest what I want. My fats come from olive oil, nuts, peanut butter, leaner cuts of beef, pork, whole eggs, cheese etc. prob get around 30% from sat fats.


#10

Because testosterone comes from cholesterol. Specifically, cholesterol->pregnenolone->DHEA->testosterone. If you don't have the bricks, you can't bulid the house.


#11

I just had some more labs done. Is there anything else I should do before moving forward with TRT. As I said in my original post my symptoms are low libido, trouble gaining muscle mass (when i increase calories my gains are mostly fat), irritability, sudden mood swings, anxiety. I don't have any fatigue and I have been sleeping better lately. I'm currently taking a low dose of Celexa to help my mood/anxiety. Biggest problem for me is the low libido.

Triglycerides 43 20-149
LDL 76 <100
HDL 83 >60
VLDL 9

Since my last labs I started eating alot more red meat/egg yolks since my cholesterol was so low.

TSH 1.788 .35-5.5 uIU/ml
T3 Total .62 .60-1.81 ng/ml
T3 Free 2.07 2.3-4.2 pg/ml
T4 6.3 4.5-10.9 ug/dl
T4 Free .9 .6-1.8 ng/dl
Estradiol 16 <54 pg/ml
PSA .49 0-4 ng/ml
Test Total 287 292-1052 ng/dl
SHBG 76 16-94 NMOL/L
Free Test 3.1 4.8-25 ng/dl

I requested to get my cortisol checked but they told me it was unnecessary. If it's necessary I can have it done on my own. The 4pt is pretty expensive but the AM one is only $35 or so. Should I do that? Anything else I should have checked before I make a decision. I have not had DHEA-S checked either. I can do that too on my own if necessary.


#12

Your Free T3 is very low and indicates hypothyroid symptoms. Since your TSH is also on the lower side, this to me means your body is not asking for more thyroid hormones. Why not? My theory would be that your body could not handle the additional thyroid metabolism without accompanying T metbolism.

Basically what I'm saying is if you increase your T, your thyroid would probably follow suit. This is usually the reverse, but most of those cased also involve high TSH. But since your LH/FSH are also on the lower side (basically, not high) this also indicates your body isn't screaming for more T.

But I'm talking in circles.

You can either start my treating T or start by treating thyroid. If the other doesn't improve, then continue treatment of the same.


#13

hmmm, you know... I can not actually remember seeing anyone actually below the lab range for Free T3... typically people are in range, just below ideal when they start treating their symptoms.... (note that this could just be my faulty memory)

but basically your FT3 is in the toilet...

cortisol tests are definitely required... and I would think testing Pregnenolone would help as well.

Low CHOL = low pregnenolone = low cortisol and low testosterone = nothing to work with your thyroid = low metabolism.

what is your waking body temp? what about at 9am, noon, and 3pm? I'm beating the average is way below 98.6.

you may want to consider trying out some over-the-counter pregnenolone but be extremely careful with the dosage, start out very very very small, and break it into multiple doses per day.

you also may want to check out stopthethyroidmadness.com

pregnenolone should help boost metabolism but it could also convert too much down one hormone stream, or it could put extra stress / demands on your other systems and cause them to crash.


#14

OK thx. I will definitely get a 4pt cortisal test done and also have my pregnenolone and DHEA tested. Today is the first I had heard of of the correlation between body temp and adrenal issues and I will do the temp test tomorrow. I tested today at noon and again at 6pm. I was 97.4 and 97.8 respectively.


#15

I had some more tests ran last week.

Profile/Panel/Test Value Unit Normal Range
25-Hydroxy, Vitamin D 26 ng/mL
25-Hydroxy, Vitamin D-2 <1.0 ng/mL
25-Hydroxy, Vitamin D-3 25 ng/mL
Pregnenolone, MS 29 ng/dL
DHEA-Sulfate 125.6 ug/dL 88.9-427.0
Cortisol 11.6 ug/dL 2.3-19.4
Progesterone 0.4 ng/mL 0.2-1.4

for some reason it doesnt show the normal range for the vitamin d or pregnenolone.

any thoughts? the cortisol was just total cortisol. my doctors lab didnt do the saliva test so they just took total via blood around 11am.