T Nation

Questions about my Prescribed Regime


#1

Hi All,

Looking for some advice and feedback on what my dr has me doing.

Since my early 30’s I’ve been feeling rather “low” (39 now). After reading this forum, what I thought were problems fairly unique to me seem to be pretty widespread.

I have a pretty great dr. Sent me for plenty of tests over the past 8 months. After trying to do some research, I found this forum and decided to post for some feedback on what he has me doing.

Initially my dr basically said I should get some supplements to ensure anything I was missing in my diet was covered. Prescribed me some DHEA (bloody expensive stuff here in canada) and 50 mb synthroid (I have a family history of thyroid issues, including 2 uncles and apparently my lab results are low). He also prescribed 50mg progesterone before bed and recommended I take melatonin as well to help improve sleep (it is much improved, instead of taking an hour to fall asleep and waking up 2-3x a night I fall asleep much quicker and wake up maybe 1x a night).

Basically he said I am a pretty healthy individual and my body should be working well, so maybe it just needs a little help/resources to build my testosterone (which he said was low) and restore my energy levels.

After my numbers didn’t improve and I felt pretty much the same in september, he decided to throw some t-cream in the mix for 2 months to see how I felt and how my numbers changed.

So since september I have been using 1/8tsp of 10% testosterone lipoderm cream twice a day. Plus my synthroid was increased to 75mg. I have felt significantly better. Heck, even my back pain I have suffered with my whole life has improved.

After my numbers came back from the november tests and my feedback about having more energy etc., he’s decided to keep me on the cream, keep the synthroid where it is and add in an injection of 300 iu of HCG 3x week. Said my estradiol is great and I need nothing for it.

Now that I have to do an injection, I decided I really needed to do some research on all of this and stumbled over to here. Where I have spent over 6 hours reading posts and stickies… I am a bit overwhelmed so forgive me if I am missing any vital information here. I do realise that I seem to be missing some information on the tests, I didn’t get any actual blood test result forms, I literally sat there in the office with my dr while he read the tests out to me, explained what they meant and I made notes on a pad of paper…

So here we go:

-age

39

-height

5’8’

-waist

33.5’

-weight

199.8lbs @ 17.8% bf

-describe body and facial hair

Mild chest hair, mostly around nipples and center of chest. Very light facial hair, shave 1-2x a week. Not a hairy man at all.

-describe where you carry fat and how changed

Butt, hips, love handles although I have a fairly even layer all over.

Over the past few years, although my exercise has stayed the same and my diet stayed consistently healthy, I’ve gone from visible abs to flat and soft - probably from 10% bf to 20-ish% before seeing my current dr and have now dropped back down a bit.

-health conditions, symptoms [history]

Generally healthy. Have caught more colds/flu over the past few years than ever before. Chronic insomniac/sleep issues since I was a young child. IBS like symptoms at times, mostly clears up when I go gluten free (don’t judge me). Bad back pain for most of my life.

What drove me to the dr was the fat gain, tiredness/lack of energy and irresistible daytime napping. My workouts lately leave me sore for 4-6 days, which seems excessive. I’ve always been slow to recover but it’s just getting worse and worse. Even with the t-cream my recovery is still 4-6 days of DOM’s, which feels like way too much. Dr says this is likely due to low igf1 score but he doesn’t want to prescribe anything for it right now, wants to wait and see if the numbers get better…

Add in loads of irritability & negative moods which are completely not my natural state, poor physical reaction to what are normal daily stresses (shaking hands, racing heart, sweating, dry mouth are things I never experienced until the past few years). Numbers in the gym declining, etc.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
– real dangers! see this http://propeciahelp.com/overview43

Yes, I was prescribed finasteride in my early 30’s, took it for 9 month or so, noticed no hair loss benefits and stopped. Strangely enough, I started experiencing my symptoms around this time. Co-incidence? I don’t know. Was a different dr than my current one who prescribed the finasteride. When I asked him about possible side effects, he said that it would reduce my chance of prostate cancer and otherwise, there was no side effects. After reading about finasteride, I am glad I stopped. I do wish I had done more research before taking it. I do not blame the dr at all, I should have been in more control of my life.

-lab results with ranges

These are what I have. I have two values, the initial tests done in april and the current results from november:

Homocyst under 8 is normal: 12.5 april, 6.8 nov
Vit D 100-150 normal: 108 april, 120 nov
Iodine test, 90% is normal: N/A april, 83% nov (my test is low but not horrible)
TSH 1.6-8 normal: 1.46 april, 2.55 nov
Free T4 16-18 normal: 11.6 april, 14.6 nov
Free T3 5.5 normal: 4.15 april, 4.23 nov
Anti TPO (no idea of reference): 101 april, 81 nov
AM Cortisol (no idea of reference I believe lower is better): 576 april, 462 nov
DHEAS 14+ is normal: 6.9 april, 13.6 nov
TEST Total 25-30 normal: 11.7 april, 30.7 nov
Progesterone (no range provided): >2 april, 4.5 nov
Estradiol (no range provided): 63 april, 137 nov
FSH 1-18 normal: 5 nov
LH 2-18 normal: 2.7 nov

Cholesterol was not done in nov (was on the lab sheet but just wasn’t done), but in april it was:

Total 42.-5.2 normal: 4.65
TGS 1-2 normal: 0.8
HDL 0.9+ is good: 1.64
LDL 2.5-3.5 normal: 2.65

GFR 90 is normal in april I was 81.

Weight: 202 april, 198 nov
BF%: 22.7% april, 17.6% nov

Bring in Canada, often my dr puts tests on the lab sheet and they simply do not get processed. These include shbg, free test, bio test, etc. I’ve no idea why this occurs but it drives the dr crazy. I’m considering driving to seattle to pay for tests… heck I had to pay for my vit d tests.

-describe diet [some create substantial damage with starvation diets]

A low carb -ish paleo diet. I consume the majority of my carbs post workout during weekdays on the weekends I don’t track much and eat more carbs - such as the home made pan fried potatoes I had for breakfast this morning. Often during weekdays I skip breakfast, though if I have time I will make breakfast. I work from home but am self employed and being PST timezone often have a LOT of work first thing in the morning from EST timezone clients.

Here is an example from my journal:

7 am - 1 cup black coffee with 75mb synthroid & 50mg dhea
9:45am - 1 cup black coffee. supps: multi vit, full spectrum b, vit c, 720mg epa, 480mg dha, 250mg DMG, t-cream 1/8tsp 10% lipoderm
noon - 50mg dhea
1:30pm - 1 large turkey sausage, 1 piece leftover homemade gf pizza, 1.5 cups pea pasta (pasta made with peas, high protein & fiber, low carb) with spinach in tomato sauce (leftovers), t-cream 1/8tsp 10% lipoderm
4pm - 1 scoop (30g protein) whey & blueberries, spinach with 1/3 cup coconut cream shake & water
7pm - spaghetti squash pasta in tomato sauce, steamed broc, 4 large lamb meatballs. supps: multi vit, full spectrum b, vit c, 720mg epa, 480mg dha, 250mg DMG, 2 squares dark chocolate & a cup of black tea with heavy whipping cream.
midnight - 200mg chelated magnesium, 5,000 iu vitamin d3 with 1000mcg iodine, 1mg melatonin, 50mg progesterone

I nearly always consume more than 2500 calories, often closer to 4000. I do not eat the same thing everyday…

-describe training [some ruin there hormones by over training]

I am for 5 hours per week (1 hour per session) of crossfit - a typical class is a 15 minute warmup, 20-30 min strength work, 5-15 minute WOD, Cooldown for the remainder of time.

5 hours per week mobility work (1 hour per session). Loaded progressive stretching, etc.

I get about 75% of that lately due to work commitments and such.

-testes ache, ever, with a fever?

no.

-how have morning wood and nocturnal erections changed

They were rare, 1-2x a week. With the t-cream it’s now near every morning.

In summary, while I am not afraid of administering a needle to myself; now that I have to perform an injection this is starting to feel like “serious business”. Thus, I am trying to figure out if this is the best route for me, what if anything else I should be doing, etc.

I could really use ANY and ALL advice.

Thanks!


#2

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

We need lab units and ranges if you can manage that.

E2=80pmol/L is your target and you need anastrozole/Arimidex to manage E2.

Self inject T with #29 0.5ml 1/2"-12.5ml insulin syringes
Take 1/2mg anastrozole at time of injections
Suggest 250iu hCG EOD SC/SQ

Are you not using iodized salt to support your thyroid hormone production.
You need a multi-vit that includes iodine+selenium
Check overall thyroid function by oral body temperatures as per the thyroid basics sticky.

TSH should be nearer to 1.0
fT3, fT4 should be near midrange.

Stress and stress history can be part of your thyroid function.

You are iodine deficient and/or under medicated.

Anti TPO is useless without range.
Auto immune disease can be from lack of selenium

FSH and LH should drop near zero on TRT.


#3

Thanks for the reply KSMAN!


Please read the stickies…

I foresee much more reading on this tonight.


We need lab units and ranges if you can manage that.

I’ll email my dr for them. Had no clue there was not a standard for this stuff.


E2=80pmol/L is your target and you need anastrozole/Arimidex to manage E2.

Self inject T with #29 0.5ml 1/2"-12.5ml insulin syringes
Take 1/2mg anastrozole at time of injections
Suggest 250iu hCG EOD SC/SQ

Thank you, I will definitely bring that up.


Are you not using iodized salt to support your thyroid hormone production.
You need a multi-vit that includes iodine+selenium
Check overall thyroid function by oral body temperatures as per the thyroid basics sticky.

I switched to iodized salt when my daughter was born 8 years ago.

I was taking 400mcg selenium for the past 6 months. I was told by my dr to give it a 6 month run and see if it helps. I currently get only 200mcg from my multi vit. I also take 1150mcg iodine daily.

Are those decent dosages?


Check overall thyroid function by oral body temperatures as per the thyroid basics sticky.

My low body temp was one of the big reasons that drove me to the dr in the first place. My thyroid is definitely not functioning at 100%.

Appreciate all the advice, will follow up.


#4

That is all good and 200mg selenium should be all that you need.