T Nation

Spinup's TRT Log

I am a 38 year old male, 6’ 205 lbs. My labs were just processed and are as follows:

Test Result
Total Testosterone 421 ng/dL
Free Testosterone 8.9 pg/mL (8.7-25.1)
Dihydrotestosterone 26 ng/dL (low, 30-85)
DHEA-Sulfate 105.3 ug/dL (102.6-416.3)
LH 5.8 mIU/mL (1.7-8.6)
Prolactin 8.9 ng/mL (4.0-15.2)
Estradiol 17.1 pg/mL (8.0-35.0)
SHBG 39.6 nmol/L (16.5-55.9)
IGF-1 211 ng/mL (83-233)
TSH 3.72 uIU/mL (0.450-4.500)
Free T3 3.3 pg/mL (2.0-4.4)
Reverse T3 26.1 (high, 9.2-24.1)
Free T4 1.54 ng/dL (0.82-1.77)
TPO 21 (0-34)

I have marked some tests in bold where they are outside of or near thresholds. It seems to me that my testosterone levels are somewhat low, although within the expected average range. DHT is clinically low, but I’m not sure what effects this may have. I also don’t know how to interpret thyroid tests, but I can see that all of them are elevated except for fT3. My PCP had just my total T tested about four months ago and it came in around 360 then.

I also had other important tests performed, such as lipids, PSA, etc, and everything looks outstanding. I lift heavy (for me) and do high intense cardio six times a week and have been for nine months (I shoot for 6x/wk - I often cannot recover well enough and only get in 3 or 4 per week). I have seen moderate strength and size gains, but not what I would expect. I am seeing some fat loss, and eating in a moderate calorie deficit (~1900 net daily), but I am really struggling to remove fat around my chest and upper back. My diet consists ONLY of fish, nuts, olives, chicken, and green leaves. That’s it, with absolutely no cheating, and I target 150g of protein daily. My blood pressure is great at around 110/77 both morning and night.

In addition to joint pain and clicking, and what seems (to me) like slow progress in strength training, what first drove me to have this testing done were a lot of the symptoms I see here in this community and others including low libido, weaker erections, fatigue, off-and-on depression and anxiety, and brain fog, and joint pain. These symptoms seem to wax and wane in severity. Also of note is that I still deal with facial and shoulder acne (also comes and goes in flairs) in my late 30s. When I went through puberty I got some moderate gynecomastia that still hangs around to this day - not sure if that’s relevant.

I have a history of major surgery (lumbar fusion) with several years of daily lowish-dose opiate use. I also used SSRIs and Xanax for many years until I had finally had enough of the psyche horse shit and stopped all medication 12-18 months ago. I cannot imagine what my T levels would have tested at during my surgery recovery while I was taking all the drugs.

I would appreciate anyone’s thoughts if they have them. I have yet to schedule an appointment with the clinic I’m dealing with (Defy), but these are the concerns I would raise with them. I realize that I’m within the range where I may be treated if I ask to be, but I want to be careful. But there may be a thyroid issue as well? Not sure.

Thanks!

Your testosterone levels aren’t normal, not according to the statistics when compared to other men your age.

Your thyroid is in trouble and TRT may make it worse because metabolic rates increase placing greater demand on other systems.

In range is BS, when compared to other healthy men your levels of free testosterone is very low. I was on the sister drug clonazepam for 30 years and crashed my HPTA, benzo have a big impact on testosterone.

Do you have any other thoughts on this? Or do I need to just consult with a doctor at this point?

You’re covered, you have Defy Medical, Dr Saya will be able to figure it out. Usually when TSH is elevated, there may be an underlining problem, rT3 can block fT3, however some docs don’t believe it, but usually when TSH is elevated, you’ll see either low fT3 ir good fT3 and high rT3.

It’s almost impossible to tell if rT3 is active.

They don’t… at least not according to literature. Opiates on the other hand (barring tapentadol) do

The consequence of benzodiazepine withdrawal however is an unknown variable

I’ve heard Dr Rob talk about how benzos can mess with the HPTA. He must have access to more data that we don’t. He has seen countless men who had been on clonazepam and now have low-T.

Exactly, say you’re overweight and a diabetic and testosterone can’t recover normally. I actually used to have a study showing testosterone increases on benzos. Clearly benzos has some effect on T, maybe positive and negative.

These seems to be the case for me. My TSH came in around 1.6 roughly 7 months ago. There’s some great info on subclinical hypothyroidism here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664572/.

Lowering the upper limit of normal for the serum TSH level from 5.0 to 3.0 or even 2.5 mIU/L has been proposed, but such proposals have been met with substantial critique. The strongest argument in favor of lowering the upper limit of normal for the serum TSH level is the higher level of antithyroid antibodies detected in persons with a serum TSH level between 3.0 and 5.0 mIU/L and the higher rate of progression to clinical thyroid disease. After exclusion of persons with goiter, antithyroid antibodies, and a family history of thyroid disease, the mean serum TSH is 1.5 mIU/L. The serum TSH distribution curve is not Gaussian; there is a tail end at the upper limits of normal. If the distribution is extrapolated to be Gaussian, then the upper limit for the 97.5th percentile will be 2.5 mIU/L.

I’ll make sure to report back after speaking with Dr. Saya to document what he recommends.

Thanks for the help!

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Clearly TSH is a poor diagnostic tool, there was a guy last year who initiated TRT (TSH @2.2) and 5 weeks later his TSH increased to 2.7 and his Free T3 was below range (<2.0-4.4) and he was full blown hypothyroid with TSH well within range.

The TSH doesn’t scale quite the same with every patient.

DHEA-S is currently the most reliable non-functional marker for adrenal insufficiency.

Consult with your physician what the borderline level means with regards to adrenal insufficiency. Discuss a potential diagnostic workup to get to a clear diagnosis (ACTH stimulation test).

rFT3 indicates a systemic problem, it’s not a marker of thyroid health.

TSH can vary widely. The reason to lower the TSH ref range is to detect occult cases of autoimmune thyroid disorders (eg Hashimotos) as early as possible. You are covered because your physician tested for thyroid peroxidase autoantibodies (TPO).

As promised I’m reporting back here for posterity after having consulted w/ the physician at Defy. I spoke with Dr. Calkins who seemed very thorough and patient and spent over an hour on the phone with me. He was very confident that his protocol would alleviate all my symptoms, which seemed unusual given the hesitancy from doctors I’ve seen in all other settings.

The protocol is as follows:

  • 70mg Testosterone Cypionate every 3.5 days
  • DHEA 25mg daily
  • Liothyronine (Cytomel) 5mcg daily
  • Anastrozole 0.125mg every 3.5 days
  • Labs in 3 months

I was also written for HCG every 3.5 days, but I’m going to hold off on that for now to limit variability while I’m going on protocol. I’m also holding off the AI given what I’ve read about its propensity to crash E2, although I did order it to have on hand in case it’s needed.

The Liothyronine is compounded T3, and Dr. Calkins’ reasoning was that because FT3 and FT4 look fine, but rT3 and TSH are elevated, I likely have a genetic predisposition to converting more rT3 which is blocking too much FT3. Simply adding T4 would be adding fuel to the fire, so he wants to bypass the conversion and just add straight T3. I explained that I had a TSH of around 1.7 about 8 months ago, so I felt hesitant to add thyroid meds, but he explained that these things just worsen with age and often worsen rapidly at some point in a person’s 30s. I guess I’ll plan on trialing the Liothyronine along w/ Test-C and DHEA. I can always quit it if it doesn’t work out.

I’ve read some posts here from the following folks that seem very informed. I’m going to take the liberty of tagging you here, but don’t feel obligated, although I would like your thoughts if you have time. @davidsherlockio @dbossa @dextermorgan @TRT_Phoenix

I would be lying if I said I wasn’t absolutely dreading self-administered injections. Whatever.

Why are you taking Anastrozole? What is with these doctors?

I was deathly afraid of needles. Like, pass out at the mere sight of them afraid. Now I inject daily without issue. If you’re starting out, you can try using small 27 or 30 gauge needle, 1/2, and do SubQ injections in the belly fat. That’s how I started.

I’m going to hold off on this given what I’ve read here and everywhere, really, although I did order some to have on hand.

I’ll keep that in mind, thanks. I guess the protocol seems pretty straightforward other than the T3? Do you have any experience with that?

It’s a relatively small dose. It’s roughly a quarter of what I was taking daily… and I was taking half of what some other guys were taking.

This video I made might be useful for you:

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That video is great. Thanks a ton for posting it. Do you think I could just do SubQ every 3.5 days without changing the dose? Or would that be too much oil for SubQ?

Also, where do you order your needles? I could get them from Defy but shipping is outrageous.

Here’s one place and there’s always Walmart. Ask for a box of 1/2 inch needle 1CC insulin syringes. They’ll tell you what sizes they have (31-28g).

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I order my needles in bulk online. Works out to much cheaper. I live in Canada so the website wouldn’t be any good for you. Maybe the others can chime in.

You can TRY to do 70mg 3.5ml every 3 days and just check to see if you get any of those bumps I was talking about in the video. Massage the area really well after you have injected to disperse the oil as much as possible as that helps quite a bit.

Thanks for the tips. I ended up getting these from Amazon: https://www.amazon.com/EasyTouch®-U-100-29G-1cc-Box-100/dp/B07P11F21N

Can’t beat the free shipping.

That’s what I use and where I get them (except 30g instead of 29g). Hard to beat amazon.

Good find. Although I prefer 28g there’s not much difference