T Nation

Started TRT Past December

My name is Mark. I’m 55 6’6" and weigh 330. Big spare tire around waist. Started TRT this past December. Will give my history first, then delve into current status. I just discovered this site…so I haven’t done everything according to the stickies correctly yet…Right now I don’t have all my lab numbers…but will get them posted this week. Dr is GP…the Endo’s around here suck…and while this guy doesn’t know everything about T replacement(as you will see by his mistake in E test)…he’s willing to work with me.

Age 19 testicular cancer. Treated with surgery and pretty intensive radiation. Age 32 had heart attack following 3 mile run (yeah back then I weighed about 225) Angioplasty done. Age 31 diagnosed hyperthyroid. Given radioactive iodine…now on Levothyroxin. Age 43 had aortic valve replaced and bypass. Dr’s were confused as to why with no family history of heart problems and normal cholesterol readings why I was having heart problems. Surgeons said when they opened me it looked like my insides had been blowtorched…they say due to the radiation during cancer treatment. Past 2 years have been feeling tired…sleep all the time, weight gain. Talked to a trainer who put me on exercise regimen and diet.

After almost 2 years with no results was bitching to my Dr about it and he suggested getting T checked.

So in December 2012 I started this odyssey with a T level of 94. Dr put me on 1 ml of 100Mg/ml cyp every 2 weeks. Follow up test done 6 weeks after starting at the end of the 2 week cycle. T had fallen to 73. He put me on 1 ml of 200Mg/ml every 2 weeks. Felt like a new man well into February…but then seemed to crash back to the old me about the time I started the higher dose. Re-tested in mid March…this time half way through the 2 weeks. T now at 866. But I also started to retain fluid in both legs…left breast started to enlarge…back to sleeping all the time…and new symptom…loss of erections. Not good!
Saw Dr last week. He decided to test estrogen…found this site the day after…which leads me to today.

Got results back Friday. Now I know after reading here that he didn’t order the right test. He tested total estrogen. So I’ll have to get it re-done. BUT…he also gave me Anastrozle which he wanted me to start even without the lab back…his thinking that given my symptoms it would be needed. I’ve had 1mg this week. (What a pain it is to break that little pill into 1/4’s!!)

My plan right now is to split my T dose into at least every week starting with my next scheduled dose. My dilemma…is what to do about the labs. Should I just go ahead next week and get the proper E-2 lab having taken the AI this past week, or wait until my next check of the T…which will be another month?
Current meds
warfarin 6mg ED levothyroxin .3 mg ED bisoprolol 2.5 mg ED T Cyp 1ml of 200mg/ml every 2 weeks

That’s a pretty good “BUT”, msvid. Testing for E2 is the most important one, but if your total estrogens are elevated your E2 will be elevated as well, so he didn’t screw it up too bad. I think the term we use on here is “enthusiastic GPs”. Sounds like you have one which is awesome.

Try to get things in line with protocol for injections sticky. This will prevent the roller coaster effect and keep levels more stable.

Cutting anastrozole up can be a pain. Google ‘anastrozole research chemical’. There are several reputable companies out there and it’s much easier to dose properly.

See if he will prescribe hCG for you as well. Keeps the boys downstairs from shrinking, along with other health benefits. Google Dr. Crisler hCG update. There is a lot of good info there, but he got the protocol wrong. Every other day seems to work best for most. Print it out and take it to your Doc. When your Doc has trouble finding hCG, just tell him to call a compounding pharmacy.

Welcome to the forum. There’s a wealth of experience and information here.

Your labs should have included LH/FSH before starting TRT. If your ?testicle? is non functional, hCG would not do anything. If your ?testicle? was small and scrotum not hanging, then we can assume that LH was very low and you had secondary hypogonadism.

With total E and not E2, we can set an ideal target for total E at 50% if the top of the total E2 range and compare your level to that.

So your BP is high?
Fasting glucose?
Cholesterol?

CV health:

  • DHEA to get DHEA-S to at least mid range, take with higher fat meals, fish oil and vit-D
  • T levels near top of range, not age adjusted, TT=900-1000
  • E2 in lower 20’s
  • Fish oil, nuts and/or flax seed meal/oil for EFA’s
  • high potency B complex multi vit with trace elements and iodine
  • antioxidants: vit-C, natural source vit-E, CoQ10 [ubiquinol form, 50 or 100mg]
  • 5000 iu Vit-D, take 25,000 per day for the first week, find tiny oil based caps, also at USA Walmart

Were you on a salt restricted diet and iodine deficient? That can make you hypo and that can progress to hyper. See the thyroid basics sticky. Is your Levothyroxin right? Eval that with checking of body temperatures as per the sticky. Some do not do well on that drug. Some do not convert T4–>T3 adequately in peripheral tissues and can have inadequate T3 levels and can still be hypo. And given your history, you could have adrenal fatigue issues.

Do you have any iodine intake now? There are roles for iodine in the body other than production of T3, T4.

Need:
TSH
fT3
fT4
AM Cortisol, wake up at 7 and get labs at 8AM, not later
DHEA-S
vit-D25
fasting cholesterol and glucose
IGF-1
TT
FT
E2
PSA
consider doing your own lab work

If your thyroid meds are not working right and/or your adrenals are a mess, TRT outcome can be poor.

Suggest injecting T twice per week and take 1/2mg anastrozole at the time of injections. Use insulin needles as per the sticky. For your body weight, you may need more than 100mg T per week. And may need more than 1mg anastrozole per 100/mg T. Understand “anastrozole over-responder”.

“”"
Testosterone injection, Testosterone topical (patches and gel), Testosterone buccal system, Stanozolol, Oxandrolone, Testolactone

MONITOR: Androgens may induce reversible clinical hyperthyroidism in patients receiving thyroid hormone replacement therapy. The proposed mechanism is androgen-induced decrease in T4 binding globulin resulting in decreased serum T4, increased T3 uptake resin and free T4, and decreased TSH levels.

MANAGEMENT: Clinical and laboratory monitoring of thyroid function may be necessary, as may a 25% to 50% reduction in thyroid hormone dosage.

Calcium carbonate, Multivitamins and minerals, Prenatal multivitamins, Calcium acetate, Calcium gluconate, Calcium lactate, Calcium phosphate, tribasic (tricalcium phosphate), Calcium glubionate, Calcium citrate

ADJUST DOSING INTERVAL: Concurrent administration of calcium-containing products may decrease the oral bioavailability of levothyroxine by one-third in some patients. Pharmacologic effects of levothyroxine may be reduced. The exact mechanism of interaction is unknown but may involve nonspecific adsorption of levothyroxine to calcium at acidic pH levels, resulting in an insoluble complex that is poorly absorbed from the gastrointestinal tract. In one study, 20 patients with hypothyroidism who were taking a stable long-term regimen of levothyroxine demonstrated modest but significant decreases in mean free and total thyroxine (T4) levels as well as a corresponding increase in mean thyrotropin (thyroid-stimulating hormone, or TSH) level following the addition of calcium carbonate (1200 mg/day of elemental calcium) for 3 months. Four patients had serum TSH levels that were higher than the normal range. Both T4 and TSH levels returned to near-baseline 2 months after discontinuation of calcium, which further supported the likelihood of an interaction. In addition, there have been case reports suggesting decreased efficacy of levothyroxine during calcium coadministration. It is not known whether this interaction occurs with other thyroid hormone preparations.

MANAGEMENT: Some experts recommend separating the times of administration of levothyroxine and calcium-containing preparations by at least 4 hours. Monitoring of serum TSH levels is recommended. Patients with gastrointestinal or malabsorption disorders may be at a greater risk of developing clinical or subclinical hypothyroidism due to this interaction.
“”"

Thanks guys. I don’t know if LH/FSH was done prior to starting T. I can’t find my copy of the labs from then but will pick it up this week at the Doc’s. Testicle was neither small nor non hanging. BP is not high. Typical is 135/75. Bisoprolol given to reduce heart rate. (least that’s what I was told) It’s been fast since the valve replacement. General consensus for hyperthyroid was due to damage from radiation. I was blasted in an 8 inch swath basically from my lower abdomen to mid-throat, front and back for a total of 32 weeks(150 rads IIRC five days a week). Was not on a salt restricted diet per see…just told not to over do it. Was never told I had iodine deficiency…but that doesn’t mean someone checked…

I’ve done the body temp thing in the past and was OK. I’ve griped at the Docs since going on levo about steady weight gain and being unable to lose it…was about 230 pounds when it went hyper.

The total E from last week 95pg/mL 40-115 ref int
PSA from last week was 0.7 0.0-4.0 ref int
Labs from mid march was…
Total Cholesterol 176 100-199 ref int
Triglycerides 129 0-149 ref int
HDL 27 >39
LDL 123 0-99 ref int
T 866 348-1197 ref int
FT 19.0 7.2-24.0 ref int
T4 free 1.45 0.82-1.77 ref int
TSH 2.53 0.45-4.5 ref int
fast glucose 110 don’t have the paperwork but just remember this number from last December
did have fT3 done last year…will have to get it
Should I get all the tests you listed as needed again…or just the ones I’m missing? The only ones I don’t think I’ve ever had in the past couple of months are AM Cortisol, DHEA-S, vit-D25, IGF-1 and the E2.
Thanks again
Mark

TSH indicates that hypothalamus is signalling for more TSH because is it not seeing enough T4-T3 effect.

Please recheck body temps as per thyroid basics sticky.

Hypothyroid state and/or low T can cause weight gain and elevated E2 makes it all worse.

Total E is too high, lowering it will have good benefits.

Suggest 1mg/week anastrozole in divided doses as per my post above. As per the stickies, understand what anastrozole over-responder means.

Supplements suggested should increase HDL and combat endothelial dysfunction [Google that].

Get the labs posted, ping me on the KSman is here thread.

You have come to the right place, I hope that we can be helpful.

2 days of temp reading…cause I didn’t believe the first one 96.2 morning 98.4 mid-day second day 95.8 morning 98.5 mid-day…
Working on getting the other missing labs…

Mark

If they nuked your thyroid completely, iodine will not improve body temps, but still needed as a trace element.

Your low body temps indicate that your thyroid meds are not enough.
– your fT4–>fT3 conversion may be weak, you may need some T3 meds
– but remember that rT3 can also be interfering with fT3
– T4 is a reservoir and should be allowing you to get though the night without temps going too low, but above can be at play
– suggest that you try a T4+T3 med and see how you do
– some are poor at T4–>T3 conversion in peripheral tissues, not going to happen in a non-functional thyroid.

Did you fully understand this:
“”"
Were you on a salt restricted diet and iodine deficient? That can make you hypo and that can progress to hyper. See the thyroid basics sticky. Is your Levothyroxin right? Eval that with checking of body temperatures as per the sticky. Some do not do well on that drug. Some do not convert T4–>T3 adequately in peripheral tissues and can have inadequate T3 levels and can still be hypo. And given your history, you could have adrenal fatigue issues.
“”"

Need:
TSH, fT3, fT4, rT3
AM Cortisol, wake up at 7 and get labs at 8AM, not later

KSMAN…Thyroid was completely nuked…an Endo I saw after the first one couldn’t believe how much radioactive iodine the previous doc gave me.
Not on a salt restricted diet…other than to not over do it. I assume Levo dose is correct…I have to rely on Doc for that…will get the rest of labs done this week.

NEW QUESTION… Initial T dosage was 200mg/ml every 2 weeks. I started 2 weeks ago with .5 ml of 100mg/ml twice a week. which if my math is correct puts me at 100 per week…200 every 2 weeks. Taking .5 mg tab of anastrozole same day as injection, which if my math is again correct puts me at 1 mg AI per 100mg/ml of T. Have not had any labs since changing the dosing.
When I initially started TRT in December I noticed some swelling in my feet/ankles. With the change in dosing, the swelling has increased 10 fold…probably 30 pounds. I always had a slight problem with the left leg since that is where the vein was removed for bypass…but not like this. Doc seems to think it is TRT related…possibly E way too high…and maybe the T as well as my last test was 866 after 2 weeks. His thinking is maybe the twice a week dosing has elevated my levels.
Question is should I give it another week before repeating labs (so that would be 3 weeks on the new dose) or go ahead and test next week… My e-2 was not tested before…total e instead was done. That, FWIW was high at 95.

Test soon, hopefully the labs provide clues re the fluid balance. Get full CBC, lipids, AST/ALT etc.

AMA reduced salt recommendations have been dealt a blow… not supportable anymore.

Do your own research on bloat etc.

New labs…was hoping to find T or E2 totally out of whack to help explain the edema…but they aren’t bad. As to the rest of the labs I don’t have a clue. Have increased H2O intake…tried adding small amount of sea salt to it…edema still bad. FYI…when the edema started in January the Dr had me stop T…edema went away.

Came back when I started up again and got worse when I went on twice a week T. Currently taking .5 ml of 100mg/ml T cyp twice a week. Wondering if I should scale that dose back and go to once a week?? Don’t see the T3 on here…was supposed to be done. I’m guessing there is a lot here that you guys don’t need…so sorry for info overload.
Mark

HDL Cholesterol 28 Low mg/dL >39
Triglycerides 105 mg/dL 0-149
Cholesterol, Total 169 mg/dL 100-199
Iron, Serum 34 Low ug/dL 40-155
ALT (SGPT) 18 IU/L 0-44
AST (SGOT) 24 IU/L 0-40
LDH 367 High IU/L 0-225
Alkaline Phosphatase, S 99 IU/L 25-150
Bilirubin, Total 0.6 mg/dL 0.0-1.2
A/G Ratio 1.2 1.1-2.5
Globulin, Total 3.3 g/dL 1.5-4.5
Albumin, Serum 4.1 g/dL 3.5-5.5
Basos 1% 0-3
Eos 3 % 0-7
Monocytes 11 % 4-13
Lymphs 20 % 14-46
Neutrophils 65 % 40-74
Platelets 186 x10E3/uL 140-415
RDW 15.7 High % 12.3-15.4
MCHC 30.3 Low g/dL 31.5-35.7
MCH 24.8 Low pg 26.6-33.0
MCV 82 fL 79-97
Hematocrit 41.2 % 37.5-51.0
Hemoglobin 12.5 Low g/dL 12.6-17.7
RBC 5.05 x10E6/uL 4.14-5.80
Estradiol 16.3 pg/mL 7.6-42.6
TSH 2.940 uIU/mL 0.450-4.500
Cortisol 17.8 ug/dL 2.3-19.4
DHEA-Sulfate 102.1 ug/dL 51.7-295.0
T4,Free(Direct) 1.30 ng/dL 0.82-1.77
Dihydrotestosterone 33 ng/dL ES
Pregnenolone, MS 17 ng/dL ES
Free Testosterone(Direct) 18.9 pg/mL 7.2-24.0
Testosterone, Serum 713 ng/dL 348-1197
Sex Horm Binding Glob, Serum 23.0 nmol/L 19.3-76.4
Triiodothyronine,Free,Serum 2.2 pg/mL 2.0-4.4
Phosphorus, Serum 3.3 mg/dL 2.5-4.5
Calcium, Serum 9.1 mg/dL 8.7-10.2
Carbon Dioxide, Total 27 mmol/L 20-32
Chloride, Serum 102 mmol/L 97-108
Potassium, Serum 4.4 mmol/L 3.5-5.2
Sodium, Serum 140 mmol/L 134-144
BUN/Creatinine Ratio 18 9-20
eGFR If NonAfricn Am 72 mL/min/1.73 >59
Creatinine, Serum 1.14 mg/dL 0.76-1.27
BUN 21 mg/dL 6-24N
Uric Acid, Serum 8.5 mg/dL 3.7-8.6

fT3 is what does the heavy lifting. Should be near mid scale 3.3, 2.2 is way low.
fT4 is good
not converting fT4–>fT3 properly in peripheral tissues, thyroid gone, you need T4+T3 drug which should help waking body temperatures.

Low iron can be responsible for some of this, ferritin would be good to have

Hematocrit is low, iron is low, hemoglobin is low.

  • may be blood loss from a GI bleed
  • get an occult blood test kit, smear poop at home and mail it
  • any food sensitivities?
  • digestive problems?

If your blood vessels are leaking, fish oil might improve cell structure. Supplements?

Thanks
Dr agreed on occult test. Waiting those results. Will investigate with him on T4-T3. So nothing here that would indicate my problem with the edema other than I may just be someone more sensitive to the fluid retention side effect of the T cyp?? Since it got much worse on the twice a week dose I’m thinking of cutting back…maybe that will help me to kick the fluid…
Mark

So I’ve been off the T for 3 weeks. Down 26 pounds and still falling. Obviously I have a problem with T Cyp and edema. Maybe try starting back up once the edema is gone but use a lower dose…my E2 was 16…so probably not an estrogen problem…