Starting TRT, Have Some Concerns

mcs2012 · August 2, 2013, 7:23am

I apologize for the length here, but it’s always extensive and never easy with my issues.

I am about to embark on a TRT program through my physician. I am 53 and am in good health other than the following issues. I’ve discussed such with my physician, but he thinks most of these will resolve and not worsen with TRT as long as we monitor everything on a regular basis. My purpose for this email is to get other opinions.

My scrip is for 200mg/week of cyp. My most recent TT was 425, FT was
9.70 (ref range: 9.0-46.0ng/dL).

BLOOD CLOTS: I had two clots in my legs last year. Knowing that exogenous T can raise RBC/HCT/HGB, is there anything else besides monitoring these levels and getting regular therapeutic phlebotomies when necessary that I should be aware of given my prior issues?
SLEEP APNEA: I have mild sleep apnea. Sleeping on sides to avoid it. Trying to avoid CPAP. Knowing that exogenous T is a double-edged sword: if low T, then it improves sleep apnea, but it can also worsen it over time via central apnea.
HYPERTENSION: I am controlling this naturally. Will only resort to meds if absolutely necessary.
From what I researched, it is from the increase in blood volume that cause this, so same, thing phlebotomies?
LIPIDS: LDL-C (153) has improved, but is still elevated; HDL-C (46) has improved, but needs to increase. TRT can reverse that (increase LDL and decrease HDL).
HYPOTHYROID - I have been treating my hypothyroidism with dessicated thyroid/T3. I’ve read that TRT can reduce thyroid function.

But my biggest dilemma has been the inability to lose excess body and visceral fat no matter what I try diet or training-wise (and I have tried everything over the last 4 years - i.e. low carb, intermittent fasting, keto, counting calories, etc.). In addition to hypothyroidism, I believe insulin resistance is still an issue which obviously plays a major role in preventing fat loss. I also have a MTHFR (methylation) genetic defect which I am treating with targeted methylated B-vitamins, etc…

I agree with my doc that much of the above issues will improve by reducing body and visceral fat via TRT but still am concerned.

I would say I am 25lbs overweight based on my body composition (which doesn’t help BP). My bf runs 25-29% no matter what I do. Losing weight isn’t the issue; it’s losing the fat.
Stats:
AGE: 53
WT: 179
HT: 5-07

My latest BodPod showed I weighed less but had more bf and less lean mass which was really disappointing:
BODYFAT %-31.10%
BODYFAT-LBS: 53.9
LEAN-FFM: 68.90%
LEAN-FFM-LBS: 119.6
TOTAL WEIGHT: 173.5
RMR: 1500

Training routine (up until I had to eliminate press movements in the last two weeks because of my shoulder impingement got much worse):
Resistance training: every other day - 45 min. 30 sec. rest; 25 sets total
Cardio: 3 x’s/week on off days - 30-45 min.; elliptical/bike; outdoor (until my lower back became inflamed). I do both steady state and HIIT, depending on my energy level.
I am also engaged in a 6-week PT protocol for the shoulder and back which is a workout in and of itself.

I have been training fasted with 20g BCAAs and 5-10g glutamine to try and shed bf, but it has done nothing. I have 2 main meals/day and one snack following workouts. I am gluten-free and soy-free, eat organic only, no processed anything, lean meats, fish, poultry, eggs, Healthy fats are from whole avocados, coconut oil, seeds, nuts and nut butters, olive oil, flax oil. Carbs are mostly from veggies and a small amount of fruit (berries). Only grains are wild rice and quinoa which is technically a seed which I eat maybe once a week.

AVG MACROS:
CALORIES: 1500-1800
PRO: 150-170g
CHO: 40-50g (will cycle carbs so I eat a little more post workout; but no more than 50g)
FATS: 80-100g

I have not attempted to eat less than 1500 calories/day than the above because it’s already at a low threshold and any lower I would fear would put me into starvation mode, damage my metabolism and worsen my thyroid function.

I can lose weight; but all I do is get skinny fat. My doc think it’s largely because my free T is in the dumps (despite my TT being in the 400s) and this is primarily why I continue to have a hard time gaining lean mass and dropping bf. My SHBG has been a bit high (42), but that’s because of taking T3. My E2 is actually too low (4)!

Appreciate any input.

KSman · August 2, 2013, 6:45pm

200mg T/cyp per week is insane, read the stickies.

What is hematocrit now?
Probably will make this worse unless some other factor can be ID’d and managed.
Do things to increase HDL [high potency B-vit complex with trace elements and iodine, fish oil, nuts, flax seed meal/oil, anti-oxidants, natural source vit-E, 5000iu Vit-D3, increase T, keep E2 in lower 20’s], you may need to donate blood or equiv, 25mg DHEA
Total cholesterol of 180 is idea, do not go after low levels
see thyroid basics sticky

Low T and hypo thyroid can make one fat and make fat loss impossible. Get T up, E2 down, fT3 and fT4 mid range and you should be able to go from catabolic to anabolic.

canned info here:

You really need to consider that you have a thyroid problem. The ranges are statistical norms and there are pathologies within those norms. The problem is that docs think that the norms imply normal health and do not look deeper.

You need LH/FSH to determine is your testes are failing [primary hypogonadism] or your pituitary is not delivering LH/FSH [secondary].
You need E2 to see if that is the problem.
In your situation, one needs to test for prolactin to see if that is elevate or high, which can reduce LH and FSH. If prolactin is up, a MRI is performed to see if a pituitary adenoma is the cause.

Right now, you know you have a problem, but that is the symptom, you need a diagnosis that identifies the cause and then you deal with the cause or start TRT.

Your total cholesterol is pathologically low. Are there dietary extremes to explain this? This 140 number will be undermining your who spectrum of steroid hormones, probably vit-D as well. Some simply have low cholesterol. Don’t believe it when someone tells you that your cholesterol is healthy.

here is my canned contribution:

This is standard advice maintained here:

There is a huge amount of knowledge in the stickies. Please study these. Start with the advice for new guys sticky.

There is a lot to read there, so read carefully. There are suggestions for things that are root causes of low testosterone [T]. Low T is a symptom, not a root cause itself. But low T itself is a root cause of many of the symptoms one experiences. Note that other things cause the same spectrum of symptoms, so do not have T tunnel vision. Many docs are guilty of that and they only treat the symptom [low T] and do not attempt to find the real problem. If you go to a clinic that specializes in low T, you will get T tunnel vision for sure.

Post info about yourself as suggested in the above sticky. We need labs, almost all of your labs, not just hormones. We also need the lab ranges.

We see a very high number of thyroid issues in the population of guys that show up here. So there is a strong focus on that. Most people are iodine deficient to some degree. Your history of iodine intake from iodized salt and vitamins that list iodine is important. If you become iodine deficient, the RDA [recommended daily allowance] is inadequate for recovery of iodine stores. Please see the thyroid basics sticky for more information.

You do not want to suffer from subclinical hypothyroidism or get Rx thyroid meds to treat iodine deficiency.

If you are injecting T or contemplating that, read the protocol for injections sticky.

There are stickies for finding a TRT doc, estradiol [E2] and lab work.

Do not place your history or treatment details in the stickies! That belongs in your thread. Keep all of your posts in your thread so we can have a clear picture of your situation and needs.

mcs2012 · August 3, 2013, 6:54pm

[quote]KSman wrote:
200mg T/cyp per week is insane, read the stickies.

What is hematocrit now?[/quote]
41.3
Probably will make this worse unless some other factor can be ID’d and managed.

[quote]KSman wrote:
3) Do things to increase HDL [high potency B-vit complex with trace elements and iodine, fish oil, nuts, flax seed meal/oil, anti-oxidants, natural source vit-E, 5000iu Vit-D3, increase T, keep E2 in lower 20’s], you may need to donate blood or equiv, 25mg DHEA [/quote]
Doing all that already and more but still have low HDL/high LDL, so exo T is of concern. E2 is in the dumps at 4.

[quote]KSman wrote:
4) Total cholesterol of 180 is idea, do not go after low levels[/quote]
Last TC was @ 220, before that 187. But LDL-C is still too high. TC means nothing. It’s the particle size of the LDL that counts.

see thyroid basics sticky

Low T and hypo thyroid can make one fat and make fat loss impossible. Get T up, E2 down, fT3 and fT4 mid range and you should be able to go from catabolic to anabolic.

canned info here:

You really need to consider that you have a thyroid problem. The ranges are statistical norms and there are pathologies within those norms. The problem is that docs think that the norms imply normal health and do not look deeper.

[quote]KSman wrote:
You need LH/FSH to determine is your testes are failing [primary hypogonadism] or your pituitary is not delivering LH/FSH [secondary].
You need E2 to see if that is the problem.
In your situation, one needs to test for prolactin to see if that is elevate or high, which can reduce LH and FSH. If prolactin is up, a MRI is performed to see if a pituitary adenoma is the cause.[/quote]
PROLACTIN: 12.3
LH: 4.5
FSH: 5.2

THE REST OF MY LABS CAN BE VIEWED HERE: Box