T Nation

Struggling with Levels for Years

So, I found a clinic that is currently providing me treatment (insurance covers it). I am currently on 160mg/week. Total test was 596 on day 7 before next injection. Estradiol was a little high at 54, and am now taking 200mg DIM/day to see if that helps. Retesting in January after some time with the DIM. Free test is 16 (10-20), SHGB is low, everything else looks good.

I may even order some tests beforehand from PrivateMDlabs and check to see if the DIM is doing anything for my E2 instead of waiting. Also, check ft3, ft3, cortisol AM, and do another AST/ALT panel, just to make sure everything’s still good. The doc only has a set number of tests he does.

They also said we could add HCG to keep me fertile once we get my test, free test, and E2 numbers stable. My question is - what would be the best dosing and timing plan for the HCG to keep me “working” until I’m ready to have kids? My cyp shot is 1x/week on Tuesday afternoon. Any suggestions would be great! Thanks

Adding on to my last post…I hear a lot about guys feeling their best when E2 is in the 20-30 range. My question is, is that number referring to the serum E2 test, sensitive, ultra sensitive, etc?

TSH was mid range? Should be closer to 1.0

I don’t think that DIM will tackle E2=54

Post labs in list format with ranges.

Please read these stickies:

  • advice for new guys
  • protocol for injections
    That should address your questions

[quote]KSman wrote:
TSH was mid range? Should be closer to 1.0

I don’t think that DIM will tackle E2=54

Post labs in list format with ranges.

Please read these stickies:

  • advice for new guys
  • protocol for injections
    That should address your questions[/quote]

KSman,
I am getting the bloodwork listed below done once I have some time on the DIM. If my thyroid numbers are messed up, do you think that could be the cause of all this? And if so, would that be a reason to stop TRT and treat my thyroid to see if that resolves it?

To recap: the bloodwork posted in the beginning of this thread is BEFORE starting TRT. I have been on it for about 3.5 months now.

Total test
Free test
e2
liver function profile
TSH
fT3
fT4
CMP
CBC
Lipids
Vit-D 25-hydroxy
Cortisol, AM

I’m not sure if this helps anything, but here is some more bloodwork with the dates taken (a couple years back).

2/13:

TSH 2.60
TESTOSTERONE, TOTAL, LC/MS/MS 240 Range: 250-1100 ng/dL
TESTOSTERONE, FREE 44.1 Range: 46.0-224.0 pg/mL
TESTOSTERONE,BIOAVAILABLE 102.2 Range: 110.0-575.0 ng/dL
SEX HORMONE BINDING GLOBULIN 18 Range: 10-50 nmol/L

4/13:

LH 1.5
FSH 2.6
Testosterone Total 416
Prolactin 3.7

2/14:

Testosterone, Serum 311 Low
Free Testosterone(Direct) 8.2 Low
T4,Free(Direct) 1.31 ng/dL 0.82 - 1.77 01
TSH 1.850 uIU/mL 0.450 - 4.500 01
LH 2.7 mIU/mL 1.7 - 8.6 01
Estradiol 30.6 pg/mL 7.6 - 42.6 01
Prostate Specific Ag, Serum 0.6 ng/mL 0.0 - 4.0 01
Insulin-Like Growth Factor I 192 ng/mL 98 - 282 02
T3 Uptake 27 % 24 - 39 01

But, as you can see, my testosterone was still low even when my TSH was lower.

The two often are related, often not.

If TSH is elevated, it that because you were not using iodized salt? Changed over time?

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

fT4 looked good, fT3 is what gets the job done and would be good lab data to have.

You have secondary hypogonadism and prolactin was not the cause. You had high E2 with low T. Now on TRT your E2=54 is VERY high. You should have been on anastrozole from day 1. Your weight is probably a significant factor with your E2 levels.

Can’t see your age above.

In the advice for new guys sticky, you will see that there are is a lot of requested info.

[quote]KSman wrote:
The two often are related, often not.

If TSH is elevated, it that because you were not using iodized salt? Changed over time?

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

fT4 looked good, fT3 is what gets the job done and would be good lab data to have.

You have secondary hypogonadism and prolactin was not the cause. You had high E2 with low T. Now on TRT your E2=54 is VERY high. You should have been on anastrozole from day 1. Your weight is probably a significant factor with your E2 levels.

Can’t see your age above.

In the advice for new guys sticky, you will see that there are is a lot of requested info.[/quote]

Thanks KSman,
I just got some iodized salt. When my TSH was 1.8, my testosterone was still low so I’m not sure that it’s the cause. I will check temps (although I am definitely always on the hot side instead of cold (I sweat like a maniac, always have, even when I was 170lbs). I will be checking ft3 in a few weeks with my next round of bloodwork, along with a bunch of other stuff listed above. I talked with my doc and we will add anastrozole if the DIM has no effect (he mentioned starting with .25mg 1x/week on day 2/3 after injection (when test levels are highest). Before starting TRT I was lighter, and E2 was 30. I am 27, been having these issues since high school, even when I was 165-ish pounds.

Thanks for the response!

I think that you will find that anastrozole, will be lower than cost of DIM.

I suggest T injected twice a week and anastrozole at same time.
Once a week is wrong.

[quote]KSman wrote:
I think that you will find that anastrozole, will be lower than cost of DIM.

I suggest T injected twice a week and anastrozole at same time.
Once a week is wrong.[/quote]

I will talk to my doc about twice a week.

Random question - could it be that I just have low t, lh, and fsh for no reason aka idiopathic? Those are the only tests that have come back low that I’ve ever taken…starting when I was 20.

Also - since my bloodwork has historically only shown low T, free T, LH, and FSH, do you think I should try HCG mono-therapy first instead of continuing with the TRT…to see if my testes respond?

Also should I test for DHEA-S or would that number be skewed since I’m on testosterone currently?

KSman - what are the odds I have secondary hypogonadism for no reason? How common is this?

Ok…got some news. My doc will not prescribe HCG along with my TRT. He sighted some study that said only 2 in 1000 men will be unable to return to their previous testosterone levels / sperm production after stopping TRT…which is what he suggested I would need to do when I started trying to have kids.

  1. What do you guys think of this advice? Should I continue TRT without HCG? He did say they would do HCG WITHOUT testosterone if my sperm count was low after stopping TRT when the time came to have kids.

  2. Do I stop TRT until I have kids…and in the meantime keep trying to diagnose what may be causing my low T…aka wait it out so to speak.

KSean - would love your input…or anyones.

It is idiopathic if the doc can’t diagnose the problem.

Have you read the finding a TRT doc sticky?
Your doc is the problem at this point.
You need to be more proactive.

You don’t do TRT, damage the testes then try to restore fertility afterwards.

I may stop for now then until I either diagnose the real problem or find another doc who can do hcg. I’ve only been on for about 3.5 months so recovery should be relatively easy.

I have stopped TRT for now, I’m not comfortable moving forward without HCG. I have been off since November 3rd. I have a follow up with my primary care doc on December 23rd to run the following bloods (hopefully):

Total T
Free T
Estradiol, serum
CBC
CMP with AST/ALT
Lipids
PSA
IGF-1
TSH
FTI
T4
T3 Uptake
Free T3
Free T4
DHEA Sulfate
Vit D, 25-hydroxy
Cortisol, AM

I’ll be back to baseline by that time and we can get a holistic view of anything else that may be going on. I am also taking bioresponse DIM to see if that helps my HPTA at all until then. See you guys then I’m sure!

While I wait to get my new bloodwork, is there any herbs, etc that can stimulate the pituitary, GnRH release, LH/FSH, etc?

Hopefully you have gotten some iodine in your body now.

Is this difficult: Check oral body temperatures to eval overall thyroid function as per the thyroid basics sticky.

Hey KSman, I have been off of shots now since November 3rd. I just had bloodwork taken by my doc on the 23rd of December and am awaiting the results. I have been taking Bioresponse DIM in the meantime, along with D3 with iodine. Here is what I am getting done:

Total Test
Free Test
E2, serum
TSH
LH
FSH
free t3
free t4
thyroid antibodies
CBC
CMP
Cortisol, AM
Vit D-25 hydroxyl

I will report back with the results when I get them.

KSman,
Here are my bloodwork results taken December 23rd, fasting, at 9am. I have been off TRT since November 3rd (I was only on for about 3.5 months). Not sure what else to test…feel like I’ll never get to the bottom of this. Should I try any herbs like Tongkat Ali, etc. to try and get my LH and FSH levels up? Would GHNRh shots help my pituitary produce LH and FSH? Looking for any alternative except a lifetime of TRT. The problem is clearly my body not producing enough LH and FSH.

Testosterone, Free & Total LC/MS/MS:
FREE TESTOSTERONE 42.5 Range: 35.0-155.0 pg/mL (Collection Date: 12/23/2015)
TESTOSTERONE, TOTAL, LC/MS/MS 274 Range: 250-1100 ng/dL (Collection Date: 12/23/2015)

FSH:
Follicle Stimulating Hormone 1.8 (no range given)

LH:
Luteinizing Hormone 1.7 (no range given)

Cortisol 10.80 (no range given)

Free T4 1.0 Range: 0.7-1.8 ng/dL (Collection Date: 12/23/2015)

Free T3 276 Range: 200-490

TSI (Thyroid Stimulating Immunoglobulin):
TSI <89 Range: <140 % baseline (Collection Date: 12/23/2015)

THYROID PEROXIDASE ANTIBODIES 1 Range: <9 IU/mL (Collection Date: 12/23/2015)

ESTRADIOL 26 Range: < OR = 39 pg/mL (Collection Date: 12/23/2015)

Prolactin 1.7 Range: 3.3-20.8 ng/mL (Collection Date: 12/23/2015)

TSH 1.81 Range: 0.50-6.00 MIU/mL (Collection Date: 12/23/2015)

FOLATE, SERUM 17.6 Range: ng/mL (Collection Date: 12/23/2015)
VITAMIN B12 668 Range: 200-1100 pg/mL (Collection Date: 12/23/2015)

Vit D 25 OH (Total) 61.5 Range: 31.0-100.0 ng/ml (Collection Date: 12/23/2015)

CBC:
WBC 6.3 Range: 3.8-10.6 K CUMM (Collection Date: 12/23/2015)
RBC 5.71 Range: 4.20-5.80 M CUMM (Collection Date: 12/23/2015)
HGB 16.3 Range: 13.5-18.0 g/dL (Collection Date: 12/23/2015)
HCT 49.3 Range: 42.0-52.0 % (Collection Date: 12/23/2015)
PLT 113 Range: 130-400 K CUMM (Collection Date: 12/23/2015)
BASO # 0.1 Range: 0.0-0.2 K CUMM (Collection Date: 12/23/2015)
BASO % 1.0 Range: 0.0-3.0 % (Collection Date: 12/23/2015)
EOS # 0.2 Range: 0.0-0.4 K CUMM (Collection Date: 12/23/2015)
EOS % 2.5 Range: 0.0-7.0 % (Collection Date: 12/23/2015)
LYMPH # 1.7 Range: 0.7-4.5 K CUMM (Collection Date: 12/23/2015)
LYMPH % 27.4 Range: 14.0-46.0 % (Collection Date: 12/23/2015)
MCH 28.6 Range: 27.0-31.0 pg (Collection Date: 12/23/2015)
MCHC 33.1 Range: 32.0-36.0 g/dL (Collection Date: 12/23/2015)
MCV 86.3 Range: 78.0-100.0 fL (Collection Date: 12/23/2015)
MONO # 0.5 Range: 0.1-1.0 K CUMM (Collection Date: 12/23/2015)
MONO % 7.6 Range: 4.0-13.0 % (Collection Date: 12/23/2015)
MPV 10.1 Range: 7.4-10.4 fL (Collection Date: 12/23/2015)
NEU # 3.9 Range: 1.8-7.8 K CUMM (Collection Date: 12/23/2015)
NEU % 61.5 Range: 40.0-74.0 % (Collection Date: 12/23/2015)
RDW 13.1 Range: 11.5-15.5 % (Collection Date: 12/23/2015)

CMP:
Albumin 4.8 Range: 3.5-5.0 g/dL (Collection Date: 12/23/2015)
Alk Phos 81 Range: 23-159 U/L (Collection Date: 12/23/2015)
ALT 19 Range: 21-72 U/L (Collection Date: 12/23/2015)
AST 24 Range: 17-59 U/L (Collection Date: 12/23/2015)
BUN 17 Range: 8-24 mg/dL (Collection Date: 12/23/2015)
Calcium 9.9 Range: 8.5-10.5 mg/dL (Collection Date: 12/23/2015)
Chloride 101 Range: 98-107 mmol/L (Collection Date: 12/23/2015)
CO2 27.0 Range: 22.0-30.0 mmol/L (Collection Date: 12/23/2015)
Creatinine 0.9 Range: 0.3-1.4 mg/dL (Collection Date: 12/23/2015)
GFR 101 Range: >60 mL/min per 1.73 (Collection Date: 12/23/2015)
Glucose 92 Range: 74-100 mg/dL (Collection Date: 12/23/2015)
Potassium 4.7 Range: 3.5-5.3 mmol/L (Collection Date: 12/23/2015)
Sodium 142 Range: 134-144 mmol/L (Collection Date: 12/23/2015)
T. Protein 7.8 Range: 6.3-8.4 g/dL (Collection Date: 12/23/2015)
Total Bili 0.8 Range: 0.2-1.3 mg/dL (Collection Date: 12/23/2015)

Urinalysis:
Bilirubin negative Range: negative (Collection Date: 12/23/2015)
Blood negative Range: negative (Collection Date: 12/23/2015)
Clarity Clear Range: clear (Collection Date: 12/23/2015)
Color straw Range: yellow (Collection Date: 12/23/2015)
Glucose negative Range: negative (Collection Date: 12/23/2015)
Ketones negative Range: negative (Collection Date: 12/23/2015)
Leukocytes Negative Range: negative (Collection Date: 12/23/2015)
Nitrite negative Range: negative (Collection Date: 12/23/2015)
pH 7.0 Range: 5.0-9.0 (Collection Date: 12/23/2015)
Protein negative Range: negative (Collection Date: 12/23/2015)
S.G. 1.016 Range: 1.001-1.035 (Collection Date: 12/23/2015)
Urobilinogen Negative Range: negative (Collection Date: 12/23/2015)

You have low thyroid function.
Did you see my comments re thyroid Dec 28?
Body temperatures now?

You still need TRT and are secondary.
You could do low dose Nolvadex as an alternative to hCG.

HTC is strong and may easily get too high back on TRT.

You are strongly estrogen dominant now.

Cortisol seems to be near bottom of acceptable. 2% transdermal progesterone may help. This is over the counter in USA and look for “KAL” brand on amazon.

Why do you say low thyroid function? Because of the T3 number?

I will check body temps, need to grab a thermometer.

Nothing I can do to get LH and FSH up without going on TRT?

Are you saying progesterone cream may help my T, LH, and FSH numbers??

Have been looking at symptoms of low progesterone in men (estrogen dominance) being one of them. Maybe I’ll give this a try. How much mg per day of the cream?

Is anything else missing in my bloodwork?

What do you think about me taking pregnenolone or DHEA? Would either of these help me possibly?

There is no evidence that DHEA is low. DHEA-S is what you get tested. [not DHEA].
Progesterone may increase cortisol.

LH/FSH is not depressed by prolactin. E2 does not seem high enough to be a cause.

Where was LH/FSH before your TRT?

TSH should be closer to 1.0 and fT3 and fT4 should be midrange and are low.
Body temps will measure the effect.
Need to look at optimal values and disregard lab normal ranges.