T Nation

Testosterone - Sorting Through Numbers/Options


1st off, I apologize for starting yet another thread on this. Just wasn't sure where to put it. I will make this as terse as possible.

Had my TT and FT tested earlier this year.

TT - 346 range: 240 - 950 NG/DL
FT - 15 range: 9 - 31

Symptoms: all of them, minus loss of body hair

Was referred to an Endo who was more than willing to put me on androgel, or injections, if I wanted. I took the script for Androgel. He thought HCG was for weight loss only and had never considered an AI for anyone. Great guy. Very easy to talk to and honest. Said he doesn't feel comfortable scripting HCG or an AI, as he is not that well versed in them in reference to TRT. I offered to bring/e-mail him info on them and he, amicably and honestly, said that HRT wasn't enough of his business to warrant diverting research time to it. Yeah, pissed me off too.

He did an ultrasound of my thyroid and said it looked great. Also more blood work.

TSH - 3.30 range: .49 - 4.0 MCIU/ML
Fr. Thyroine (T4) - .79 range: .6 - 2.0 NG/DL
FSH - 3.33 range: .7 - 11.1 MIU/ML
LH - 4.29 range: .8 - 7.6 MIU/ML
Prolactin - 5.95 range: 2.5 - 13.0 NG/ML

Anything there look abnormal? Or indicative of an issue?

As to the Androgel, there is no way I am getting on it without, at least, HCG or a like alternative. Unfortunately, this is the only Endo in town. Anti-aging docs? Forget it. I live in OK. The Endo did suggest, if I really want HCG, to go to a weight loss doc. I am sure I could get it, as I have been putting on weight, but that would stop when the weight disappeared. So I would be back to square one.
I am going to hit my GP up about the HCG and AI. We have a great relationship, but I would be surprised if he would feel comfortable going there, as it is well outside his area of expertise. Barring that, I am going to see if HE can find a Urologist that is actually up on TRT.

In the interim, I think I am going to try Alpha Male again. I was on it for about 3 weeks. After a week and a half, I did feel stronger, less fatigue, more aggression (when lifting), increased libido. It didn't seem to do anything for the cognitive issues, but maybe in time.

Any suggestions? Thanks...


Your TSH is very high, and where is your T3 number? A TSH of 3.3 say your brain is requesting more thyroid, but your body isn't producing enough, otherwise your TSH would be below 2.0 or so.
Your T4 in theory should be higher, especially with a TSH that high, but the proof is there. Your TSH is high, your T4 is barely off the bottom, and DO NOT use Androgel with a compromised thyroid like yours. Hypothyroidism like yours typically causes absorption problems with gels. Shots are the only good option for you now.

Here's the other really important question; where is your E2? I know the doctor you have currently have doesn't know enough to know enough, but weight gain and lethargy are also caused by elevated E2.
So there you have it, hypothyroidism and probable high E2.
Alpha Male isn't going to long term fix your problems,and even if you do respond to it and make more T, you will make more E2 and just make things worse as a side effect.

LEF.org is a good place to get blood tests done if your doctor won't order them for you. It may not change what he prescribes for you, but at you'll know better what your body is doing...


Thanks, KNB. I think I can get my GP to do the labs. No reason for him not to.
The 3.3 is actually significantly better than in April. Then it was 3.98. Maybe just a natural variance?

Assuming that E2 does show high, are there any options other than scripts?


In reference to the potential E2 issue, I have seen Arimidex mentioned as an AI. Can something like that be taken without being on T? What would be the protocol for addressing high E if that was the root issue?




If my other response pops up sorry. I hit the enter button by accident. Anyway Arimidex is ok as a standalone to lower elevated E2 but not to raise T with normal E2. If your E2 is normal (Below 30) Arimidex will raise your T but to do so it will run your E2 into the ground. That's what happened to me when I used it as a standalone compound. You really don't want to touch T without HCG and an AI. Arimidex and Aromasin are good ones. Arimidex is the most popular but Aromasin is a good compound and I've been using it. I prefer it's mode of action.

Just keep your expectations realistic with T. There are many many things that play into libido and sexual function and they all need to be considered. It's not as easy as smearing on some gel or taking a shot. Be patient because it will take time to hit your chemistry right.


Thanks for the info. Honestly, I just want to feel and act normal again. I am not trying to run my T through the roof. If I can get to where I can think clearly again, enjoy waking up in the morning and feel like my lifting is more than pounding my head into a wall, I will be very pleased, whether my T is 400 or 800.

I have scheduled a visit with my GP for Monday afternoon. I will discuss the thyroid results and getting E2 tested. Honestly, I am hopeful that the E2 is my issue. I can take care of that, as long as I can get the labs. It will be a much easier road that trying to get a local doc to go with T +HCG +AI.


It sucks to say, but the more I learn about this, the more interesting it becomes: turns out that sleep apnea can cause many of the same symptoms as low T, and can in fact contribute to low T. I never would have thought of getting checked for it, but turns out I've got it, bad.

Even though you don't wake up to consciousness all through the night, your body's busy producing stress hormones, staying out of deep and REM sleep, and not doing the metabolic recovery it should be doing when you've got it. you also typically have low blood oxygenation all through the night, which has its own bad side effects.

Just a thought. I wouldn't wish having to wear this stuff at night on my enemies, but if it helps, it helps.


After reading your log, mcl, I did consider that. I know it isn't scientific, but I have had my wife observe my sleeping/breathing, if she comes to bed after me or wakes up. She says that I snore (when on my back), but she has never heard me stop breathing. It is in my mind, though.


brentf13 makes a valid point: too much arimidex will make you wish you never took it; but, if you "OD" the bad symptoms are gone in three days just like it never happened.
So the real thing about adex is moderation. If a person uses the liquid version, their control over their dosage is precise. The way to start out if you are going to use a "little" adex w/o TRT, (or with TRT) start at 1 drop a day and wait three weeks to see if any changes are noticable. If not, try two drops a day and wait another three weeks to notice a change, and so on, and so on.

A little adex goes a long way, and taking too much will make life suck. Really suck.
But there is the other side to adex too; the clear headed, non stop energy at the gym, the feeling like you're 17 again morning woodies, and last but not least; the same sexual energy that comes back like you were young again. Okay, maybe not everybody is a sexual dynamo again, but you get the point...

To mcl, the guy with sleep apnea, do you have metabolic syndrome too? Is your waist girth over 40 inches?



Is liquid Adex the name on the bottle? I have seen LiquiDex. With respect to the latter, what I read said that a drop was 1mg but that .5mg gave the same results.
Assuming I can get my GP to do the E2 test, at what E2 level would liquid Adex be warranted? Or does that just depend on the individual?
If he won't, it looks like LabCorp does have a presence in OKC.

Is a waist girth over over 40" indicative of hypothyroidism? Or is it a function of girth in relation to other measurements?

Thanks again for all the help.


Currently it's hovering just below 40 inches. But, when I'm not bulking, it's more around 36. It'd take an act of Congress to get it any lower, though.


I thought they not only looked at waist girth but the waist to hip ratio as well. With the desired ratio being less than 0.9 or so.


By the way my TSH was about 2.7 and getting on T3 did me a lot of good, atleast in the past few weeks. We will see how it turns out.


As far liquid adex goes; generally speaking 30 drops equals 1mg so precise dosing is very easy.
The waist girth to hip ratio is important, but if your waist girth is over 40 inches and you have apnea (due to being overweight) some docots will say you have metabolic syndrome or 'syndrome X' as it is also known. Low testosterone levels coupled with elevated estrogen, on top of insulin resistance, and there you go syndrome x...

I am speaking in generalities of course, but if your waist takes an act of Congress to get below 36", how about acting on your own behalf and cutting out the carbs for three weeks and see what happens. Syndrome X is usually accompanied by denial as well as actual medical issues. The problem usally becomes exponential as time goes on; more body fat, more estrogen. More estrogen less testosterone. Less testosterone, more body fat.
And so on, and so on.

What I refer to as "really good doctors" when the TSH gets above 2.0, they start their patients on thyroid.
I hope all the guys on TRT and thyroid know to get their thyriod levels checked every six months. There is a lot of info regarding how TRT supresses the conversion of T4 to T3, so in the beginning TRT and thyroid make you feel great, and then 5 or 6 months later the feeling like crap starts again and it's not E2 either.
I know because I went through it myself.

The thing about adex is everyone is different and what is a perfect dose for one guy, is either not enough or too much for another, so you really never know.
There is a rule of thumb though: 1mg a week of adex will cut your E2 level in half, if you weigh approximately 160 pounds. If you weigh more or less than 160 pounds, then your dose should be adjusted accordingly.


In my case, I have apnea because my jaw and palate are rather malformed and restrict my airway.

It's a common misconception that apnea's a "fat person's problem". Being overweight can exacerbate an existing problem, but it doesn't generally cause it except in extreme cases. It's a structural problem.

Hell, one of my coworkers has really bad apnea, and he's maybe 150 soaking wet, and a long-distance cyclist.

As to my carb intake, thanks for the input, but frankly I know my body, and when I say my waist doesn't get below 36", I mean it doesn't EVER. Period, full stop, end of story. I'm all for clean eating and macro manipulation, but short of starvation -- which I HAVE done, involuntarily, for long periods of time out of necessity (and I DO mean 'starvation'; I was eating out of dumpsters every second or third day) -- my waist will not go below 36".

It's interesting that you assume it's my diet without knowing simple things like...oh, I don't know... my height, for starters. Or my lean body mass. Or any number of other things that would make 36" a reasonable waist size for someone.

If I sound a bit defensive, you're right; I am. Having a 36" waist isn't a problem. At a 36" waist, I can see and feel my hipbones. I get tired of people who either think I should have a certain BF %, or a certain BMI, or like to chalk up health problems to "just lose a few pounds" (and those people invariably think less weight == healthier, and never consider that a lot of that weight is lean body mass.

Hell, if I was actually at the recommended weight for my height per the BMI, I'd have 5% bodyfat. I enjoy throwing that back at medical professionals, since almost all of them consider sub-5% BF unhealthy.)

And, since you insist on throwing denial in there, I've done the Velocity Diet. End result? A 36" waist. That was cutting out carbs completely for FOUR weeks. I've also done a sub-20g/day carb restricted diet for a year. End result? A 36" waist.

So, er...just no. I have no desire to ever be sub-10% bodyfat. I'm perfectly happy around 15%, and moving heavier weights each day in the gym. I long since gave up caring what other people think about how I look. I do what I do (and look how I look) because of how I feel.


Appointment is today....gonna ask for E2 test. Anything else I should ask for?


GP, God love him, agreed that my TSH should be between 1.0 and 2.0 and that my T4 was low, in general, but especially in light of the TSH levels. He is putting me on a low dose of Synthroid. I am going to have my levels rechecked in 6 weeks and will go from there.

Also, he agreed that the E2 test was worth the look see. I'll have the draw in the morning.

Great, great guy. And on of the few docs I have used that actually appreciates the patient having done a little homework.


Sorry to hear you've got the problem, but congrats on having a sane doc and getting a prescription.


Lots of good advice on this thread. Congrats on finding an open-minded/educated doc. I think no matter how good of a doc you have, the fastest way to health is to be proactive and educate yourself.

Something that I think is worth mentioning is to be patient. It can be a long, sometimes frustrating (and expensive) road getting your levels dialed in, but it is well worth it when you feel like a normal man again.

BTW, if your doc is not open to the idea of adex and hcg, it can be found rather easily online.