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The3Commandment's TRT Profile


#1

Disclaimer: I hope this posts in a readable way.

It is thought that my pituitary gland no longer works due to a concussion that I suffered years ago. That, or something like Klinefelterâ??s Syndrome. Going to be beginning TRT in a few weeks, most likely. Iâ??m currently a student in the northeast, but Iâ??m from the South and have been going through an endocrinologist from my small hometown.

I got a brain MRI, which came back negative, as well as a colonoscopy and an upper GI regarding my mysterious aenemia. Came back negativeâ??they believe the aenemia is being caused by the low T levels.

In your case/thread opening post:
-age 24
-height 5â??10â??
-waist 32-33
-weight 185
-describe body and facial hair: Grow both body and facial hair at a normal/average rate.

-describe where you carry fat and how changed: mostly in lower back and legs, hasnâ??t really changed.

-health conditions, symptoms [history] : aenemia since 2010; only got my T levels tested because I noticed a long-term drop in libido. Suffered a concussion of some degree my roughly 7 years ago.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever

-lab results with ranges

-describe diet [some create substantial damage with starvation diets] : High fat, high protein, low carb. Chicken breasts, ground beef, a TON of fish (canned mackerel, canned tuna), lots of whey, lots of green vegetables, eggs.

-describe training [some ruin there hormones by over training]: 2 hours of weight training per day. Walk on treadmill sometimes.

-testes ache, ever, with a fever? No.

-how have morning wood and nocturnal erections changed : I almost never have them anymore.

LAB VALUES:

here are the labs: * indicates low value

12/13/2011 "normal range"

wbc 4.9 4-10.5
hgb 8.2 * hemoglobin 12.5-17
hct 27.9 * hematocrit 36-50
platelet 245 140-415
iron bind cap tibc 507 250-450
iron, serum 14 * 40-155
iron saturation 3 * 15-55

estradiol 11.1 7.6-42.6
tsh 2.42 .450-4.500
prolactin 13.6 4-15.2
lh 0.8 * 1.7-8.6
fsh 2.1 1.5-12.4
testosterone, serum 44 * 348-1197

12/12/2011

testosterone, serum 32 * 348-1197

12/21/2011

celiac disease serology cascade 165 61-356
tissue transglutaminase Ab, IgA, S less than 1.2 less than 4 (negative)
acth 23 10-60
cortisol 8.7 4-22
vitamin B 12 level 843 208-964
somatomedin C 236 116-341
Sodium NA 138 136-145
Potassium K 4.4 3.5-5.1
Chloride Cl 102 100-109
Glucose 88 70-100
BUN level 25 5-25 blood, urea, nitrogen
Creatinine level 0.9 0.57-1.25
Calcium 9.1 8.8-10.6
Total protein 6.8 6-8.3
Albumen 4.2 3.5-5
Bili T 0.2 0.2-1.2
Alk P 69 40-150
AST (SGOT) 44 10-58
ALT (SGPT) 63 5-50
Anion Gap 8 8-16

thyroxine free 0.82 0.70-1.48

12/27/2011

hemoglobin 9.4 * 12.5-17
hematocrit 30.8 * 36-50
platelets 191 140-415


#2

I don't know if this is additionally relevant, but the drs. who are looking at my case are pretty bewildered by the whole thing. I literally had to talk my doc into giving me blood panels in the first place (the 12/12/11 test) because he thought there was no way that I could possibly be testosterone deficient due to how I look.

One thing I also should have added is that I lost a ton of weight at one point during college. Reached a high bodyweight of 250 in high school (was an offensive lineman, benched over 300, powercleaned over 300, squatted around 375, but had some bodyfat, as ou can imagine). I dropped in weight to about 165 during undergrad, ultimately running a marathon in 3:05.

I hit a low point as far as bodyweight goes in my first year of law school, being at 139lbs, at which point I realized that I was near the danger zone. That's the same time that I was diagnosed as aenemic. I was eating very little for the period leading up to that low point in bodyweight.

After hitting that low bodyweight, I started getting back into weightlifting. Here's an example of one period of weightlifting for me that I tracked on here:
http://tnation.T-Nation.com/free_online_forum/blog_sports_body_training_performance_bodybuilding_log/getting_back_on_the_horse_and_living_the_big_three?id=4338856&pageNo=1

You'll see on page two where there are some progress pics that I do benefit from being in the weight room and such and am able to put on lean mass, pretty much like a normal male (...I think?)


#3

And if there's any more information that would be helpful, please ask.


#4

Sorry to keep adding on things: also thought to mention that I have seen a urologist, and he found that I had totally normal genital development (i.e., no abnormalities).


#5

Wow....this is one of the most bizarre cases I remember seeing. Everything is low--its like your body is shutting down, especially pituitary. I'm not sure how that plays into your hematology though. But your T is low, your Thyroid is bad, and your cortisol is on life support.

What time were your blood tests taken? Specifically that one on 12/21. Morning cortisol levels that low are serious.

Ok, so lets get down to your post:

Seriously? 7 days a week you go into the gym and lift weights for 2 hours? Hrmmmm....

Your caloric intake seems low, but I didn't bother to actually go and verify. how many calories a day do you average?

You lost a significant amount of weight while training hard--this could have something to do with your current situation.

Do you take deloads?

You say they did an MRI of your brain--is this a pituitary MRI (with contrast)? To see if you have a tumor on your pituitary gland affecting your pituitary output.

Did you see a hematologist about the blood issues? Or is this just an endocronologist? I would definitely enlist the help of an expert for blood specifics.

My suggestion: take 2-4 weeks off from training entirely. Develop yourself in other areas--read books, volunteer, develop relationships. Try to destress. If at the end of that time, get another hormone panel done and compare.


#6

First, thank you for responding.

Regarding the 12/21 test:

That was done in the morning fasted. Additionally, I had not lifted weights for a week (only light jogging for physical exercise of any kind). 12/12 was the last day that I lifted (lol, was squatting 300+ lbs for my work sets only to find that I have no T in my body).

Regarding 2 hours per day, that's 6x/week, with one day of maybe 30-45 minutes.

The significant weight loss was my sophomore year of college (currently in my third year of post-graduate education), so we're talking 5 years ago. I did increase training gradually, ultimately running a 3:05 marathon my last year of undergrad.

Caloric intake: when I'm just running/jogging, I don't eat as much--probably 2.5k calories a day. When I'm lifting, I down calories like a house. By last May, I was housing 5k cals most days to put on weight. Right now, I'm around 4k, although I haven't calculated exactly.

The brain MRI was with contrast.

The thing about not training is that I've tried that. This past summer I tried just running for a while, and I did the same this winter break after getting the low T level test in. It never makes me feel any better, and I'm just done with not lifting. Perhaps as a consequence of the low T levels, when I take layoffs like that I come back with massive losses in strength and basically have to start back at square one.

The most bizarre thing about all of this is that I don't present as someone who is crashing. I have no symptoms other than having no sex drive and basically being impotent. In other words, I seem like a pretty energetic young man. And it's not like I have no life outside of physical training....heck, I'm a law student at an ivy league school.


#7

Crap lighting, but here are two pics that I took with my computer this morning:


#8

And here's a back picture. I've basically gone from 160lbs in August to 190 by Xmas break, but then during the Xmas nonlifting during this whole blood panels thing, I went back down to 180 and lost a lot of muscle mass.


#9

If you don't mind my asking, I don't understand your point about my cortisol levels...

My cortisol was cortisol 8.7 4-22.....so 8.7 is in the normal range, yes...?

Here are additional labs that were taken on 1/12/12 when I had a stomach flu. This was taken at like 4pm, and I hadn't eaten anything that day due to said stomach ailment. This was after I started taking an prescription-strength iron supplement:

Na 137 (138-146) slightly low
Potassium 3.6 (3.5-4.9)
Chloride 103 (98-109)
TCO2 1.05 (1.12-1.32) low
Glucose 93 (70-105)
BUN 27 (8-26) slightly elevated
Creatinine 1.3 (.6-1.3)
Hematocrit 37 (38-51) slightly low
Hemaglobin 12.6 (12-17)
Anion Gap 14 (10-20)


#10

I should add that at least as of the last time I spoke with my endo, her basic position was that "You don't have a tumor or pituitary scarring, but your pituitary gland does not seem to be working, and I'm just not sure why yet."

That said, my body did respond to the iron supplementation (at least in terms of my 1/12 blood test), which is good. Although I don't feel any different now that I'm taking them. And I've just never been very symptomatic in general, at least as far as I can tell (other than ED issues mentioned above).


#11

Regarding cortisol, yes its in range but it is far from optimal. Its important to understand the difference.

It does look like your pituitary is lazy, but does not seem to have a problem with a couple of its other output, specifically prolactin (which can hinder T production, but not to the degree you are experiencing at the level its at currently) and TSH.

I'm really lost here--this is far beyond the scope of my knowledge and expertise.

Suggestion would be to rule out all blood diseases that you can, as well as AIDs, Cancer, etc. If that doesn't work, try hcg monotherapy or a SERM restart to see if that wakes your pituitary up and helps your produce T.


#12

I've thrown out a batsignal (er....PM) to PureChance and KSMan...think either of them will be able to give some insight? Or is my case just that bizarre?

The weird thing is, it's just hard for me to think of my whole situation as one that should be accompanied by a sense of urgency. Maybe it's just because I've been living the same way for years or whatever....but I mean it's just very strange that I'm apparently a step away from having some sort of critical mass episode when I feel fine...or at least I think I do....

I really appreciate your looking at my case VT.


#13

I see hypothyroidism, not major, but considering everything else, it might be contributing more than one would expect. Do you use iodized salt? Iodine in vitamins? Check body temp when you wake and mid afternoon and report. If you have an iodine deficiency, then that needs to be treated with iodine replenishment. If body temps are low, one can try iodine replacement. If that works, great, otherwise explore treatment with thyroid drugs to restore body temps. Your TSH sucks. Do not accept your doc stating that that is normal. It is normal to find people with thyroid problems that are not been treated and that creates a normal range. Where you are is not optimal.

should be getting iodine in your seafood, but may be loosing iodine in parallel with your iron losses. You may be deficient in other trace minerals as well, get a vitamin that has trace minerals and high potency B-vit complex.

You may be picking up mercury with the sea food that you are eating. Get tested. Mercury gets concentrated at the top of the food chain. Farm raised salmon might be safer if there is substantial vege content in their diet.

You have many hormone deficiencies: T, E2, progesterone, pregnenolone, DHEA and others.

Start taking 2x25mg DHEA per day, will reduce if your E2 over responds.
Google for pregnenolone caps, you have low pregnenolone and that affects the adrenals and the brain.

These are hydrophobic. Take with oily food! Take with a large amount of fish oil. You diet sounds very EFA deficient. Also use olive oil and eat olives. Do not take high fiber foods with healthy fats as absorption will be impaired.

Report your cholesterol lab results or get tested after a 12 hour fast. Low cholesterol rate limits all of your steroid hormones. If cholesterol is low, you will need a high cholesterol diet. Study this! http://en.wikipedia.org/wiki/Steroid_hormone

Eat nuts and add ground flax seed to food.

Take 5,000iu vit-D caps, tiny oil based caps at Walmart or elsewhere. Do not get dry caps. Start taking 25,000iu for two weeks, then down to 5,000. Later on you can test vit-D25 to see what your levels are.

We have seen extremes of diet and training cause problems similar to yours. Starvation can do terrible things and some are permanent and http://en.wikipedia.org/wiki/Epigenetic_theory in nature.

Starvation also lowers thyroid hormones and the stress of starvation increases RT3 - as can any stress or long term infection/inflammation.

"The weird thing is, it's just hard for me to think of my whole situation as one that should be accompanied by a sense of urgency. "

-define apathy, and you get apathy with hypogonadism

How large are your testes, how changed and how are they hanging?

Please note all items that need a reply

You are spilling iron and the body does not do that naturally. You can be loosing iron from intestinal conditions or diseases where bleeding is occurring. Get tested for blood in your stools or urine. If nothing there, perhaps a lab needs to look at your blood with a microscope.

Before starting with testosterone, you need a SERM challenge to see if your pituitary and hypothalamus can play the game. Either clomid or nolvadex could be used, but some react adversely to clomid [read]. Take for one month, note changes to how you feel and testes. Then test E2, TT, FT, LH, FSH, DHEA-S, pregnenolone. If things are working well, you can keep going then after another month, taper off of the SERM and see if you can restart your HPTA. If you do not respond to the SERM, there are serous problems that might not be surmountable then you can try hCG monotherapy, which can work well for younger men. If that fails, start a standard T+AI+hCG protocol where AI is adjusted to get near E2=22pg/ml.

If you get your T levels useful with hCG, stop the DHEA and test for DHEA-S after 3-4 weeks to see if you are making enough.

Note that if LH increases or hCG is used, T production depends on DHEA for a raw material. If DHEA does not recover, you must supplement for hCG to be effective as DHEA-->T can be rate limited by low T.

You need to monitor E2 as some hyper covert DHEA-->E2, probably in the adrenals and DHEA dose may need to be adjusted or eliminated. And same for hCG, which can lead to high E2 production in the testes for a few on normal hCG doses. High hCG doses makes this very likely. Do not let a doc put you on more than 500iu hCG EOD. And huge doses of SERM can make LH too high, creating the same problem. And do not stack a SERM and hCG.

Print and read, do research, show this to your doctor to discuss lab work. You tagged me for my input. You have a lot of work to do and you cannot be passive. You need to manage your own health care.


#14

Body temperature immediately upon waking: 97.8

As to my testes, probably the most helpful thing I could say is that I was examined by a urologist who said that I had normal (average) development both of my testes and my penis.

As to idodine, I do put a cajun seasoning on my meat that has a lot of salt in it, and I also eat a small amount of cheese, as well as of course the canned mackerel that has a lot of salt in it. As to EFAs, I don't see how it could be deficient...I eat a ton of fatty fish (mackerel, salmon), take 4 fish oils a day (more if I eat less fish). I also eat a serving of peanut butter in the morning with my whole eggs.

Regarding intestinal conditions: I have had a colonoscopy and an Upper GI. There was no ulcer found. They did find an internal hemorrhoid, but it was not even close to being something that would put my iron levels where they currently are.

To follow up, the GI doc took the blood samples from the colonoscopy and upper GI work and scanned them for signs of cancer or other disease, all of which came back negative.

Just to be clear, anything resembling a starvation diet was committed almost exactly two years ago.

I don't challenge that I am apathetic dispositionally to a far greater degree than I was in the past. I think my point about urgency was that I'm unclear as to how much imminent danger I am in regarding all of this, mostly because I've apparently been living with it for many years.

Out of curiosity, do you have a position on why I am not physically symptomatic to a larger degree than I am? I feel like that's one thing that the drs. have had a hard time getting their heads around--looking at me and saying "this is a person who has the blood makeup of someone who is crashing....but doesn't appear to be at all..."


#15

What dose of Clomid or Nolva would you use?


#16

my doc ran a battery tests to rule out heavy metal issues - lead, mercury, etc. and there is an immunoglobin e, g, m?? panel he ran looking for something. My tests came back fine, but may be something to rule out.


#17

I greatly appreciate all of the input on this thread.

Two updates:

Seeing my university's GP (so, basically transferring my case) on Wednesday. I'm very disappointed that my endo in my hometown has dragged her feet and not contacted me at all, but my university is one of the top two or three medical research universities in the country, so hopefully it will be for the best.

Other sort of strange update:

I guess this is another part of "data." I tried to see if I could get an erection and/or achieve orgasm last night when I was sort of half asleep. I did achieve orgasm and erection (though unsure of how much control I had over stimulating it--it was sort of one of those half-sleeping things). However, no ejaculate came out of my penis. I'm unsure what significance this has at this point in my case.


#18

Update: Spoke with my endo last night for a long time.

I guess I'll start with the bottom line: I'll be doing 100mg/week injectable testosterone. She said she wanted me to do 50mg/week the first month, then 100 after that, in 50mg doses (i.e. 2x/week).

Ultimately, she decided that after the MRI, upper GI, urologist examination, and colonoscopy, the best possible explanation of the low T is the concussion I suffered in high school because the timing of it works out.

I brought up the cortisol, TSH, etc with her (I should mention here that thyroid is her specialty). She basically said that she didn't feel that any of my levels merited being medically treated at this point before starting testosterone therapy, especially because I'm not symptomatic for having problems on those fronts. She basically wants to change one variable at a time--start with the T and see where that brings us.

Does that seem reasonable? It did to me, but it was also very late at night that she called me (i.e. I wasn't exactly at the height of my argumentative powers).

Thanks again for all the help you all have provided. I really appreciate any input you might have.


#19

Still think you have a blood ailment. You should resolve that. Hematilogist.

Buy your trt protocol us premature IMO. You are secondary not primary. This warrants SERM or hcg trial first. Also the lesser dose to start is rather silly. If anything you want to take MORE to start so your levels comeuppances faster


#20

Thanks for the response, VT. When you say blood ailment, do you mean like heavy metal poisoning? Are there other ailments you have in mind?