T Nation

TRT: 31 YO Male, 184 Pounds, 6'2


#1

-age: 31
-height: 6' 2"
-waist: 34"
-weight: 184 lbs
-describe body and facial hair: full hair on head (though on propecia and rogaine for past 6 years); hairy legs; light hair on arms and chest, no hair on back; have thick facial hair, but in the last 6 months, I have developed 4 quarter sized patches on beard area that no longer grow hair

-describe where you carry fat and how changed: I carry fat in my stomach and love handles and face
-health conditions, symptoms: I seem to be tired a lot; It takes me a while to recover from weightlifting; I seem to be stalled on lifts despite a few years of training; I don't put on much muscle, more fat from bulking diet
-Rx and OTC drugs, any hair loss drugs or prostate drugs: Yes 1mg propecia per day for the past 6 years and rogaine
-lab results with ranges: so far just 331ng/dL total testosterone (waiting to get add'l tests)
-describe diet: 3 meals per day, I try to get 50g of protein per meal from chicken, fish, beef; I aim for a healthy balance of fat, carbs, protein; I don't eat much junk food
-describe training: I do bench, leg press, and pullups 2 to 3 times per week
-testes ache, ever, with a fever?: no testes never ache
-how have morning wood and nocturnal erections changed: no morning wood seems pretty steady; I have it on most days if not all

Hi, I am new. I read the Lab Work sticky and the Advice for New Guys sticky, and did a forum search, but I am still not clear on the exact test I should get.

I have been experiencing some symptoms of low testosterone (tiredness, slow recovery from workouts, difficulty putting on muscle) and recently went to a TRT clinic in Miami and got their free total testosterone blood work done (they only measured total, not free). They tell me I am 331ng/dL. I am a male 31 y/o, 6'2", 184 pounds. This is on the low end, I understand, so it seems to be a good idea to get a more comprehensive test done.

So I am trying to figure out what to get done next. The clinic is suggesting a follow up "comprehensive" blood test for $395, but I figure it might be cheaper to use privatemdlabs or lef.org.

Should I just get the $63 "Hormone Panel for Females" http://www.privatemdlabs.com/lab_tests.php?view=all&show=1032&category=14&search=#1032

Or something more comprehensive like the $203 "Male Anti Aging Deluxe with Free Test" http://www.privatemdlabs.com/lab_tests.php?view=all&show=2110&category=14&search=#2110

Or the $269 "Male Panel" test from lef.org http://www.lef.org/vitamins-supplements/ItemLC322582/Male-Panel-Blood-Test

or the mac daddy $353 "Male Anti Aging Ultimate" http://www.privatemdlabs.com/lab_tests.php?view=all&show=2111&category=24&search=#2111

I've compared them all to what is recommended on the Lab Work sticky, but I'm unclear on which one I should start with right now, given my first initial reading of 331ng/dL total testosterone.

Thanks!


KSman is Here
#2

Here are my newbie stats btw:

-age: 31
-height: 6’ 2"
-waist: 34"
-weight: 184 lbs
-describe body and facial hair: full hair on head (though on propecia and rogaine for past 6 years); hairy legs; light hair on arms and chest, no hair on back; have thick facial hair, but in the last 6 months, I have developed 4 quarter sized patches on beard area that no longer grow hair

-describe where you carry fat and how changed: I carry fat in my stomach and love handles and face
-health conditions, symptoms: I seem to be tired a lot; It takes me a while to recover from weightlifting; I seem to be stalled on lifts despite a few years of training; I don’t put on much muscle, more fat from bulking diet
-Rx and OTC drugs, any hair loss drugs or prostate drugs: Yes 1mg propecia per day for the past 6 years and rogaine
-lab results with ranges: so far just 331ng/dL total testosterone (waiting to get add’l tests)
-describe diet: 3 meals per day, I try to get 50g of protein per meal from chicken, fish, beef; I aim for a healthy balance of fat, carbs, protein; I don’t eat much junk food
-describe training: I do bench, leg press, and pullups 2 to 3 times per week
-testes ache, ever, with a fever?: no testes never ache
-how have morning wood and nocturnal erections changed: no morning wood seems pretty steady; I have it on most days if not all


#3

Also, I am in South Florida (Fort Lauderdale/Boca Raton/West Palm Beach area). If anyone has recommendations for a reputable, knowledgeable doctor or clinic for TRT in this area, I would much appreciate it!


#4

When do you feel the problems started to occur?

How well are you managing your hair loss?

We might be dealing with an “organic cause”, but the hair loss drugs can cause these issues too.


#5

Thanks for the reply ksman! To answer your questions, I would say I started experiencing these issues back in 2010. That’s when I started working out, and despite many tries, never seemed to be able to put on much muscle, and would often fall asleep at work (though some of that was lack of sleep).

The hair loss has been managed well I’d say. Basically, as soon as I started the rogaine (once a day) and propecia, the hair loss stopped and some probably grew back. I started both almost immediately after noticing my scalp thinning, so it never had much chance to progress. I have a receding hairline on the sides of my forehead, but otherwise, no bald spot in the back or too much thinning anywhere.


#6

Trashes hormones for some males. If that was so, how does this fit your symptom time line?

Please read these stickies:

  • advice for new guys - look for causes that might fit

Labs:
TT
FT
E2
prolactin
CBC
LH/FSH
IGF-1
TSH
fT3
fT4
DHEA-S

There are a lot of T-shops in your area. If you are a member at LEF, they can do referrals. Otherwise, see the finding a TRT doc sticky.


#7

I can’t really remember any before or after difference when starting the finasteride. I’ve been on it for 7 years, so it’s hard to remember that far back.

I read the Advice for New Guys sticky and the Things that Damage your Hormones sticky, and I didn’t see any causes that would fit me (I don’t smoke, drink heavily, haven’t been exposed to heavy metals, etc.)

I read the Finding a TRT Doc, and called a local pharmacy. They mentioned Dr. Rodriguez who has a TRT clinic in South FL called Royal Men’s Medical Center. Anyone know anything about them, and whether they are good or bad? I paid their initial $125 fee which includes a bloodtest by LabCorp, a consultation wit the doctor, and a phsyical. I already went in to LabCorp and gave the blood. The results are attached. I am going into the clinic tomorrow for the initial consultation/physical.

One thing to note. I first got my blood tested a few weeks ago through NuLife Institute in Miami. They offered a no cost testosterone bloodtest. They called me to tell me my total testosterone was 331ng/dL (they never sent my the actual lab report despite requesting though, so I’m just going by the number I was told on the phone.) In the results below (from a bloodtest just two weeks later) my total testosterone came back at 468ng/dL. I guess that kind of variance can happen normally? The 331ng/dL results was from a blood draw at about 12:30pm. The 468ng/dL was from a draw at 8:45am, so maybe that has something to do with it.


#8

For the record your “workout” is dog crap, and it is no surprise you can’t put on muscle even if your hormones were fine. So don’t fool yourself there.

That being said listen to KSman.


#9

Labs overall look good.

HTPA seems functional. Impeded by E2

You are estrogen dominant.

E2=34 is holding down your T levels. Suggest 0.5 mg anastrozole per week in divided doses.
Also consider Rx or OTC drugs that might interfere with liver clearing E2. AST/ALT are great.

TSH is good. You can still check oral body temperatures as per the thyroid basics sticky to evaluate overall thyroid function.

You only evident issue is E2=34 and why that might be occurring.

Would have been good to have FT in labs. Assumed to be low as E2=34 and lower TT should increase SHBG.


#10

Thanks so much for the response KSman!

So based on your last post, what do you think of this plan?

-Get a new bloodtest for just Total Testosterone, FT, and E2 to have baseline
-Start taking 50mg of zinc per day
-Repeat above bloodtest in 4 weeks to see if E2 has dropped and TT has increased
-If little or no affect then try 0.25mg of anastrozole every 3.5 days
-Repeat bloodtest in another 4 weeks to check change in TT, FT, and E2

What is a good target level for E2?


#11

Zinc will help if you are deficient. Otherwise maybe not. High amounts can block absorption of copper and might induce a deficiency over time.
If you also have zinc in multi-vits, note the total.

Many do well getting near E2=22pg/ml. A good balance of energy and libido.

The only major unknown is how fast/slow SHBG response is to a drop in estrogen levels.

Zinc and other trace elements form the reaction sites in many enzymes and are thus mission critical for things to work properly. A good high potency B-complex multi-it with trace elements, including zinc, selenium and iodine would be beneficial and perhaps better than focusing on a single mineral. Men should avoid supplements and iron fortified foods unless iron levels are low. [Low (iron, hemoglobin, hematocrit, ferritin) can be indications of a GI bleed from a food allergy/sensitivity or other condition.]


#12

Ksman,

Thanks so much for your latest reply. Per your advice, I started taking a B-Complex/zinc vitamin about 1.5 months ago. (It’s called Nature’s Bounty Stress B-complex with Zinc, see attached image for ingredients.) To see it’s affected my T levels, I just got a new blood test done 2 days ago for Total and Free Testosterone (see attached image). My TT levels are about the same as last time (a bit lower) at 432ng/dL but my FT levels seem to be at a great level (23.2 pg/mL). My earlier blood tests didn’t measure FT so unfortunately I have no baseline to compare this to.

Any thoughts on what I should do going forward?


#13

It seems good. But with natural guys FT levels are pulsatile. So you do not know average levels. But it seems to be a great result.

The TT/FT ratio implies lower SHBG. E2 labs would have clarified things a bit.

How are you feeling now? Any changes to mental clarity, energy, libido, socialization or mood?


#14

I haven’t really noticed a difference in mental clarity, energy, libido, socialization, or mood since 1.5 months ago before the B-complex and now.

I have noticed that some of my lifts are going up again though (like my bench press and number of pullups I can do).

Maybe I should test for TT/FT and E2 in another 1.5 months and report back? At this point, can you say definitively that I do not need TRT?


#15

Did you do anything about E2?


#16

Are you asking if I got bloodtested for E2 recently or if I am taking anything to manage it lower?

If the former, I didn’t get E2 tested, just FT and TT this time. If the latter, then I am just taking the B-complex with zinc as I thought I would try an over the counter method to get E2 lower and increase TT/FT before trying anastrozole.

Thoughts?


#17

If zinc worked well we would not be needing anastrozole. Zinc does help if one is zinc deficient.

OTC is basically ineffective


#18

Ksman,

So I decided to get a full panel of blood tests done again before I started taking anastrazole. Above are the results from this week. Now I am confused on what to do as my estradiol now seems to be at a good level at 21.5 vs last time it was tested it was 34.7. The only difference between then and now is that I’m taking the B-Complex vitamins with zinc daily.

Also, my TT is low at 403, but my FT is toward the high end of the range at 19.3.

What do you think I should do next?


#19

You total cholesterol is too low. 180 is ideal. 160 and below are associated with increased all-cause mortality.
Please change diet to increase cholesterol. Cholesterol is the foundation for all of the steroid hormones, including cortisol and Vit-D.

TSH=2.24 is too high. Better near TSH=1.0
The thyroid ranges are misleading.
Your TSH could be elevated from not using iodized salt.
Please see the thyroid basics sticky and check oral body temperatures as suggested [I asked in August].
Why did TSH increase?


#20

Hi Ksman,

I saw a testosterone doctor (Justin Saya from Defy Medical). Based on the above test results I already posted, he said the following:

-Needs to test but would bet his house my DHT is probably low due to finasteride use
-My free T is high but TT is low; wants to raise SHBG; your body is keeping your T in FT form but it’s getting excreted quickly; body is probably doing this to compensate for the low DHT
-LH is normal, but could get it higher
-Doesn’t want to throw me straight on testosterone replacement off the bat
-Wants to try a stimulation regimen first; if that fails then we have other backup plans including TRT
-Suggests clomid: half tablet every day for 35 days; wants to look at T, E2, and LH, DHT, and prolactcin (if elevated, can cause low libido and lack of erections) again at 30 day point

After the above, he had me get my DHT and prolactin tested. The results were:

Dihydrotestosterone 9.3 ng/dL / Reference Range: Adult Male: 30 - 85
Prolactin 8.0 ng/mL (4.0 - 15.2)

KSman, do you think the 25mg a day of clomid is a good idea like the Doctor is suggesting? Thanks again!