T Nation

TRT a Year Later, Still Not Dialed In


#1

Hi all,

I had labs done with Defy Medical. My appointment isn’t until June, so I am eager to find out what the hell is going on in the meantime. No disrespect to Defy, those guys have been awesome so far!

A little back story…I got on TRT about a year ago, was suffering from the typical symptoms. No libido, impotency, depression, lethargy, etc… I got on TRT at first with a dosage of 125mg/wk. It worked great at first because I was coming from such a horrible place. However, as I started to adjust, I became extremely irritable\angry. This is not like me because I am not an angry person.

Fast forward a year and I am still experiencing these symptoms, along with a very unpredictable libido. Sometimes I feel great, sometimes I feel a general sense of malaise. It is very unstable. I’ve tried dropped my dose to 100mg/wk. I have also switched from EOD to ED injections. Nothing seems to be helping. And the most frustrating part is that my labs look perfect…

This is why I sought out Defy. But like I said, I am eager to get other opinions while I wait for my appointment.

Here are the labs: (Not sure why LH was left blank…and also not sure why there was no test for t3, prolactin, pregnenolone, etc… but I am sure there is a good reason) *note: the number after the F is my result.

Notes Testosterone,Free and Total [Final]
Testosterone, Serum 348-1197 ng/dL F 688
Testosterone(Direct) 8.7-25.1 pg/mL F 14.5
DHEA-Sulfate 138.5-475.2 ug/dL F 330.9
TSH 0.450-4.500 uIU/mL F 2.150

LH 1.7-8.6 mIU/mL FL<0.2 blank wtf?
PSA, Serum 0.0-4.0 ng/mL F 010.8
Estradiol, Sensitive 8.0-35.0 pg/mL F 27.2
SHBG, Serum 16.5-55.9 nmol/L F 37.3

Cholesterol, Total 100-199 mg/dL F 126
Triglycerides 0-149 mg/dL F 49
HDL Cholesterol >39 mg/dL F 40
VLDL Cholesterol Cal 5-40 mg/dL F 10
LDL Cholesterol Calc 0-99 mg/dL F 76
T. Chol/HDL Ratio 0.0-5.0 ratio units F 3.2

WBC 3.4-10.8 x10E3/u L F 5.5
RBC 4.14-5.80 x10E6/u L F 5.35
Hemoglobin 12.6-17.7 g/dL F 15.7
Hematocrit 37.5-51.0 % F 46.3
MCV 79-97 fL F 87
MCH 26.6-33.0 pg F 29.3
MCHC 31.5-35.7 g/dL F 33.9
RDW 12.3-15.4 % F 13.1
Platelets 150-379 x10E3/u L F 169
Neutrophils % F 67
Lymphs % F 21
Monocytes % F 11
Eos % F 1
Basos % F 0
Immature Cells X NP
Neutrophils (Absolute) 1.4-7.0 x10E3/u L F 3.7
Lymphs (Absolute) 0.7-3.1 x10E3/u L F 1.1 Monocytes(Absolute) 0.1-0.9 x10E3/u L F 0.6
Eos (Absolute) 0.0-0.4 x10E3/u L F 0.1
Baso (Absolute) 0.0-0.2 x10E3/u L F 0.0
Immature Granulocytes % F 0
Immature Grans (Abs) 0.0-0.1 x10E3/u L F 0.0

Glucose, Serum 65-99 mg/dL F 89
BUN 6-20 mg/dL F 10
Creatinine, Serum 0.76-1.27 mg/dL F 0.95
eGFR If NonAfricn Am >59 mL/min/1 .73 F 105
eGFR If Africn Am >59 mL/min/1 .73 F 121

BUN/Creatinine Ratio 9-20 F 11
Sodium, Serum 134-144 mmol/L F 142
Potassium, Serum 3.5-5.2 mmol/L F 4.5
Chloride, Serum 96-106 mmol/L F 100
Carbon Dioxide, Total 18-29 mmol/L F 27
Calcium, Serum 8.7-10.2 mg/dL F 9.5
Protein, Total, Serum 6.0-8.5 g/dL F 7.1
Albumin, Serum 3.5-5.5 g/dL F 4.5
Globulin, Total 1.5-4.5 g/dL F 2.6
A/G Ratio 1.2-2.2 F 1.7
Bilirubin, Total 0.0-1.2 mg/dL F 0.6
Alkaline Phosphatase, S 39-117 IU/L F 42
AST (SGOT) 0-40 IU/L F 16
ALT (SGPT) 0-44 IU/L F 20


#2

Do not even have your age.

Your hematocrit [HTC] says you are anemic and that can be from GI blood loss, get an occult blood test that detects blood not visible in your poop. HTC should be >45 on TRT.

Cholesterol is very low and unheathly. 180 is ideal, <160 is associated with increased all-cause mortality.

Describe diet
Describe all health issues
List all medications, Rx and OTC
age
height
weight
waist size

TSH should be closer to 1.0, thyroid lab ranges are bogus
If you have not been using iodized salt, that is a major problem.

E2=27 is not horrible

LH/FSH–>zero on TRT, doctors writing such lab orders are stupid

You appear to need 150mg T per week.
T ED not expected to have any advantage over T EOD.

Have you considered anastrozole to manage E2? E2=22pg/ml suggested?
Have you discussed using hCG to maintain testes physically or fertility?

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#3

Thanks you KSman,

Here are my details:
-33 years old, 6’2", 190Lbs, waist size is about a 32. I am in good shape, no excess fat. Around 9% body fat.

  • Eat super clean food (organic, low glycemic, no processed stuff, gluten free, etc…), with little sugar and I recently quit caffeine. I do not eat beef, pork or chicken. I eat eggs and fish however.
    -I have crohn’s disease which could explain the iron issues. I have had low iron in the past.

I currently do not take any medications for crohn’s, I try to manage it through diet as much as possible. The sides on some of the medications are horrific and I want to avoid that as much as possible.
I am only taking Testosterone. I haven’t taken any supplements or anything for a few months prior to the labwork in order to establish a baseline.

I was trying to avoid using anastrozole due to the negative side effects and long term effects. I have heard of many people on strictly T that don’t use it.

I have considered HCG and that is mainly why I am seeking out help from Defy Medical.

What tests should I have done in order to get a clearer picture of what is going on? I can order labs myself through discountlabs.com. What supplements should I take?

I assumed that E2=27 was a good number. What do you mean when you say not horrible?

Thank you so much. I have read the stickies as well and understand the important of supplementing with Iodine. I will do so one I get the proper blood tests to establish a base line.

D


#4

Documented side effects are from women with E2–>zero and you are not doing that, you are modulating to near E2=22pg/ml. There are also known effects from BB guys trying to get very low estrogen levels and the problems they experience are from very low E2, not direct effects of anastrozole. One needs to be a bit more intelligent about reading these things.

E2=22pg/ml is very good more most guys, so your E2=27 is not creating any major problems. Higher T dose will need some anastrozole as FT–>E2 production rates are linear to FT levels.

More T will compensate for your expected GI blood loss. While most males should avoid iron supplements, you should use them. Find iron bound to amino acids / proteins. Iron rich food will be helpful too.

Cholesterol suggests that you should seek more fats and cholesterol rich foods. Cholesterol is the basis for all of your sex hormones and Vit-D3 production as well as cortisol and other adrenal hormones. However, your DHEA-S is quite robust. You could test Vit-D25 or for the expense, take 5000iu Vit-D3 per day.
Your total serum proteins are good considering your condition.


#5

I encourage you to find another clinic where you don’t have to wait 2 months for an appointment - that’s just ridiculous, and is why I left Defy. Find a better clinic - they’re out there, and they’re cheaper.

We are in the early years of understanding male hormone problems and just because one clinic rises to the top because they will do X, Y, and Z, (i.e. the very basics) doesn’t mean they’re the best and you should postpone your wellbeing and buy everything they say.

Take matters into your own hands by reading everything on this site, doing your own labwork, and finding a clinic that is more accessible. I can call my clinic on the phone and get hold of a person right away. I can get a doctor’s appointment in a few days. I pay less than $200/mo for my meds. I do my own labs and manage my own protocol based on what I have learned here.

Not trying to bash Defy but I hate to see people 1) relying on doctor and 2) delaying their wellbeing unnecessarily.


#6

Thanks guys,

I really appreciate the input. I understand that it is important to do my own research and educate myself. That is why I came here in the first place. I will take this into my own hands as much as possible.

KSman…from what I gathered from your responses I should do the following:

  1. Ask my doctor to up my dose to 150mg/wk with HCG and AI
  2. Switch to EOD.
  3. Eat more cholesterol rich foods and iron rich foods
  4. Take vitamin D3 (which I just started doing anyways)
  5. Perhaps I should get my thyroid labs checked? And depending on what that test shows perhaps I will take an Iodine supplement per the thyroid sticky.
  6. Also was considering getting a full cortisol/adrenal workup to see if there is anything going on there. I tend to only feel “optimal” after I am caffeinated. Even though I quit about a month ago.

Let me know if you can add to this or have any recommendations. And btw thank you so much for everything. I would buy you a beer if we lived in the same city!

D


#7

Skip the thyroid labs until you get the request oral body temps. That can provide more info than thyroid labs.

Please explain your history of using iodized salt!


#8

OK, I will test myself over the next few days and let you know the results.

I have been primarily using Himalayan Sea Salt for the past few years. No Table Salt.


#9

Himalayan Sea Salt = no iodine


#10

I have taken my Basal Temp for the last 3 days, not sure if that’s enough to come to any conclusion, but I thought I would post it anyways.

Sunday May 7th - 96.3 degrees
Monday May 8th - 96.5 degrees
Tuesday May 9th - 96.1degrees (take around 4am) / 96.6 degrees (taken around 6am)

I am just basically using a regular thermometer that you use when you are sick. Putting it under my tongue.

In regards to Iodine, I have read the Thyroid sticky and understand that if I supplement with Iodine it may help with my basal temp.

Thanks,

D


#11

If someone else can get 98.6F on that thermometer, that provides some confidence.

It is also useful to see what temperatures you get mid-afternoon.

96.x degrees is very low.

  • Do you feel cold easily?
  • Are outer eyebrows sparse?
  • Thyroid enlarged, sore, asymmetrical, lumpy?
  • Might have generalized hair thinning. -Not male pattern baldness.

I now think that thyroid labs are advisable.

Please note carefully that you must have selenium in your diet to avoid thyroid damage and possible auto-immune response from enzyme deficiency from low selenium. I typically suggest a high potency B-complex multi-vit with trace elements including 150-170mcg iodine and 150-200mcg selenium.

You appear to be a clear cut case of iodine deficiency and from your reading you should see that maintenance doses are not sufficient to get better.

I have never seen a report of a doctor asking about iodine intake. In the 1920’s doctors were all about the benefits of iodized salt, now forgotten.


#12

Thanks KSman,

I do feel cold easily, especially hands and feet, but I like the cold so I guess I never really have paid much attention to it.

I wouldn’t say my eyebrows are sparse, but the outer edge is definitely thinner than the main part of the brow.

Thyroid feels lumpy, but not sure I am even touching the right thing.

My hair does seem a lot thinner, not balder, but just thinner in general. It used to be very coarse and thick, now it is a lot softer and thinner. Sort of like it does when you use conditioner, but I never use conditioner.

What tests should I get? I have some Iodoral that I bought a while back, should I start taking that or should I wait until tested?

I really appreciate the advice.

D


#13

You could start taking iodine now IF you are also getting selenium.

Note that TSH gets pushed up by high dose iodine, so TSH labs then not very useful.


#14

No labs?

I can just eat a few brazil nuts to supplement the selenium each day.


#15

I do not see the point of doing labs when iodine deficient and the numbers will change anyways. Do labs later when on a maintenance dose for a few weeks if body temps still low. If body temps are good, no hurry. You can do labs if you want, but will doc repeat later if in his eyes everything was ‘normal’?

Brazil nuts will work for selenium.

Who else in your home is at risk of iodine deficiency?


#16

Most likely everyone.


#17

Women need more iodine than men, and more again during pregnancy, very important for development of babies and children. Iodine stored in breast tissue for iodized breast milk.


#18

Ok, I will be sure to let them know.

How do I know if I have an adrenal or cortisol issue?


#19

UPDATE:
Doctor put me on 110mg T-Cypionate per week and 700UI HCG (20UI HCG EOD about 2 months ago , I think the math is correct) per week.
I started to feel extremely tired, greasy skin/acne, no libido (although once aroused my erections were good), muscle weakness, lack of motivation.

I got labs to see what is going on, here are the results:

Testosterone, Serum 264-916 ng/dL F 852
Free Testosterone, Serum 52-280 pg/mL F 170
Bioavailable Testosterone, S 128-430 ng/dL F 466
Dihydrotestosterone 30-85 ng/dL F 65
Estradiol, Sensitive 8.0-35.0 pg/mL F 43.6

TSH 0.450-4.500 uIU/mL F .658
T4 .82-1.77 ng/dL F 1.54
T3 2.0-4.4 pg/mL F 3.3
Prolactin 4.0-15.2 ng/mL F 11.1
Cortisol AM 6.2-19.4 ug/dL F 8.8

Cholesterol, Total 100-199 mg/dL F 136
Triglycerides 0-149 mg/dL F 57
HDL Cholesterol >39 mg/dL F 47
VLDL Cholesterol Cal 5-40 mg/dL F 11
LDL Cholesterol Calc 0-99 mg/dL F 78

WBC 3.4-10.8 x10E3/u L F 3.9
RBC 4.14-5.80 x10E6/u L F 5.28
Hemoglobin 12.6-17.7 g/dL F 16.3
Hematocrit 37.5-51.0 % F 46.1
MCV 79-97 fL F 87
MCH 26.6-33.0 pg F 30.9
MCHC 31.5-35.7 g/dL F 35.4
RDW 12.3-15.4 % F 13.9
Platelets 150-379 x10E3/u L F 146 Low???
Neutrophils % F 61
Lymphs % F 31
Monocytes % F 7
Eos % F 1
Basos % F 0
Immature Cells X NP
Neutrophils (Absolute) 1.4-7.0 x10E3/u L F 2.4
Lymphs (Absolute) 0.7-3.1 x10E3/u L F 1.2
Monocytes(Absolute) 0.1-0.9 x10E3/u L F 0.3
Eos (Absolute) 0.0-0.4 x10E3/u L F 0.1
Baso (Absolute) 0.0-0.2 x10E3/u L F 0.0
Immature Granulocytes % F 0
Immature Grans (Abs) 0.0-0.1 x10E3/u L F 0.0

Glucose, Serum 65-99 mg/dL F 95 Is this high? What is it?
BUN 6-20 mg/dL F 13
Creatinine, Serum 0.76-1.27 mg/dL F 1.01
eGFR If NonAfricn Am >59 mL/min/1 .73 F 97
eGFR If Africn Am >59 mL/min/1 .73 F 112

BUN/Creatinine Ratio 9-20 F 13
Sodium, Serum 134-144 mmol/L F 140
Potassium, Serum 3.5-5.2 mmol/L F 5.1
Chloride, Serum 96-106 mmol/L F 100
Carbon Dioxide, Total 18-29 mmol/L F 24
Calcium, Serum 8.7-10.2 mg/dL F 9.4
Protein, Total, Serum 6.0-8.5 g/dL F 6.7
Albumin, Serum 3.5-5.5 g/dL F 4.5
Globulin, Total 1.5-4.5 g/dL F 2.2
A/G Ratio 1.2-2.2 F 2.0
Bilirubin, Total 0.0-1.2 mg/dL F 0.6
Alkaline Phosphatase, S 39-117 IU/L F 38 Low?
AST (SGOT) 0-40 IU/L F 13
ALT (SGPT) 0-44 IU/L F 17

Iron, Serum 38-169 ug/dL F 96
Vitamin B12 211-946pg/mL F 425
Calcitriol (1,25 di-OH Vit D) 19.9-79.3 pg/mL F 40.7

Not sure how soon I will be able to see my doctor so any comments or suggestions would be greatly appreciated. Thanks guys…


#20

KSman, any thoughts?