T Nation

TRT Advice for a UK Veteran with PTSD

Please note I live in the UK so some of the terms used and blood measurements may differ to those in the US.

-age 42

-height 5’10”

-waist 44-46 inch

-weight 118Kg (259 lbs)

-describe body and facial hair: facial hair no issues have a good beard. I would describe my body hair as normal as it always was with the exception of lower leg hair. Lower legs, no hair below knee and skin shinny until about July 16 when GP prescribed T, shortly after hair has returned (about the same as other body hair) to about mid shin. Mid shin-ankle no hair but no longer shiny skin.

-describe where you carry fat and how changed; I carry fat around lower abdomen (like a woman) some also around chest. I seem to put fat on easily no matter what I do. This started to come on around 2009 before then I was very lean runner type appearance.

-health conditions, symptoms [history]: diagnosed with Compound Combat Related PTSD , which includes periods of high anxiety, depression, hypervigilance, hypersensitivity, night terrors.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever; I have had several anti-depressants between 2009 and 2014 when I came off them due to the issues they caused my physical state (zombie feeling, weight gain, lack of motivation, lack of energy, nocturnal emissions, constant over sleeping, lack of appetite, and involuntary limb movement (ticks.)), also the fact that the anti depressants don’t work for PTSD. Drug free until June 2016 when I found my new GP she totally agreed re Low T and needing TRT but new nothing about it. Prescribed 50mg T in gel daily. No hair loss drugs or prostate drugs ever.

-lab results with ranges: I have only been able to get those bloods the GP would agree to. It is too expensive on my pension to go private to get all those suggested. Please note July 15 was a different GP and different Lab.

-describe diet I have a good diet around 32-35000 kcal daily try to eat as lean as possible and on a lean gain however as stated I am still putting on fat even if cutting kcal down. I am allowed 1-2 cheat meals a week.

-describe training 5 day a week training 3 days powerlifting style with main lift accessory, 2 days bodybuilding style for upper and lower. Each Powerlifting day around 2hrs bb days around 60-90mins. I have recently added 20mins hiit on rower 2-3 times a week in am and conditioning 2-3 times after lifting which is either prowler push, yoke, or farmers walks in pm.

-testes ache, ever, with a fever? Testes have ached but not for more than a few hours, and only 2-3 days maybe a month I have difficulty remembering the exact occurrence of this but now it is a lot less. No fever however since starting T in July they have shrunk and pulled towards body

-how have morning wood and nocturnal erections changed: very rare morning wood or nocturnal. Very low sex drive

In July 16 my GP booked appointment for Endo, this took place last week Jan 17 (the great UK NHS). The endo stated he would give TRT but would be T injection once every 6 weeks called Nebido. He had no concern re E at all and said it’s not important and due to not wanting children was not concerned re testicular shrinkage or signs of Hypogonadism. Each time I raised an objection or showed clinical proof he deflected or did not answer the question. Getting another opinion is almost impossible as he was the head Endo in my area and they tend to stick together not wanting to challenge a colleague, I cannot afford for private care in UK. My GP was aghast at the endo’s response and will support me self-medicating.

I am looking at the following protocol
100mg test cypionate or ethanate injected per week with two or more injections per week.
250iu (25mg) hcg sc eod [every other day]
1.0mg Arimidex/anastrozole per week in divided doses. However at this time I am unsure if I can get the anti-E in less than 1.0mg dose.

I am booked in for more bloods next week which will be
SHBG, Ferritin, Testosterone (male), Cortisol, Full Blood Count.

Target is E2=80pmil/L
Transdermal T has the highest potential for T–>E2 aromatization, and more fat means more of that too.

You can cut 1mg anastrozole in two. If that dose is not suitable, dissolve in vodka 1mg/ml and dispense by volume or drop.

Anastrozole needs to match serum T levels and with 6 weeks injections, that cannot work well.

TSH should be closer to 1.0
Have you been using iodized salt or vitamins that list iodine+selenium
You can eval overall thyroid function via oral body temperatures as per the thyroid basics sticky.
Low thyroid function can lead to low energy, mood/depression issue, fat gain etc.
The thyroid lab ranges are quite useless.
It is very common to see low thyroid function and poor absorption of transdermal T
Doc will think that your thyroid is normal.

Have you been tested for:
serum glucose

Any tingling or numbness in your feet?

  • diabetes…
    Diabetes can lead to low SHBG

Blows to the head can damage your pituitary gland.
As a Vet, do you get any better med services?

Thaks for the reply KSman.

I aim to move over to the protocol you posted in one of the stickies which i hope will help resolve some of the T-E2 aromatization, plus with the added anastrozole hoping it will bring my E down.

Unfortuatly I do not know if the E was a sensitive test or not so will need to insist on the next one.

I will read the thyroid stickie too I must have missed that one.

I started Animal pak this week (i take one pak a day not two) and it does contain Iodine 20mcg and Selenium (as sodium selenate) 25mcg.

I also take .5g Electrolyte powder during workouts this contains
Sodium (Na) 130mg Potassium (K) 38.5mg Calcium (Ca) 23.5mg Magnesium (Mg) 3.75mg
salt is added to food during cooking but no informaition if sea salt or deionised etc.

could thius cause the slightly high TSH?

I dont think I have been tested for serum glucose or A1C but will ask for a test.

No numbness or tingling in feet.

Re the pituritary gland my GP says it could be the possible cause of low T due to the constant stess, fight/flight etc from the ptsd.

As a vet I get no better med services. I fell ill in 2009 its took 4 doctors and a 100 mile house move to find my current doc who luckily understands ptsd and is a vet her self. I consider myself far luckier than most.

This may not be related to your TRT but it is related to your PTSD. Find a hyperbaric oxygen clinic. This is a wonderful therapy for PTSD. It is much more widely accepted in the UK for neural disorders than in the US. Go to HBOT.com. This website is a great resource. I know the doctor personally and have witnessed great transformations from hyperbaric oxygen therapy. Also, consider a modified ketogenic diet.

That is stress. Please see the thyroid basics sticky noting references to: stress, illnesses, inflammation, adrenal, fT3, rT3, adrenal fatigue and “Wilson’s book”.

Thyroid can affect T levels as secondary hypogonadism, to the extent that we see a clear association here.

Thank you again for your response and time.

I have looked at the Thyroid basics sticky and I will monitor my temps over next few days. My gp has mentioned getting an MRI (I think for pituritary) of my brain for any TBI’s but due to the confined space and noise this at present has had to be ruled out.

Thank you for this info, it is not something I have ever come across. I will certainly look at the information and raise it with my GP and see if treatment is available.

First off - thanks for your service brother.

Now - part of the issue with PTSD in addition to the anxiety and depression is how it affects sleep quality. You only produce Testosterone during stage 4 REM sleep. This is why many first responders such as firefighters and policemen have low T: from the cyclical shift work and working through the night.

So fixing your sleep would improve things but frankly- your T levels are so low that it would not majorly improve things I don’t think. TRT seems like a good plan for you and the new protocol you laid out with bi-weekly injections and an AI seems sound. Regarding the AI - you could dissolve it in alcohol and use a dropper as was stated, get some from a research lab since they already come in droppers, or just get a pill cutter and chop them up.

Regarding your training program - I think you would do better with more holistic training that would lower your body fat and recomp your physique (unless you are competing or chasing powerlifting records). I used to powerlift through the early 90’s and was 245lbs at 6’1. Now I’m close to 50 y/o and am a much leaner 200lbs and feel so much better. You will still maintain a ton of strength and look great - especially after going on TRT.

Anyway - good luck bro and keep us posted.


Firstly Thank you, I was glad to, (not had ppl thank me for service before, guess it’s not a UK thing).

You are spot on with the sleep, guess I have a double whammy, after leaving forces I was a police officer for several years before I fell ill. My sleep now is not as bad, some nights I manage 4-6 hours but I average 2-4. Which I know is a lot more than fellow vet’s. White noise or the sound of rain seems to really help me drift off, it blocks out all the other background noise that normally startles me. Also having a routine for sleep, same time every night, bedroom just for sleeping, etc.

I will look up the holistic training idea I am looking at competing hopefully this year.

Thanks for taking the time to post and your advice.

Have taken body temps over last couple of days

Tues am 35.9c (96.6f)
Wed am 36.5c (97.7f) pm 35.6c (96.08f)
Thurs am 35.2c (95.3f) pm 35.5c (95.9f)
Fri am 35.2c (95.3f)

Due to getting overly hot/sweating easily I do spend the majority of my day in shorts and t shirt. Tues, Thurs and Fri the day and night air temp was a lot lower than Weds. To me it makes sense that if your skin temp is colder your core temp is likely to drop a little. I very rarely feel cold either.
I will get some iodine supplements they are Lodoral 12.5mg one a day. I need to look again at the thyroid sticky as can’t remember if any dosage advice given in it.

Good luck bud. Thanks for your service and hope you find the sweet spot soon.

x2 here. At your height you want to get down to at least 100kg with all these issues. Try this template at maintenance cals or very small deficit -will lean you out fast as well as get you bull strong:

I would also swap out the rower for the bike/less stressful cardio now and again

@RampantBadger Thank you for your input and taking the time to respond. My current training plan ends in about 2 weeks I will look at refining my diet as you and @jimgainz suggested then. I don’t really want to do it before my testing week. I agree my workout programme also needs some changes so will speak to my trainer about the Westside article as well. I know he has run Westside before which will help.

New blood results from bloods taken on 9th Jan @9am non fasted.
Any advice please .
Haemoglobin concentration (Xa96v) 148g/L (range 130-178)
Red Blood Cell Count (426…) 5.48 *10^12/L (range 3.01-6.79)
Haematocrit (X76tb) 0.450 L/L
Mean cell volume (42A…) 82fL (range 80.0-100.0)
Mean cell Haemoglobin level (XE2pb) 27.1 pg (range 27.0-32.2)
Mean cell haemoglobin concentration (429…) 332 g/L (range 300.0-350.0)
Red blood cell distribution width (XE2mO) 13.2% (range 8.0-14.0)
Platelet count-observation (42P…) 273 *10^9/L (range 150.0-400.0)
Mean platelet volume (42Z5.) 9 fL
Total white blood count (XaldY) 8.9 *10^9/L (range 4.0-11.0)
Neutrophil count (42J…) 5.6 *10^9/L (range 2.2-8.0)
Lymphocyte count (42M…) 2.3 *10^9/L (range 0.5-4.0)
Monocyte count observation (42N…) 0.8 *10^9/L (range0.1-1.1)
Eosinophil count observation (42K…) 0.1 *10^9/L (range 0.0-0.4)
Basophil count (42L…) 0.0 *10^9/L (range 0.0-0.5)
Nucleated red blood cell count (4266.) 0.0 *10^9/L (range 0.0-0.0)

Serum SHBG level (44CD.) 11 nmol/L “below range” (range 13.0-90.0)
SHBG is down from 15 nmol/L in Nov 16. Why? Is it due to taking in the transdermal gel T?

Serum testosterone level (XE2dr) 11.9nmol/L (range 6.0-27.1)
Serum Testosterone level is up 0.9 nmol/L from Nov 16 again why?

Liver Profile
Serum total protein level (XE2e9) 78g/L (range 60.0-80.0)
Serum albumin Level (XE2eA) 45g/L (range 35.0-50.0)
Serum globulin level (XE2eB) 33 g/L (range21.0-37.0)
Serum total bilirubin level (XaERu) 9umol/L (range 0.0-20.0)
Serum alanine aminotransferase level (XaLJx) “above range” 73 U/L (range 10.0-40.0)
Serum alkaline phosphatase level (XE2px) 103U/L (range 30.0-130.0)

Now the Endo and hospital are worried about the liver results, my GP (doctor) is not she puts it down to my protein and also the extra amino intake plus I lift weights. Funny how the endo is worried about this but not my high E lvls (see previous results above)

Serum Ferritin level (XE24r) 87ug/L (range 24.0-336.0)

Serum cortisol level (XE2xW) 161 nmol/L (range 185-624 nmol/L)
Taken due to my ptsd strange it is so low but recently been feeling realy well and not as stressed or other effects from ptsd so that my explain the level it is. My GP who specializes in ptsd cannot explain it either but does suggest it could be due to the way I have been feeling.

My GP has said today that she would be happy for me to contact a trt specialist in the US and share my bloods etc with them and see what they say and advise me/her to do. She has no faith in the Endo or how we treat trt in the UK. If anyone has any idea how I could do this or how to find a trt specialist in the US it would be very helpful.

Oh I have been taking 12mg of iodine for two weeks now, my feet dont get cold anymore and I am now feeling the cold more when outside, I never used to. Although not taken temps this week will do so from tomorrow. GP says it is possibly due to a rise in my core temp as to why I am feeling the cold more. @KSman Thank you for the advice re iodine.

You absolutely need to be able to identify a source of selenium. For most, a multi-vit listing iodine+selenium is a good choice, should not contain iron.

Glad to hear a positive experience.

Can you report feeling more energy and clarity of thought?

AST/ALT can easily be elevated from recent training, muscle injury or soreness

Trivial change, can be from changes to lab timing relative to T gel application and absorption can change with skin conditions, temperature, humidity, sweating etc

They simply do not understand issues noted above

Ferritin is good level to support fT4–>fT3

Cortisol should be tested at 8AM, later in day is hard to work with as it stars to drop later in morning.

I can provide standard TRT recommendations that are better than what many self proclaimed TRT specialist doctors practice. Have you read the protocol for injections sticky? If you GP is willing… Can you get T cyp/eth/sust Rx there?

For sure -finish the current plan first. Hope feeling better soon

Unfortunately due to my feeling of wellbeing over the last few weeks I would be remiss to say it was down to the Iodine supplementation. However normally my mood follows a 4 week cycle where there is a higher feeling of happiness (for want of a better explanation) followed by a weekly down turn of brain fog, unable to think, forgetfulness, speech becomes impaired (I forget words even if I’m looking at the object), moodiness, depression, lack of energy motivation, and a rise in the anxiety, hypervigilance and hyper sensitivity.
Now I did re start Animal Pak vitamins 3 weeks ago and did feel an improvement in wellbeing and energy a few days later.
I would normally have expected the mood change by now but this hasn’t come on, also I could say my brain function has been better but as stated I could not 100% put this down to the Iodine. Do I think it has helped? Yes