T Nation

TRT(Bad Protocol?), Thyroid (iodine)?, Adrenals?


#1

Oh, where to begin? I have not been a member here long, but have been monitoring the site for a long time and I really feel like I trust you guys. I haveve poured over the stickies here (especially those of KSman...very impressed!) and I am (1) not sure if I'm anywhere close to being on the right TRT protocol, plus I am pretty sure that (2) I am hypothyroid due to my body temps and (3) I am not quite sure if I need to address adrenals (although I have experienced HIGH HIGH stress over the last 10 years with 3 deaths, divorce, remarrying, dealing with new child rearing in my early 50s and marital strife due to owning and operating a business with my new wife.).

I have spent quite a bit of time lately on http://www.drrind.com under sections Treatments | Metabolic Energy and also http://www.wilsonssyndrome.com regarding low body temp, but I was originally turned on in 2011 to the thought of TRT by a doc named E Barry Gordon at www.thehiddendisease.com/blog/ (under sections Viewpoints, Educational Videos, Patient Videos and Medical Studies). This led me to the Aging Male Syndrome (AMS) Questionnaire and the ADAM questionnaire, both of which (symptomatically) I scored strongly enough to warrant looking into TRT. My initial lab tests showed me to be at the lower end of the range for T, but not below.

But I insisted and pushed beyond my GP doc (who said I was fine and within normal ranges) and insisted on seeing a Urologist here in my city at a major midwest univeristy medical center who 'specializes in TRT'. (Oddly, my TRT Urologist never even bothered to discuss my AMS questionnaire... but he has been pretty good and understanding about prescribing what I want as long as my 6 mo visits and protocol can fall under the proper billing codes for hypogonadism/libido). But he seems to be interested ONLY in total T and not free T or bio T.

With me at 55 years old, I would think that he would recognize that free T is a more important measurement. Still, he has recommended on numerous occasions that my other sypmtoms (sexual performance issues) be addressed in sexual therapy, which I will not do. Also of note, he started me initially on Androgel 1.62% (which seemed pretty great for about 3-4 months, unless it was just psychosematic), then when I started feeling as if it was not doing anything I blamed my concern on spreading gel to my wife and 4-5 year old (then) son to get T-Cyp injections. He didn't blink an eye and just switched me to 100mg T-Cyp with no questions. However, it was not until much much later that he prescribed Arimidex (anastrozole).

I am getting ahead of myself here.

I hope I do not piss anyone off (or drive them away from guiding me) by writing a book here and hitting too many major topics at once, but I am pretty sure this is going to be a pretty long post. The bottom line is that although I am stronger and more in shape now, I do not have the 'I feel great!', 'my libido is through the roof!', 'I feel like I'm in my 20s again', optimal quality-of-life that some guys discuss and that which we are all trying to achieve. I am not a bodybuilder or anything like that, but I am in pretty good shape for 55, although 2 recent sports injuries [cycling crashes], one resulting in shoulder surgery, have set me back a bit and I'm now 12 lbs overweight and the visceral belly fat is starting to creep back. Since being cleared to go back to cycling and weights, I have sort of lost my mojo mentally and physically and have not really gotten back into working out every day or EOD.

Let me start by giving you my personal details and what meds I have been on (and are on). But first I will list some of the questions that I hope to get some quidance on:

In light of my lab tests (below), does it look like I am on the right TRT protocol?

Should I bypass other, new, more extensive thyroid labs and go directly to iodine supplementation?

Am I getting the right labs? Notice that FSH, LH, PSA, Prolactin were only taken as baselines in Sept 2011. None of those were ordered after that first time for baselines. I do not even know what labs to get, other than the slew of labs I've heard discussed on boards here and elsewhere and reading stuff that Dr. John Crisler has written.

Any suggestions about the acne problem due to TRT?

My Details:
-AGE : 55 (wife attractive 44, son 7)

-HEIGHT : 6ft 0in

-WAIST: 34''(9 months ago I was 32'')

-WEIGHT: 191 lbs (9 months ago I was 179 lbs)

-FACIAL & BODY HAIR:
Pretty solid facial hair (gray) bald on top, very thin & gray sides and back, scarce eyebrows, chest hair from shoulders to navel, back hair (spotty), spotty leg hair, moderate forearm hair.

-WHERE I CARRY FAT AND HOW CHANGED:
Typically carry visceral belly fat and waist handles. Belly fat and weight typically change during cycling season when I am riding 140 miles/week (which is approx 7 hrs of high intensity cycling/week).

-HEALTH CONDITIONS, SYMPTOMS, HISTORY:
Always and still consider myself very healthy, never really get sick, but had a kidney stone in early 2014. I have sleep problems (falling asleep/staying asleep), high stress issues, higher cholesterol number but ratios are good, A.D.D., libido issues, irritability, lacking interest/enthusiasm about much of anything, achieving less, decrease in muscular strength (before TRT), lack of drive, decreased sexual performance/enjoyment (once in June 2012 I experienced some anxiety and sexual dysfunction [see the labs below] and then 12 months ago started having again, extreme difficulty with ejaculation/orgasm), always had generally smaller sized testicles and attributed periodic testicle recession to being cold or being in a cold room. Never have the recession issue in a warm shower. Acne (very troubling to me) probably due to the TRT. A small, manageable bit of psoriasis on knee, scalp, behind ears. Memory, focus, concentration issues. Sleepy in late afternoon when off TRT. (Note: once or twice I stopped TRT for 2 -3 weeks and really noticed no great difference, except for increased sleepiness in the late afternoon.) Hair loss. Of late, I have measured my body temp a lot. Consistently upon rising, my temp is 96.5 - 96.7 with two different types of under the tongue thermometers. Mid-day temps (betw 12:00 and 1:30pm) are usually 1 degree warmer at 97.5 - 97.7.
Regarding body temp/thyroid/iodine supplementation, two things: (1) I asked my TRT doc (urologist) if he knew anything about this and he said no. I asked for a referral to an endocrinologist at the university hospital, which he did and also ordered labs for me. When the 9/10/2014 labs for TSH, T3 and T4 came back, endocrinology contacted me and told me not to bother making an appointment because I was 'within ranges'. Typical, I guess. (2) Having read KSman's stickie on thyroid and all of the comments, I started with iodine supplementation (slower) at 25mg/day plus a can of sardines for selenium each day or every other day. The first few days it felt as if I had a marble in my esophagus. That subsided and I upped my dosage to 37.5mg/day and then, after reading lots of other comments by iodine enthusiasts and medical professionals on the internet, I stopped completely, thinking that maybe I should get some labs done first and maybe I should not be as aggressive as KSman's 50mg/day. At this date, I've been off of iodine for about 1 week. but believe that it's definitely necessary. I just don't know how much. I just don't want to hurt myself. Note: I score pretty heavily on the thyroid side of thyroid vs. adrenal scorecard at http://www.drrind.com/therapies/metabolic-symptoms-matrix
This is a great chart. Also, I got a lot out of understanding FT3, FT4 and TSH and their true optimal relationships (instead of just looking at lab 'normal' ranges) by looking at Dr. Rind's page http://www.drrind.com/therapies/thyroid-scale Very informative. As far as adrenals, cortisol, etc., I do not know. I do know that I have experienced more than my fair share of stress, but I don't know what to do about the triad between TRT, thyroid and adrenals for optimal health and feeling of well being.

-Rx AND OTC DRUGS, ANY HAIR LOSS DRUGS OR PROSTATE DRUGS EVER:

NOTE: luckily most of what I have taken has been covered pretty well under my Rx Health Plan....so I do consider myself fortunate. Androgel was $25 for 2 bottles, T-Cyp $10/bottle, Anastrozole $5/mo, Cabergoline $5/mo. Needles/Syringes $5. I am a bit concerned, though, about some of the other things that you all take and whether it is going to break the bank if I need to get those things....not that I even know where to get them.

--I never had any hair loss or prostate drugs.

Currently,
--.5ml (100mg) of 1000mg/10ml T-Cyp 2x/week

--Anastrozole 1mg/week but I'm only prescribed for .5mg/week (for the past 3 weeks I have started taking more (because I saved some extras up due to prescription refill cycles) due to what I have read here and b/c of my labs, but unknown to my Dr. I don't believe I "feel" any difference with the 1mg/week vs the .5mg week of anastrozle. After reading some stuff here (and seeing that the T/E or E/T ratios were not optimal and my E was nowhere near 30), I did ask my Dr. for an increased dose of anastrozole.

Here is our email exchange:

My comment: ''I am not surprised that the Total Test seems high (in light of injecting both the test cyp and the hcg for the last couple of months), but that level of TT is not really a concern to me considering my age and the things that I have read about the TT vs Free T. I think, according to the free and bioavailable scores, that this level (of Free T) is one that I am comfortable being at. Nevertheless, it doesn't surprise me that the estradiol has shot back up again (and possibly has given me some of the same sexual side effects that I complained of before) becuase of the limited level of anastrozole that I am on. I would like to remain at the same levels of injections, but could we go to doubling the dose of anastrazole (taking the same dose I take now, but taking it twice a week instead of once)? I would like to get the estradiol back down around 30 as we discussed before. Not being able to reach climax with my wife has been very frustrating of late.''

His response was: ''The Estradiol is within normal range, and the Testosterone to Estradiol ratio is normal at >10:1. Estradiol is higher than previous check because total Testosterone is too high. If you continue the same dose of T and HCG, and if you double the arimidex to 1mg/week, your T will go up even higher.''

This does not sound right to me according to what I have read here. Please note my lab scores for June 2014 (below), considering that I was on the T-Cyp .75mg/week, HcG (Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri) + Anastrozole .5mg/week for about 6 weeks at that point.

--Cabergoline .5mg/twice per week (to help with ejac/orgasm issues)

--dextroamphetamine .5mg daily in the morning (for ADD)

--bupropion (wellbutrin) 150mg/day (at times I have gone off for weeks and did not notice anything different)

--Clonazepam 1mg/day for sleep issues (used to take zolpidem (ambien)). Neither does a great job keeping me asleep.

--Vit D3 6000-8000/day (I live in the cold, dark upper midwest)

--Super Colon Cleanse (prone to constipation)

--Probiotic for gut health

--Vit B-Complex 100 1/day

--have taken a lot of different types of nutritionals over the years, but as of now I am only on what I have noted.

--used to take refrigerated fish oil daily, but somehow got out of the habit.

--have tried Cialis and Viagra. Not on it right now, although I do have a open Rx. Unsure about positive effects although I have great morning wood...as if have a huge hard on from 4am - 6am has any value to me. In the last year, in addition to the ejac/orgasm issues, I have always started sex with good erections, but due to the long hard work getting to orgasm, I have gone (not completely) soft at times.

--originally was on Androgel 1.62% beginning with 2 pumps/day and progressing to 3-4 pumps per day.

--was on HcG for 4 months earlier this year with reduced T-Cyp. Did not really notice any difference in well-being or testicular size changes.

-DESCRIBE DIET
--have at times had limited starvation type diets ... never long lasting.

--generally eat pretty well, fruits, avocados daily, almonds, limited meat, greek yogurt, hummus w/vegetables, not a dessert eater, not generally a chips or fries eater (will usually go for a salad instead), have a weakness for alcohol (wine & cocktails, almost never beer). Have abstained alcohol for long times during training and have benefitted with weight loss and toning (shouldn't be a big surprise.) I love my coffee with milk and sugar in the morning. I do eat chocolate a bit more than periodically. Pizza probably once every couple of weeks. Eat a lot of sushi...at least once a week. Got into the bad habit of having cereal with my 7 year old in the morning. So, some good....some bad here.

-DESCRIBE TRAINING
--have done the old Power 90 with good success. Stopped due to shoulder and right knee probs (cannot squat/lunge so much anymore).
--cycling every day or every other day for 1 hr (20mph) maintaining a heart rate of 155-165pbm

-TESTES ACHE, EVER, WITH A FEVER?
--No.

-HOW HAVE MORNING WOOD AND NOCTURNAL ERECTIONS CHANGED
--Somewhat had morning wood issues prior to TRT. Not so now. Wood during sex has been noted.

-MY LAB RESULTS WITH RANGES:

Name.. ESTRADIOL
Standard Range .. <=75.0 pg/mL
12/7/2011.. 32.3 (baseline taken by urologist, began 2 pumps Androgel 1.62/day)

3/20/2012 .. 50.8 (after using 2 pumps/day)
4/3/2012.. 45.5 (after using 2(3?) pumps/day)
5/11/2012.. 35.9 (after using 3 pumps/day)
6/19/2012 .. 94.2 (after using 4 pumps/day)
7/31/2012.. 40.7 (after using 3 pumps/day)
3/15/2013.. 26.7 (after using 3 pumps/day)
9/24/2013.. 33.2 (after using 3 pumps/day, stopped pump, began injections)
10/29/2013.. 54.8 (after injecting .5ml T-Cyp 2x/week[(100mg)of 1000mg/10ml])

3/3/2014.. 74.7 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

4/4/14.. 30.4 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

4/24/14.. began Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
Continued with 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week)

6/6/14 .. 67.9
(after using Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
and 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week + .5 mg anastrozole/week). Discontinued Pregnyl approx 8/20/14, returned to
injecting .5ml (100mg) of 1000mg/10ml T-Cyp 2x/week + .5 mg anastrozole/week)

9/5/14.. 72.2 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

Name.. SEX HORMONE BINDING GLOBULIN (ARUP)
Standard Range .. 11 - 80 nmol/L
9/30/2011.. 40 (baseline taken by GP)
12/7/2011.. 51 (baseline taken by urologist, began 2 pumps 1.62/day)
3/20/2012.. 49 (after using 2 pumps/day)
4/3/2012.. 53 (after using 2(3?) pumps/day)
5/11/2012.. 59 (after using 3 pumps/day)
6/19/2012.. 54 (after using 4 pumps/day)
7/31/2012.. 44 (after using 3 pumps/day)
3/15/2013.. 59 (after using 3 pumps/day)
9/24/2013.. 59 (after using 3 pumps/day, stopped pump, began injections)
10/29/2013.. 50 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

3/3/2014.. 45 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

4/4/14.. 52 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

4/24/14.. began Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
Continued with 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week)

6/6/14.. 42
(after using Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
and 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week + .5 mg anastrozole/week). Discontinued Pregnyl approx 8/20/14, returned to
injecting .5ml (100mg) of 1000mg/10ml T-Cyp 2x/week + .5 mg anastrozole/week)

9/5/14.. 36 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

Name.. TESTOSTERONE, ADULT MALE (ARUP)
Standard Range 300 - 890 ng/dL
9/30/2011.. 473 (baseline taken by GP)
12/7/2011.. 490 (baseline taken by urologist, began 2 pumps Androgel 1.62/day)

3/20/2012.. 378 (after using 2 pumps/day)
4/3/2012 .. 553 (after using 2(3?) pumps/day)
5/11/2012.. 281 (after using 3 pumps/day)
6/19/2012.. 1164 (after using 4 pumps/day)
7/31/2012.. 351 (after using 3 pumps/day)
3/15/2013.. 666 (after using 3 pumps/day)
9/24/2013.. 333 (after using 3 pumps/day, stopped pump, began injections)
10/29/2013.. 1105 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

3/3/2014.. 888 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

4/4/14.. 884 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

4/24/14.. began Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
Continued with 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week)

6/6/14.. 1225
(after using Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
and 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week + .5 mg anastrozole/week). Discontinued Pregnyl approx 8/20/14, returned to
injecting .5ml (100mg) of 1000mg/10ml T-Cyp 2x/week + .5 mg anastrozole/week)

9/5/14.. 873 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

Name.. TESTOSTERONE, BIOAVAILABLE (ARUP)
Standard Range 131 - 682 ng/dL
9/30/2011.. 229 (baseline taken by GP)
12/7/2011.. 203 (baseline taken by urologist, began 2 pumps Androgel 1.62/day)

3/20/2012.. 158 (after using 2 pumps/day)
4/3/2012.. 230 (after using 2(3?) pumps/day)
5/11/2012.. 102 (after using 3 pumps/day)
6/19/2012.. 548 (after using 4 pumps/day)
7/31/2012.. 157 (after using 3 pumps/day)
3/15/2013.. 275 (after using 3 pumps/day)
9/24/2013.. 123 (after using 3 pumps/day, stopped pump, began injections)
10/29/2013.. 536 (after inejcting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

3/3/2014.. 433 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

4/4/14.. 403 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

4/24/14.. began Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
Continued with 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week)
6/6/14.. 682
(after using Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
and 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week + .5 mg anastrozole/week). Discontinued Pregnyl approx 8/20/14, returned to
injecting .5ml (100mg) of 1000mg/10ml T-Cyp 2x/week + .5 mg anastrozole/week)

9/5/14.. 496 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

Name.. TESTOSTERONE, FREE CALCULATION (ARUP)
Standard Range 47 - 244 pg/mL
9/30/2011.. 77 (baseline taken by GP)
12/7/2011.. 70 (baseline taken by urologist, began 2 pumps Androgel 1.62/day)

3/20/2012.. 53 (after using 2 pumps/day)
4/3/2012.. 77 (after using 2(3?) pumps/day)
5/11/2012.. 34 (after using 3 pumps/day)
6/19/2012.. 188 (after using 4 pumps/day)
7/31/2012.. 52 (after using 3 pumps/day)
3/15/2013.. 86 (after using 3 pumps/day)
9/24/2013.. 41 (after using 3 pumps/day, stopped pump, began injections)
10/29/2013.. 188 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

3/3/2014.. 155 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

4/4/14.. 136 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

4/24/14.. began Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
Continued with 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week)

6/6/14.. 234
(after using Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
and 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week + .5 mg anastrozole/week). Discontinued Pregnyl approx 8/20/14, returned to
injecting .5ml (100mg) of 1000mg/10ml T-Cyp 2x/week + .5 mg anastrozole/week)

9/5/14.. 164 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

Name.. TESTOSTERONE, PERCENTAGE FREE (ARUP)
Standard Range 1.6 - 2.9 %
9/30/2011.. 1.6 (baseline taken by GP)
12/7/2011.. 1.4 (baseline taken by urologist, began 2 pumps Androgel 1.62/day)

3/20/2012.. 1.4 (after using 2 pumps/day)
4/3/2012.. 1.4 (after using 2(3?) pumps/day)
5/11/2012.. 1.2 (after using 3 pumps/day)
6/19/2012.. 1.6 (after using 4 pumps/day)
7/31/2012.. 1.5 (after using 3 pumps/day)
3/15/2013.. 1.3 (after using 3 pumps/day)
9/24/2013.. 1.2 (after using 3 pumps/day, stopped pump, began injections)
10/29/2013.. 1.7 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

3/3/2014.. 1.8 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

4/4/14.. 1.5 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

4/24/14 .. began Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
Continued with 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week)
6/6/14 .. 1.9
(after using Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
and 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week + .5 mg anastrozole/week). Discontinued Pregnyl approx 8/20/14, returned to
injecting .5ml (100mg) of 1000mg/10ml T-Cyp 2x/week + .5 mg anastrozole/week)

9/5/14 .. 1.9 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

Name... HEMATOCRIT
Standard Range .. 40-54 %
9/30/2011.. 44.7 (baseline taken by GP)
3/20/2012.. 45.7 (after using 2 pumps/day)
3/15/2013.. 50.6 (after using 3 pumps/day)
9/24/2013.. 50.8 (after using 3 pumps/day, stopped pump, began injections)
10/29/2013.. 48.1 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

3/3/2014.. 48.0 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml])

4/4/14 .. 49.0 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

4/24/14.. began Pregnyl 10,000 units, inj .5ml IM Mon, Wed, Fri
Continued with 75mg (.75ml) of 1000mg/10ml T-Cyp 1x/week)

9/10/14 .. 45.0 (after injecting .5ml T-Cyp 2x/week[(100mg) of 1000mg/10ml] + .5 mg anastrozole/week)

Component... Standard Range ... Your Value
TSH .. 0.36-4.57 uIU/mL.... 4.41
General Information
Collected: 09/30/2011 8:32 AM

Component... Standard Range ... Your Value
TSH .. 0.36-4.57 uIU/mL... 4.04
General Information
Collected: 09/10/2013 4:06 PM

Component Results
Component... Standard Range... Your Value
TSH .. 0.36 - 4.20 uIU/mL ... 2.20
Collected: 09/10/2014

Component... Standard Range... Your Value
T3, Free.. 2.2 - 4.0 pg/mL... 3.4
Collected: 09/10/2014

Component Results
Component... Standard Range ... Your Value
T4, Total.. 5.0 - 12.5 mcg/dL.. 5.8
Collected: 09/10/2014

Component Results
Component... Standard Range ... Your Value
T4, Free.. 0.70 - 1.45 ng/dL.. 0.79
Collected: 09/10/2014

Component... Standard Range ... Your Value
FSH .. 1.0-42.5 mIU/mL.. 6.8
General Information
Collected: 09/30/2011 8:32 AM

Component... Standard Range... Your Value
LH .. 1.7-11.2 mIU/mL .. 2.0
General Information
Collected: 09/30/2011 8:32 AM

PSA Standard Range .. 0.00-3.50 ng/mL
3/20/12... 3/15/13
Your values
0.25 ... 0.35

Component.. Standard Range.. Your Value
Prolactin .. 4.4-16.4 ng/mL .. 5.6
General Information
Collected: 12/07/2011 10:02 AM

LIPID PANEL
Component.. Standard Range.. Your Value
Cholesterol.. <=199 mg/dL .. 205
Triglycerides.. <=149 mg/dL.. 76
HDL Cholesterol.. >=40 mg/dL.. 53
LDL, Calculated .. <=129 mg/dL.. 137
Cholesterol/ HDL Ratio.. 1.0-4.5.. 3.9
Collected: 03/02/2012 9:22 AM

BASIC METABOLIC PANEL
Component.. Standard Range .. Your Value
Glucose.. 70-99 mg/dL.. 91
Creatinine.. 0.50-1.20 mg/dL .. 1.10
e-GFR .. >=60 mL/min/1.73 sqm.. 76
(e-GFR Interpretive Statement:
Chronic kidney disease, e-GFR <60 mL/min/1.73sqm
Kidney failure, e-GFR <15 mL/min/1.73sqm
**For African-Americans multiply reported e-GFR result by 1.159.)
BUN .. 7-23 mg/dL... 17
Sodium .. 135-148 mmol/L ... 137
Potassium.. 3.5-5.3 mmol/L... 3.9
Chloride.. 96-108 mmol/L... 98
Carbon Dioxide.. 22-31 mmol/L... 31
Calcium .. 8.4-10.4 mg/dL... 9.8
Hours patient was fasting 4 hours
General Information
Collected: 09/10/2013 4:06 PM

VITAMIN D (Vitamin D, 25-Hydroxy by HPLC)
Component.. Standard Range .. Your Value
Vitamin D3, 25-Hydroxy.. 29
Vitamin D2, 25-Hydroxy .. <5
Vitamin D, 25-Hydroxy 30-80 ng/mL.. 29

(Vitamin D status in a patient is judged by Total 25-OH Vitamin D.
Total 25-OH Vitamin D clinical reference values:
< 10 ng/mL Severe deficiency
10-29 ng/mL Mild to moderate deficiency
30-80 ng/mL Optimum levels

80 ng/mL Toxicity possible )

Collected: 03/15/2013 10:40 AM

HEMOGLOBIN A1C
Component.. Standard Range.. Your Value
Hemoglobin A1C.. 4.2-5.8 %.. 5.1
Estimated Average Glucose .. 100
(The eAG result represents glucose levels over a 24 hour period and may not correlate with the average glucose seen on
the patient's glucose meter. Results may be affected by hemoglobin variants, anemia, uremia, RBC lifespan and pregnancy)
General Information
Collected: 03/15/2013 10:40 AM


#2

More vit-D3

Your TSH, T4 and fT4 are low which might be from iodine deficiency. You have not discussed your history of use for iodized salt. You have used vitamins that have iodine for how long?

Your vitamins list selenium?

Your fT3 is mid range, but body temps are low. That suggests adrenal fatigue with elevated rT3. See the thyroid basics sticky and note references to body temp, rT3, stress and Wilson’s book.

1500 per week hCG is expensive. All that is needed is 250iu SC EOD and 10,000iu lasts 80 days. That will keep your testes plump etc and you inject T to get your target serum T levels. High dose hCG can create high T–>E2 inside the testes which anastrozole cannot manage.

The only additional labs to consider for thyroid would be auto-immune related and your endo does not see a reason to do that. If you are getting selenium, there should not be a risk of iodine replenishment triggering a new auto-immune problem. You have to take some action, your thyroid is a mess. Your response re your iodine intake is important.

Your poor response to transdermal T would have been recognized here as a symptom of hypothyroidism. Doctors do not understand this. We could call that the KSman syndrome :wink:

Get switched to 200mg/ml cyp and inject less, should be cheaper for someone as well.

Ask for 100mg T cyp per week, 200mg/ml in divided doses [50mg .25ml] twice a week.
1mg anastrozole per week, 1/2mg at time of injection
250iu hCG SC EOD [because of half life]

Always to labs 1/2 way between injections.
Do labs 4 weeks after switching to the above and fine tune after that.

Doc is wrong that more anastrozole will increase T. If you lower E2, SHBG should drop and then FT would increase.

You get the prize for the longest opening post!

PSA should be checked at 6 months. Prolactin will not change. LH/FSH will be zero, nothing to test.

Please discuss mg’s and iu’s for doses, no need to discuss volumes.


#3

Thank you, thank you KSMan for your response! (Yes, [sorry] it was one damned long post…I was thinking that it was the length of it or that I had said something ‘wrong’ that resulted in no replies for a week or so. Now, I realize that it is YOU that many are trying to tap info from, so I have to learn to be patient, knowing that you might not be able to respond all that quickly.) Heartfelt thanks though! I do have some additional info (clarifications, I guess) and probably questions based upon your comments, but I can’t do it right now. I just wanted to get back to you as promptly as possible. Will post some more details soon…promise to be more brief.

Best,
midwest89


#4

Was an interesting read and useful to see Ksman’s response.

I see you guys in the US are getting T+HCG+AI which is impossible here in the uk (HCG is only used for fertility and AI’s aren’t discussed.

If I have to move onto T injections ill be keeping an eye on my E and will have an AI on hand (sourced myself).

I am finding a lot of conflicting information on HCG use, some saying use it intermittently a few months a year, others saying use long term.

With there being no studies on it, and bar aesthetics (nut size) is there truly a need to run it with test?

Im currently on testogel and haven’t seen anyone run HCG + Testogel from what i can find, i understand it has metabolic pathways - DHEA etc but not sure how useful that is in the whole context when it increases estrogen risk etc.

Any insight would be appreciated.


#5

hCG + T:
If you increase T by any means, LH–>0 and testes shrink. So hCG is needed.

Very few have problems with E2 from hCG. Those that do use less hCG.

Many* not using hCG will get a 24x7 dull ache in their testes that is long term and hCG resolves that.

    • others not

Your testes are a major source of pregnenolone and some other hormones and hCG helps support that.


#6

[quote]KSman wrote:
hCG + T:
If you increase T by any means, LH–>0 and testes shrink. So hCG is needed.

Very few have problems with E2 from hCG. Those that do use less hCG.

Many* not using hCG will get a 24x7 dull ache in their testes that is long term and hCG resolves that.

    • others not

Your testes are a major source of pregnenolone and some other hormones and hCG helps support that.[/quote]

Thanks, Im trying to find useful journals to put a good case to my endo to save myself self prescribing. Would you be able to provide me with anything useful to present?

thanks


#7

There is good resource material out there, but that provides only a few pieces of the puzzle. The main issue is that doctors there do not see a problem with testes shrinking, scrotums pulling up tight, lost fertility as a problem; so they are not looking to avoid those outcomes. There are no “papers” that address the need to avoid those effects. The “do no harm” requirement does not mean much and if one presses the issues, most docs would “do no harm” by not prescribing T or terminating treatments.

"Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression."

Low dose hCG preserves testicular function and fertility. Low dose hCG is not intended to create large amounts of T in older men, injected T is much more cost effective in any case.

Part of the issue is preserving the testes as this is important to many men as their “sexual self-image” and also how one is perceived sexually by one’s sexual partner.

TRT is part of general HRT, which is restoring youthful and balanced hormone levels. This is more that TT, FT; E2 also needs to be in a favorable/optimal range. Most doctors do not know how to manage that. They only see “normal” ranges and no need to address a problem until they see values outside of the ranges where they suddenly see a pathology requiring intervention. From this angle, one can argue that LH levels also need to be maintained and hCG–>LH_receptors is one way of managing that.

Docs want simple pathology leads to a prescription. TRT, when done right involves many factors that need to be regarded. But docs are trapped by a system that does not work that way. That problem is universal, but much worse in countries with socialized/free healthcare and this is also true in all of the “Commonwealth countries”. Doctors are mostly driven by disease management and don’t know how to do health management.


#8

[quote]KSman wrote:

More vit-D3[/quote]

… How much would you suggest? 10,000/day? 12,000/day? 14,000/day?

[quote]Your TSH, T4 and fT4 are low which might be from iodine deficiency. You have not discussed your history of use for iodized salt. You have used vitamins that have iodine for how long?

Your vitamins list selenium?[/quote]

… I almost never have used salt, and when I do it’s always sea salt with no iodine. I’ve taken supplements over the years, but no Multi-Vit for a long time now so I’m sure I’ve have had pretty much no iodine intake. When I read your thyroid sticky a while ago, I started taking 25mg iodine/day with 3 or 4 cans of sardines (in water) per week (for the selenium). I stopped that after about a week when I started to read lots of other stuff on the net about much lower iodine intake amounts suggested and that 25mg - 50mg might be harmful…so I got scared of hurting my thyroid. Then, about 5 days after my first post in this thread, I went back to 25mg of iodine/day with 200mcg of selenium/day (capsules) and I still eat some sardines just because I like them. Maybe 2 tins/week. Now, having given some thought to your statement that my information “suggests adrenal fatigue”, I’ve stopped the iodine again because I’ve been reading (elsewhere) that you need to address the adrenal problem first (before iodine for the thyroid) because if you don’t, the iodine could possibly be counterproductive and maybe even harmful. So, right now I’m in limbo with no iodine/selenium intake at all.

… I will definitely do that. Thanks.

… I hope I’m not stating the amount wrong. Iu’s, mgs, etc. regarding the syringe sometimes get me a bit confused. I will say that it seemed like the 10,000 iu of Pregnyl seemed to last about 70 - 80 days though. I remember because I had been reading (elsewhere) that it would be optimal if I could get the Pregnyl in 5,000 iu because the shelf life of it after mixing with the water (even with refrigeration) is only around 30 days. Nevertheless, after mixing (as I recall, and I could be wrong) it seemed like it did last longer than 2 months.

… Nevertheless, I didn’t seem to get any positive response from it in terms of feeling of well being or any change in the size of my testes…even after about 4 months, which is how long my doc said that it might take.

…Would you suggest that I get back on the iodine and the selenium right away and try to deal with the adrenal issue ASAP? To be honest, it’s not like some guys say, where I feel shitty all the time. I don’t. I just don’t have the great sense of well being that other guys talk about, the “I feel like I’m 25 again”, the “I’m horny all the time” stuff I hear. I remember, as a test, going off the entire TRT protocol for about 2 - 3 weeks once and I don’t really remember feeling all that different.

…Yeah, I suspected something was up with that. I did feel good for a few months, but as a lot of guys say, that’s about the length of time that the topical gels are really only good for. I definitely stayed on it too long. Lost a lot of time.

… I get it. Get prescribed more but use less. I doubt that my doc is going to go for that, but we’ll see.

…this I know I can get. Plus, I’ve got some “banked away” due to my insurance company approving the refills each 28 day cycle. So I can do this.

… this is actually what I’ve been doing in practice, even though I am only prescribed for 1/2mg per week. Somehow, I guess due to the refill cycle that I follow plus the hiatus that I went on, I have enough anastrozole on hand to do 1 mg/week in divided doses. Nevertheless, it hasn’t made me feel any better necessarily.

…this I can do, but it’ll involve not being completely straight with my doc. You see, when I stopped the HcG and went back to just the T-Cyp injections, I was left with 3 unfilled scripts for the Pregnyl, which I can still go and fill. They’re still open and avail at my pharmacy.

… I always do. Any thoughts on what time of day they should be taken? My lab insists it be done first thing in the AM, like 8:00am if possible. Back when I was using the gel, I thought that putting on the gel at 6:00am and then having bloodwork at 8:00am would show a false high level. So I always had it done at 10:00am. Didn’t seem to make much difference in my scores though.

… will do.

… thanks for confirming that. I’ll address that when I see him in March. I only meet him once every 6 months at this point.

… my wife thinks I’m too wordy too :slight_smile:

…ok. Thanks.

[quote]Please discuss mg’s and iu’s for doses, no need to discuss volumes.
[/quote]

… I will talk to my pharmacist (a great guy) to get clear on this and I’ll make sure to follow that and try to be more concise in the future.

Thanks again!.. will look forward to your answers.

midwest89


#9

[quote]KSman wrote:
There is good resource material out there, but that provides only a few pieces of the puzzle. The main issue is that doctors there do not see a problem with testes shrinking, scrotums pulling up tight, lost fertility as a problem; so they are not looking to avoid those outcomes. There are no “papers” that address the need to avoid those effects. The “do no harm” requirement does not mean much and if one presses the issues, most docs would “do no harm” by not prescribing T or terminating treatments.

"Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression."

Low dose hCG preserves testicular function and fertility. Low dose hCG is not intended to create large amounts of T in older men, injected T is much more cost effective in any case.

Part of the issue is preserving the testes as this is important to many men as their “sexual self-image” and also how one is perceived sexually by one’s sexual partner.

TRT is part of general HRT, which is restoring youthful and balanced hormone levels. This is more that TT, FT; E2 also needs to be in a favorable/optimal range. Most doctors do not know how to manage that. They only see “normal” ranges and no need to address a problem until they see values outside of the ranges where they suddenly see a pathology requiring intervention. From this angle, one can argue that LH levels also need to be maintained and hCG–>LH_receptors is one way of managing that.

Docs want simple pathology leads to a prescription. TRT, when done right involves many factors that need to be regarded. But docs are trapped by a system that does not work that way. That problem is universal, but much worse in countries with socialized/free healthcare and this is also true in all of the “Commonwealth countries”. Doctors are mostly driven by disease management and don’t know how to do health management.

[/quote]

Thanks for the detailed reply, self prescribing HCG is an option for me, although it hards to find anything in relation to long term use of hcg and its safety.

Even seem some opting for a few months on few months off hcg, or even HCG then TRT then HCG then back to TRT etc…

Whats your opinion on long term use? bear in mind I’m 22 and the TRT is likely to be lifelong, I’m not sure i should be or if its safe to be injecting HCG long term.