T Nation

TRT Help Please

All in the advice for new guys sticky.

Still need lab ranges.

Hi I’ve ben back to the docs for the results;(Directly copied from the doctors notes I hope this version contains the lab ranges?)

visit 1
GFR calculated abbreviated MDRD =>=90
serum gamma-glutamyl transferase level = 20 u/l Original result 20 U/L (0-50)
serum alkaline phosphatase = 54 U/L Original result 54u/L (0-125)
serum alanine aminotransferase = 21 U/L Original result 21 u?L(0-41)
serum bilirubin = 8 umol
serum albumin 47g/l
serum creatinine = 81 umol/l
serum urea level = 5.7 mmol/l
serum pottassium 4.7mmol/l
serum sodium = 141mmol/l
serul ldl cholesterol =4.67 mmol/l
erum hdl cholesterol = 1.25 mmol/l
seum triglycerides = 1.71 mmol/l
serum cholesterol = 6.7 mmol/l High
serum TSH =5.33mU/L High original result 5.33mu/L (0.0-5.0)
serum testosterone 11.1 nmol /l
serum t4 level = 13.9 pmol/l
Score 0.6 Method:QRISK2 for :Cardiovascular diseases

After 4 weeks of Testogel , 1 sachet per day

serum testosteron = 8.6nmol/l

-age: 31
-height: 6ft
-waist: 36 in
-weight: 210lbs
-describe body and facial hair: slender body, fat on stomach . receding hair facial hair grows patchy.

-describe where you carry fat and how changed: I carry most of my fat at the stomach

-health conditions, symptoms [history]: Ed problems. Inability to develop muscle since aged21 despite powerlifting. Strength gains are lost very quickly.speech problems. Socially quite
Any thoughts much appreciated

T-gel lowered T, so you are a non-responder

  • that suggests hypothyroidism
  • TSH suggests hypothyroidism
  • hypothyroidism makes you fat and can lower T

Hard to work without the lab range data.

Please review my prior posts for things that you need to do and appear to have overlooked.

Read the thyroid basics sticky.

  • do you have dry skin?
  • brittle hair or nails?
  • get cold easily?
  • have low body temperatures?

Hi back to the specialist tomorrow can you please explain

LH/FSH, should always be done before TRT, stop TRT for 10 days to get done

Also I do have brittle hair, get cold easily and have dry skin.

Thank you again for all of your time help and knowledge

If you read the advice for new guys sticky you can answer "LH/FSH, should always be done before TRT, stop TRT for 10 days to get done " yourself. You need to read that stuff!!! TRT shuts off LH/FSH. You need LH/FSH to understand what is wrong.

Also I do have brittle hair, get cold easily and have dry skin.: You have hypothyroidism.

Read the thyroid basics sticky.

  • report AM and mid afternoon body temperatures #$%%$^$%^$%^$#%$#%@#$%@#$#@$@
  • report your history of iodine intake: iodized salt and in vitamins that list iodine ditto

You have a reading disability, do your home work, post the requested info.


serum testosterone 11.1 nmol /l

After 4 weeks of Testogel , 1 sachet per day

serum testosteron = 8.6nmol/l

We know that inability to absorb T is a symptom of hypothyroidism. And testogel lowered your T levels. You will need to inject T, you cannot use Transdermal T products. Very few docs have any understanding of this ‘syndrome’.

We cannot help you if you will not cooperate.

Hi again sorry for not doing all that you need to help.

My morning body temperatures have been ,soryy but I have not done afternoon temperatures. These were all taken a week apart from each other.

36.6
36.6
36.6

my latest results are
testosterone 9.3 nmol/l 10.0-28
Serum SHBG 33 nmol/l 14-71
free testosterone 0.18 nmol/l 0.25 - 0.79
Luteinising Hormone 2.3 IU/L 1.7-8.6
Prolactin 107 mU/L 86-324
Serum FSH level 2.0 IU/L 1.5-12.4

He diagnosed me with Primary Hypogonadism due to testicular failure. I have a normal sperm count and am going to freeze sperm as my wife and I want children. He has mentioned Clomiphene treatment at the point we are ready but until then basic TRT probably Nebido. He has not taken any E2 reading, I will insisit at the point before I go on TRT. Are their any other tests that I should insist.

Can you please explain/help /give me feedback.

Thank you again for your time and effort and sorry for the earlier post errors.

Sorry I forgot my iodine intake

Many years of sea salt consumption - recently moved to iodised salt , perhaps for the last 6 months
No vitamin supplementation until reading this site I now probably 5 days out of 7 take an Omega oils capsule and a multivitamin that contains Iodine 150 ug 100% EC RDA

A reading disability eh… Ksman you are a dick to people and u don’t answer the questions… Some people might not understand and alot of people here have brain fog so get off your high horse…

Testicular failier? Lh and fsh would be elevated…

You look like secondary to me…

What are they doing about the thyroid problem?? This is a real problem and it needs to be addressed… Sounds like you need a new doctor bud

Do not start iodine without checking antibodies…

Iodine at 50 mg can be dangerous period…

Look on page 18 if you want reassurance

Your doc is wrong

Thank you , is that good news ? What treatment would you suggest or what should I say to my doc?

I suggest treating the thyroid…

Step one: demand a thyroid ultrasound

Step two see a good endocrinologist who is versed in thyroid well, do your research on doctors and ask to see the one you want.

Step three retest lh and fsh and testosterone after your thyroid numbers are back online.

When dealing with thyroid issues( I also am and have tried trt) one may feel worse or not at all better on trt. The metabolic demands of the replacement may be to much for you to handle.

Secondary is much better then primary in the fact that you may have a chance to get the pituitary working again.

Do I have hyper or hypo thyroidism? what should normal ranges be? can you recommend a good place to read up on thyroid issues pleas?

Lol ask your doc why you have normal sperm count with testicular failier??

If they were failed would they work?!

U could try an hcg challenge if this increases testosterone you would be called secondary and ur balls are fine…

T is low because LH is low.

We know that thyroid problems can be a primary cause of low T in some guys.

You cannot recover from your iodine deficiency with 150mcg [micro-grams] per day.

Your main focus should be your thyroid.

Were those body temperatures recorded when you first woke up and before you got out of bed?

Is your thyroid big? Neck looks thick there? Feels lumpy or asymmetric? Hi TSH over time can cause this. Low iodine over time can cause this.

I cannot easily interpret your T4 labs without ranges.
However: http://en.wikipedia.org/wiki/Thyroid_function_tests#Free_thyroxine

Suggests that fT4 mid range would be 13.5, so your 13.9 then appears good. If body temps are as you reported, they a good. This implies that your thyroid function is good but TSH is beating your thyroid to get there and there are serious risks of that. Please confirm body temps and timing.


This is standard advice maintained here:

There is a huge amount of knowledge in the stickies. Please study these. Start with the advice for new guys sticky.


There is a lot to read there, so read carefully. There are suggestions for things that are root causes of low testosterone [T]. Low T is a symptom, not a root cause itself. But low T itself is a root cause of many of the symptoms one experiences. Note that other things cause the same spectrum of symptoms, so do not have T tunnel vision. Many docs are guilty of that and they only treat the symptom [low T] and do not attempt to find the real problem. If you go to a clinic that specializes in low T, you will get T tunnel vision for sure.

Post info about yourself as suggested in the above sticky. We need labs, almost all of your labs, not just hormones. We also need the lab ranges.

We see a very high number of thyroid issues in the population of guys that show up here. So there is a strong focus on that. Most people are iodine deficient to some degree. Your history of iodine intake from iodized salt and vitamins that list iodine is important. If you become iodine deficient, the RDA [recommended daily allowance] is inadequate for recovery of iodine stores. Please see the thyroid basics sticky for more information.


You do not want to suffer from subclinical hypothyroidism or get Rx thyroid meds to treat iodine deficiency.

If you are injecting T or contemplating that, read the protocol for injections sticky.

There are stickies for finding a TRT doc, estradiol [E2] and lab work.

Do not place your history or treatment details in the stickies! That belongs in your thread. Keep all of your posts in your thread so we can have a clear picture of your situation and needs.

Go to stop the thyroid madness.

A good tsh level is 1 anything over 2 is a problem or the beginning of a problem

Body temps will be low no need to check this

I’d like to see shbg numbers out of curiosity :slight_smile:

What would you like to know? Listen man the thyroid is complicated and we can guide you but you really need a good endocrinologist to deal with this issue and you can read all day people’s opinions and even books but not even many endos understand the thyroid. We are all different and react different…

Before you go to the endo.

Go to stop the thyroid madness.

A good tsh level is 1 anything over 2 is a problem or the beginning of a problem

Body temps will be low no need to check this

I’d like to see shbg numbers out of curiosity :slight_smile:

What would you like to know? Listen man the thyroid is complicated and we can guide you but you really need a good endocrinologist to deal with this issue and you can read all day people’s opinions and even books but not even many endos understand the thyroid. We are all different and react different…

Before you go to the endo.

Thyroid ultrasound

Tsh

Ft3

Ft4

Tgab

Tpo

Tsi

RT3

Hi again and thank you all for your help its making a real difference In my approach.

My temperature this morning was 36.7 like the others this was taken pretty much as soon as I wake up whilst stil imbed.

I’m seeing my gp in the next week and will explain why I disagree with his diagnosis and will ask him if I can have more tests
Into my thyroid function rather than rush into trt which may make me sterile and stop me from having a family

Is their anything else I should say/ask? If he refuses what should I do ?

Your waking temperatures seem good. Can you get to 98.6 F / 37C mid afternoon when not eating, talking or drinking for a while?

So your thyroid function, in terms of body temperature is not at this point an obvious issue.

But, your TSH, poor absorption of transdermal T, brittle hair/nails and getting cold easily are symptoms of hypothyroidism.

You may have effects of long term iodine deficiency [ID] and your 6 months of iodized salt is not expected to fix the deficiency. If you need .75 grams of iodine to recover and get 150 micro gram s per day now, after 6 months you have consumed .027 grams and most of that has cleared your body. Iodine may be a major factor in your current condition and you can be stuck with lingering effects of ID.

You have secondary hypogonadism based on your lab results. You can see if you can recover with an HPTA restart. This can be done with hCG then a SERM or SERM only and some AI use is recommended as well. I do not know where you are or what options are available where you are.

You can also ask for a trial of thyroid meds. Suggest a product that contains T3 and T4. If you feel better, that is a very important diagnostic observation and perhaps the only one that matters.

Iodine is not the only factor in low body temps do not load iodine unless your doctor has ran the above tests and feels it would be right for you. As I said a thyroid specialist should be taking care of thyroid problems not ksman. He is not a thyroid doctor and can walk away after it has adverse effects and ignore it…

50 mg is 333 times the recommended daily dose and could induce a auto immune disease into full swing with heavy loading… Naturally people would never take that much iodine in a day. It’s fucking dumb