T Nation

TRT Patient Needing Advice; Doc's No Use


#1

Hey Everyone,

I was hoping to get some advice after seeing multiple doctors that were of no use. I am 30 years old and was diagnosed with a hormone deficiency 4 years ago and have been on TRT since. After seeing multiple General Physicians that actually made things worse, I saw a Dr in Kansas City that specialized in TRT and he put me on 400mg (split into 2 injections Sun and Thurs) of Test Cyp a week and .5mg of Arimidex EOD.

My hormone levels and symptoms improved but over the last year or so I have been feeling more and more lethargic and exhausted pretty much all the time regardless of how much sleep I get. I have since moved to Delray Beach, FL and have been looking for a new Hormone Doctor. In the meantime, I have seen two General Physicians about my exhaustion and both have ordered blood panels to check my Test levels (despite the fact that I told them I just received an injection days before so they will come back high.) As expected my Test on both Panels came back slightly on the high end, so naturally both doctor’s focused on the TRT, about how i shouldn’t be on it at all and say nothing about why I am feeling so shitty 24/7.

I was hoping that someone on here might have experienced this before and could shed some light on why I continue to feel this way. Considering I am a bodybuilder and a fitness model, feeling rundown all day everyday is making my daily routine very difficult. I’ll post my numbers from my recent blood panel below, any help would be very much appreciated.

Again, I had an injection of 200mg 2 or 3 days before the blood was pulled:
Edited:

Hormone:
Total Test: 1453ng/dl Range: 250-827
Free Test: 921.1pg/ml (46-224)
Estradiol: 41pg/ml (<39)

Metabolic Panel"
Glucose: 77 (65-99mg/dl)
BUN: 22 (7-25mg/dl)
Creatinne: 1.31 (.6-1.35mg/dl)
Albumin: 4.4 (3.6-5.1)
Globulin: 2.3 (1.9-3.7)
WBC: 7.4 (3.8-10.8)
RBC: 5.51 (4.2-5.2)
Hermatocrit: 48.8 (38.5-50)
TSH: 2.4 (.4-4.5)
T4: 7.2 (4.5-12)

I’ve never had fT3, fT4, or my SHBG tested


#2

We always need lab ranges, edit to add above.
Also post other lab work, not just sex hormones.
And “normal” is a bad word, we need the numbers.
Optimal is a good word.

Get these labs or post:
TSH
fT3
fT4 [not T3, T4 or indexes etc]
SHBG
CBC
hematocrit

E2 is too high. Most need Arimidex/anastrozole to manage E2 levels.

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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#3

You’re on way too much test and your labs confirm it. Not everyone does well at the top of the range, I felt horrible at the top of the range. I’ve never heard of anyone on this much Test, have you always been on a high dose of Test? More is not always better for some and you might find being in the middle range better for you.


#4

But we do see some who are T hypermetabolizers who do need a lot more T… But I generally agree that the dosing is a problem.


#5

No, when I started a GP had me on 200mg every 3 weeks. My test numbers dropped over that year, so I saw a Urologist, an Endo, and an Internist at KU Med to took me off of it for a year and ran dozens of test which didn’t give me any answers. That’s when I saw my current TRT Dr. He put me on 300 mg a week originally but the last panel of bloodwork I had with no TRT in my system my Total Test came back at 229 (range: 348-1197) so he bumped me up to 400mg.


#6

When lab results are very strange, a lab failure is a possible explanation.

T hypermetabolizers also have short effective half-life. Please divide your dose and inject subq every other day. Then always do labs on the off-day to avoid lab changes driven by lab timing. You should also consider dosing anastrozole at time of injections.

You have never used hCG to preserve testes and fertility?

TSH should be closer to 1.0, 2.4 is a problem.
Thyroid lab ranges are stupid, forget normal.
T4 should be close to mid-range or a bit higher. Same for T3, fT3, fT4.
You may be iodine deficient from not using iodized salt.

Feeling cold easier?
Outer eyebrows sparse?
Generalized hair thinning? - not MPB

Very few doctors understand thyroid issues and are slaves to stupid “normal” curves that predetermine that only 5% a the population could have a thyroid problem. fT3 is the active hormone… why test that?

Low thyroid function can explain your issues. Do read all of the thyroid basics sticky. Your AM and mid-afternoon body temperatures will show the balance of several factors.

And doctors never ask about iodine intake and are mostly blind to the basics.


#7

Do you think I should stay at 400mg a week and divide the dosages to EOD or should I lower my overall dosage as well? Also I found a facility here in Delray the specializes in HRT (http://thebiostation.com/blood-panels/performance/) I was going to go in and have them run lab work as well. Anything else I should have tested other the my hormones, T3, fT3, fT4?

I have never used HCG no.

Not cold, actually always very hot and sweat easily
Eyebrows don’t seem to be sparse but i do have thin hair


#8

No hCG:
how small are your testes now?
pulled up tight?
dull 24x7 ache?

There is now a risk of infertility and doctors should have discussed known risk with you. At this point you need to take positive action and get semen examined for swimmers.

Body temperatures first.
History of using iodized salt? did I miss something?
Outer eyebrows.

Other labs?
AM cortisol - at 8AM or 1 hour after waking up
IGF-1
Vit-D25
fT3
fT4
SHBG
B-12
Some of the above addresses energy levels.
[Your energy levels might all be TSH=2.4 related.]

reread my posts to see if you have missed any points while drinking from the fire hose.


#9

Yes to all 3 questions.

I don’t plan on having children so I have never had my sperm tested.

No I have no history of using iodized salt

Okay, I’m going to get another panel tested this week. Thank you for all of your help and advice.