T Nation

TT 192 and Goiter: Time for War


#1

Big thanks to you all and KSman. The stickies have been an incredible resource in helping me keep myself together and prepare over these past few months. Let's get into it.

-Ethnicity: 50% Swiss and the rest even between Irish/English. First generation removed from rural farm living/eating.
-age: 30 next month
-height: 6'0
-waist: size 40' pants.
-weight: 244 lbs.
-describe body and facial hair:
Full beard/mustache. Thick at mid chest, belly, decreased but still full at pubic area and legs. One thick 4 in. oval patch at mid-left back, otherwise hairless. Thick at top of plumbers crack.

-describe where you carry fat and how changed: Centralized (belly,hips it's all in the hips,thighs)
-health conditions, symptoms [history]:
-Age 1 1/2 years fell off 2nd story balcony onto cement. Was found 30mins-hour later unconscious. Awoke at hospital admission. 4in skull fracture only found damage besides superficial bruising. 3 day hospital stay and released when I could hold down food and stand for short periods, though dizzily and walked diagnol to intended goal. No follow up Dr. appointments.
-Age 6-7 had a single incident of being repeatedly hit in the genitals by some psycho neighborhood kid.
-Around that time started receiving extreme daily migraines. They went on like that till 12-13.
-Frequent constipation since childhood into adulthood
-Age 10-11 started forming Gynecomastia (bilateral) as first sign of puberty.
-Started putting on weight easily 11 years old and onward storing it centrally.
-At 12 years was concussed and unconscious after slip at top of stairs.
-14, 145 lbs, fell during gym class breaking right ulna and hitting back of head. Concussed and unconscious. Awoke confussed but sobered fully within 15 minutes.
-By 16-17, 185 lbs, gynecomastia had proceeded to type 3 (I was packing some torpedo's), tender, swollen, and with some nipple discharge from left breast. Put on some body/facial hair around this age. Penis had little growth up to this point (no noticable growth after this point) and testes were small, scrotum tight to body.
-Present day- Scrotum loose and testes small and soft.Erections weak and fleeting. Ultrasound from last month found "Small right epididymal head spermatoceles"
-Depression
-Acquired acanthosis nigricans
-Goiter, unspecified. Ultra sound tech states Normal thyroid sonogram, though.
-Get cold easily
-Brain Fog and memory issues
-High Cholesterol
-Collapsed arch right foot. Plantar Faciitis, both. Right heel spur (recent). Right foot arthritis. Had issues with feet as far back as I can remember (possibly caused by fall as a toddler). Currently going to rehab to improve strength in right ankle and range of movement.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: No current RX. Never any hair loss or prostate. Here's my Vitamins
-Fish oil 1200mg
-Vit-D 2000iu
-One Daily Multi vit
-Magnesium 250mg
-Vit-B12

-lab results with ranges
-===Labs taken on 2/27 @11:34am===- (Ranges Parenthesized) I was eating bad for months leading up to this test and weighed 275 of flabbyness.
TT 204L (241-827 ng/dL)
FSH 1.2L (1.6-8.0 mIU/mL)
LH 2.3 (1.5-9.3 mIU/mL)
Prolactin 9.0 (2.0-18.0 ng/mL)
T3 Uptake 33 (22-35%)
T4 Total 7.2 (4.5-12.0 mcg/dL)
fT4 (T7) 2.4 (1.4-3.8)
TSH 3.68 (0.40-4.50 mIU/L)
Cholesterol Total 331 H (125-200 mg/dL)
HDL 37L (> or = 40mg/dL)
Triglycerides 180 H (<150mg/dL)
LDL 258 H (<130 mg/dL (calc))
CHOL/HDLC Ratio 8.9 H (< or = 5.0)
NON HDL CHOL 294 H (target is 30mg/dL higher than LDL target)
Glucose 94 (65-99 mg/dL)
Urea Nitrogen (bun) 14 (7-25 mg/dL)
Creatinine 0.97 (0.60-1.35 mg/dL)
eGFR NON-AFR. 105 (> or = 60 ml/min/1.73m2)
eGFR AFRICAN 122 (> or = 60 ml/min/1.73m2)
Bun/Creatinine Ratio N/A (6-22 (calc))
Sodium 140 (135-146 mmol/L)
Potassium 3.9 (3.5-5.3 mmol/L)
Chloride 102 (98-110 mmol/L)
Carbon Dioxide 26 (19-30 mmol/L)
Calcium 10.0 (8.6-10.3 mg/dL)
Protein Total 7.4 (6.1-8.1 g/dL)
Albumin 4.4 (3.6-5.1 g/dL
Globulin 3.0 (1.9-3.7 g/dL (calc))
Albumin/Glob Ratio 1.5 (1.0-2.5 (calc))
Bilirubin Total 0.6 (0.2-1.2 mg/dL)
Alkaline Phosphatase 103 (40-15 U/L)
AST 22 (10-40 U/L)
ALT 14 (9-46 U/L)
PTH Intact 28 (10-65 pg/ml)
GH 0.1 (> or = 10.0 ng/mL)
White Blood Count 10.2 (3.9-10.8 Thousand/uL)
Red 4.70 (4.20-5.80 Million/uL)
Hemoglobin 14.8 (13.2-17.1 g/dL)
Hematocrit 43.5 (38.5-50.0 %)
MCV 92.6 (80.0-100.0 fL)
MCH 31.5 (27.0-33.0 pg)
RDW 12.8 (11.0-15.0 %)
Platelet Ct 242 (140-400 Thousand/uL
Absolute Neutrophils 5590 (1500-7800 cells/uL)
Absolute Lymphocytes 3886 (850-3900 cells/uL)
Absolute Monocytes 500 (200-950 cells/uL)
Absolute Eosinophils 163 (15-500 cells/uL)
Absolute Basophils 61 (0-200 cells/uL)
Neutrophils 54.8 (%)
Lymphocytes 38.1 (%)
Monocytes 4.9 (%)
Eosinophils 1.6 (%)
Basophils 0.6 (%)
==============
-===Labs done 8/25/2014 @8:11am===- Weight 255. Didn't masturbate for 48 hours prior to test. Incomplete fasting.
TT 192 L (250-1100 ng/dL)
FT 35.5 (35.0-155.0 pg/mL)
HCG,Total,QN <2 (<5mIU/mL)
Estradiol 22 (Prolactin 11.9 (2.0-18.0 ng/mL)
LH 2.6 (1.5-9.3 mIU/mL)
FSH 1.2 L (1.6-8.0 mIU/mL)
DHEA-S 328 (85-690 mcg/dL)

Urine Volume 1500ml
Cortisol,Free,Urine 8.2 (4.0-50.0 mcg/24 h)
Cortisol,Free,Urine 5.9 (3.1-42.3 mcg/g creat)
Creatinine Urine 1.39 (0.63-2.50 g/24 h)

Glucose 100 H (65-99 mg/dl)
Urea Nitrogen (bun) 12 (7-25 mg/dL)
Creatinine 0.84 (0.60-1.35 mg/dL)
eGFR Non-African 118 (>or= 60 mL/min/1.73m2)
eGFR African 137 (>or= 60 mL/min/1.73m2)
Bun/Creatinine Ratio N/A (6-22 (calc))
Sodium 141 (135-146 mmol/L)
Potassium 3.9 (3.5-5.3 mmol/L)
Chloride 105 (98-110 mmol/L)
Carbon Dioxide 25 (19-30 mmol/L)
Calcium 9.5 (8.6-10.3 mmol/L)
Protein Total 7.1 (6.1-8.1 g/dL)
Albumin 4.4 (3.6-5.1 g/dL)
Globulin 2.7 (1.9-3.7 g/dL (calc))
Albumin/Glob Ratio 1.6 (1.0-2.5 (calc))
Bilirubin, Total 0.5 (.02-1.2 mg/dL)
Alkaline Phosphatase 91 (40-115 U/L)
AST 20 (10-40 U/L)
ALT 14 (9-46 U/L)
TSH 2.54 (0.40-4.50 mIU/L)
T4, Free 1.2 (0.8-1.8 ng/dL)
T3, Total 75 L (76-181 ng/dL)
Thyroglobulin Antibodies <1 (Thyroid Peroxidase Antibodies <1 (<9 IU/mL)
17 Hydroxyprogesterone,LC/MS/MS 27 L (32-307 ng/dL)
White Blood Ct 9.9 (3.8-10.8 Thousand/uL)
Red 4.69 (4.20-5.80 Million/uL)
Hemoglobin 14.6 (13.2-17.1 g/dL)
Hematocrit 43.3 (38.5-50.0 %)
MCV 92.3 (80.0-100.0 fL)
MCH 31.2 27.0-33.0 pg)
MCHC 33.8 (32.0-36.0 g/dL)
RDW 13.1 (11.0-15.0 %)
Platelet Ct. 234 (140-400 Thousand/uL)
Absolute Neutrophils 5356 (1500-7800 cells/uL)
Absolute Lymphocytes 3960 (850-3900 cells/uL)
Absolute Monocytes 406 (200-950 cells/uL)
Absolute Eosinophils 139 (15-500 cells/uL)
Absolute Basophils 50 (0-200 cells/uL)
Neutrophils 54.1 (%)
Lymphocytes 40.0 (%)
Monocytes 4.1 (%)
Eosinophils 1.4 (%)
Basophils .4 (%)
ACTH, Plasma 15 (6-50 pg/mL)

-describe diet: 1800-2000 cal diet. Keeping away from breads, grains, sugars.
-describe training: 45mins-Hour long walks daily with Indian club routine afterwards. Had to stop the walks 6 weeks ago after developing bad heel spur pain. Doing 1 hour long walk per week now and working back up.
-testes ache, ever, with a fever?: Never noticed having a fever during an episode. Yes, they do ache sometimes for hours or a few days.
-how have morning wood and nocturnal erections changed: Both rarely.

Tests my endo requested today. Next Appointment Oct 10th.
-PSA
-IGF-1
-Androstenedione
-MRI Pituitary

My Endo says we'll wait till these last tests are done and then I can choose have the TRT route I explained from the 'Protocol for Injections' sticky. Hearing that was such a relief. I have a few questions related to this to better help me go into the next appointment ready.

Continued for I fear this post is too long.


#2

I ordered i-Thyroid 12.5mg bottle of 90 pills. Gonna do the two week protocol from the Thyroid sticky. Will complete the PSA, IGF-1, and Androstenedione labs on the 29th and the Pituitary MRI the 2nd. I think she is looking for a Prolactinoma tumor on the pituitary. If I have one will that affect my hCG dosing?

I have a question concerning the Protocol for injection. Since my TT is 192 and my endo seems open to my suggestions for protocol, what starting EOD dose would you suggest I start at to get me up in the 7-800's? I think it'll be easier to get her to approve a higher starting protocol than asking her to bump it up a notch if it falls in the 4-500's. She said the dirty word "Normal" and "Low Normal" a lot while reading off my tests!

How often should I get blood tests after starting/changing the regimen?

When the basic protocol mentions '100mg per week, broken up into EOD injections' does that mean EOD you inject 33.3mg for a total of about 100mg for that 7 days?

Thanks in advance. You guys have helped me fight for a better QOL just from reading your posts.


#3

Prolactin levels are low. So not as you expect. MRI may show damage from blows to the head or an adinoma that is not secreting hCG or prolactin.

None of the above has any impact on hCG therapy.

After hCG mono-therapy, you need to wait a few weeks. At least four as the testes need to physically change.

With injected T, that can be done at 3 weeks.

EOD injections is 3.5 injections per week or 100/3.5 every other day.

I would seek more than 100mg, based on your body weight.

E2 management will be extremely important for you! Might need a SERM if gyno flares up. If so, you might need to drop hCG and use Nolvadex.


#4

Thanks KSman. Are you suggesting I do hCG mono-therapy first? Currently my plan is to ask for this protocol from my endo later this week

150mg Test Eth per week with EOD SC injections (I'm really not sure how much to up this from 100mg based on my 245lbs weight)
250iu hCG EOD
.38mg Arimidex EOD

I'll run the math by a friend tomorrow to keep the 1-4 ratio of AI/T.

How often do you guys suggest I get my levels checked after going on a protocol for the first time?

=======
Got the MRI of the brain and pituitary. I don't see anything to suggest tumors. I'll know for sure when I see my Endo next.

I've been taking the 12.5mg i-Thyroid @50mg per day (4 capsules) since Monday September 29th. Feeling fine.

Body Temps have been consistently low. At beginning of Iodine supplementation:
96.4 morning
97.4 evening
One week into it:
96.9 morning
97.9 evening

Tested with two different thermometers and getting same results. Seems to be improving. Looking forward to next Endo appointment as they check my temps. Will bring mine to compare.


#5

If hCG mono therapy works, great, otherwise T+AI+hCG

I was commenting on when you could do lab work for either method.

"How often should I get blood tests after starting/changing the regimen? "


#6

Thanks for the clarification. I feel ready to explain a case for each part of the protocol.


#7

Update on Temps and Endo visit:
Temps have been consistently low. Waking 96.6 , Evening 97.9.

Sad news. Endo stated:

-E doesn't follow T so no one ever needs an AI. E does not spike after T shots unless you are a body builder.
-30mg Test Cyp is dangerous! 100mg once weekly much better but 200mg once biweekly is the best
-No one needs hCG unless you are infertile. hCG is not to be used with Testosterone. Ever.
-TRT rarely causes testicular atrophy. Let's wait and see but I will not prescribe hCG even then.
-Estrogen has nothing to do with the Prostate. Let's wait and see.
-Your history severe childhood and adult gynecomastia will not be exacerbated by TRT and you will not aromatase it to estrogen.
-Compounding Pharmacies are dangerous and they put all manner of drugs in whatever you order
-No evidence suggesting that SC injections of Test are effective. Must do IM. Test Cyp won't even work in an insulin needle
-TT 400 is normal and our goal.

Next appt. in Jan.

What was Prescribed Today:
* 100mg Test Cyp. self injected once weekly (5 refills)
*script for "Testosterone Syringes" dispense 4 per refill (6 refills).
*Semen Analysis.

I'm pretty sure I'll be shooting blanks or near to it since I'm most definitely hypogonadal so don't understand the need for the analysis if she won't prescribe the hCG anyway. Nothing I said could be of any merit because it "came from the internet" and the studies I cited don't matter because they don't express current protocol.

This hurts. These forums were no small comfort before this endo visit but now even more so. Thank you, homies. I'll be reading the Finding a TRT Dr. sticky. I have little money and Medicare. Advice much appreciated.

Questions:
- As I understand it it wouldn't be wise to go along with the protocol she has set of 100mg Test cyp per week without an AI or hCG, right?

-She will only consider doing more labs at the appointment in January. And only for E2 if I show symptoms of it which she doubts I will. So, that would mean I might not actually get any test results back till 4-5 months from now. Should I just cancel our next appointment and consider working with her a lost cause?

-Should I fill these scripts anyways?


#8

I finished my two week Iodine loading. Temps didn't change and stay around 96.9 morning, 97.8 mid day. Also, having some strong joint pains across my body not related to any physical activity changes.

Until I get a new doc who'll prescribe an AI I'd still like to take some of this Test as I think my joint pain may be low E2. Anyone been in this situation? What'd you choose to do? What dosage would be ok of Test cyp only till I get other meds?

Any suggestions are appreciated.


#9

WTF, some of these docs are totally ignorant and make up shit.

Maybe we need a wall of shame for doctors, with names. But would need to be a new website.


#10

I was respectful and still ran into the wall of her ego. Half way through the appointment I realized she had decided to disagree with everything I said to the point of being absurd in her statements. It was unveiled condescension. Listening to a podcast today (Joe Rogan Experience #564 w/ Sturgill Simpson) they talk about how some people feel they can be bullies, often towards those who are more physically dominating or submissive, because they feel society will protect them from retribution. It's just so silly and ridiculous anyone would choose to act that way to a stranger coming to them for help. She needs a gallon of ayahuasca and a platter of pot brownies to put a dent in that ego.

KSman, have you come across anyone else who got intense joint pain after or during an Iodine Replenishment? I finished the two weeks and the last two days of it had increasingly intense joint pain. It's been a week since I finished the two week loading and the joint pain hasn't decreased with cessation of iodine supplementation. My joints even my knuckles are hot and swollen. I just took one 12.5mg cap to see how it will effect my joints after a week off of it.

Wonder if this joint pain is bromide detox related or if the iodine knocked down my estrogen levels a bit causing the well known low estrogen joint pains (my last blood test showed E2 22 so I wouldn't think I'd need to drop that E2 far to get this symptom).

Here's a cite I found for Iodine being found to have anti-estrogenic effects.
http://iodineresearch.com/breastpg3.html


#11

I got two of these 200mg/ml 1mL bottles but are they supposed to have so little liquid in them? It looks less than if i melted down a gummy bear. Please tell me if this looks right or not.


#12

It's fine. I use the same bottle and brand. That is 1ml dose.


#13

Thanks. Didn't think it possible but it did fill a 1/2ml #29 insulin syringe and has enough to do it again. I was suprised how smooth it went into the syringe.

As an update. I planned to start doing just 30mg EOD but got scatter brained and did the 100mg that was on the prescription. Will do 30mg EOD starting 6 days from now. If my joint pain goes away due to a rise in E2 from this Test cyp 100mg then i'll go back to a normal dose of 12.5mg iodine cap every day. That might help me keep my E2 in line. We'll see. Will check my levels in 3 weeks. Sooner if symptoms worsen.

Keep on keeping on.