T Nation

Update: 9/23/16 AI Finally Prescribed


#1

Thanks for viewing.
AGE : 33
Weight: 235
Height: 6’3"
Build: Decent, weight distributed well
Hair: Thin on top. Plenty on body and face.
Medical: Suffered from Ulcerative colitis. Colon removed 5 years ago. Low testosterone since age 24. On and off to have kids until last year.

Hello all,
I am having to restart my TRT again and have a few questions as it appears I will be on it for good this time and would like to get it right. I have been on and off once age 24. When we found out I was at 293 lbs and suffering from severe anxiety and some depression. Found out I was too low. Started injections. Dropped a ton weight and significant mood enchantment. Discontinued to have first child. Cycle continued until child 3 we just had last year.

I’ve been run through the mill and it was determined that my thyroid and pituitary are working fine. The labs indicate my feedback look is telling me I have enough T, but my number are still low. I have had high estrogen spikes in the past as well.

Last set of labs off therapy:
FT: 4.14 (1-26)
TT: 158 (249-836)
DHEA-S: low
E2: Will be taken Tuesday before I restart

Last set of labs at 30mg test cyp weekly with DHEA Supplement
FT: 15
TT: 389
E2: 17
DHEA: Normal

I am aware the Test I take is a small dose and here comes the question:

How do I handle the anxiety I receive after a dose higher than 50 mg? It feels like I’m bouncing off the walls and anxious as hell. At the end of the day my chest is exhausted from being so wound up. Am I still too low test wise? I made the mistake at one point of pushing 150 mg over a two week cycle (before I knew better) and had a massive panic attack).

Is DHEA necessary to supplement if it is low? Before it my E2 was high ass 55 with injections of 50mg. After adding the DHEA and reducing to 30mg my e2 dropped to 17 and I felt a lot better. Sex is great at those ranges. As it appears the Test/E2 ratio is much better.

Do I need to start at AI with the next injection and go ahead and push 100 mg?

I did find last year where the missing unformed testicle from birth did form and was was undescended and removed last year. When the undescended testicle was removed my E2 dropped. I am not sure if it was the DHEA or not as it happened around the same time. Would that undescended testicle be producing estrodiol?

I did attempt to bring up my TEST on my own and could only get it to low 300’s. My cholesterol was unreadable low and I brought that up with diet as well as excercise to no avail. The fatigue and lack of stamina after working out is difficult.

Any help and direction would great before I crank back up. I hope this has been easy to follow and read. Typing this with kids hanging on me.

Thanks so much. All the stickies I’ve read has been helpful. Last year I finally found a doctor to listen to me and start monitoring my E2. She’s awesome. Three doctors told me E2 isn’t a big deal and nothing to worry about. Idiots. Common sense tells you if you are double a range of a female hormone in a male it might be a problem.


#2

Please post the thyroid/pituitary labs with ranges. These may hold the key to your adverse reactions.

Do you have male pattern baldness or general thinning.
Do you get cold easily? Your wife?
Outer eyebrows sparse?
What is your history of using iodized salt and/or vitamins listing iodine+selenium?

Injected DHEA or oral?

What stickies have you read so far?

Your low cholesterol is a problem. Cholesterol is the foundation for the cascade of your steroid hormones which included adrenal hormones.


#3

1.My hair thinned and fell out with the medicine i was on for my UC. The mercaptopurine (6MP) i was taking did a number on me and my blood levels.

  1. I do get cold easier it seems in the winter but i am also 60 lbs lighter than i used to be.

  2. Eyebrows are thick.

  3. I use salt sparingly unless it is in like a tony chachere’s seasoning blend. No selenium that i know of

  4. I do oral DHEA. Is this something i can do forever? I’ve read conflicting reports about how long i can take thee supplement.

  5. I’ve read all thee stickes relevant to this area. I printed them all out.

  6. My last cholesterol was 140 which is the very bottom of the good range. I have to eat fried eggs in olive oil every morning to keep it there. Since the removal of my colon its been a struggle. IT is the building block and as such has become a focal point to keep it at at the bare minumum bottom of the range.

My last TSH was a 1.2

BLOODWORK 3/9/2011 9/16/2011 8/3/2012 12/6/2012 2/12/2013 5/14/2013 7/30/2013 2/12/2013 4/23/2013 8/23/2013 9/12/2014
FSH (1.5-12.4) 8.87 8.21 8.8 7.8 1.5 6.7 7.8 0.02 8.9
LH (1.7-8.6) 6.04 4.94 3.2 2.2 0.1 4.3 2.2 0.1 5.8
TEST-TOTAL (348-1197) 270 202 102 260 202 289 108
TEST-FREE (8.7–25.1) 12 8.8 3.5 7.2 8.8 8.2 4.7
TSH (0.450-4.500) 1.35 1.23 0.999 1.45 1.23 1.39 1.04 1.93
T4 (0.82-1.77) 0.88 0.97 1.1
Thyroxine (T4) (4.5-12.0) 4.2
T3 Uptake (24-39) 32
T3 Total (71-180) 101

Here is a rough spreadsheet i’ve kept over the years.

From Feburary:
rT3 (8-25) - 13
Free T3 (2.5-4.3) - 2.8
Free T4 (.93-1,70) - 1.03
Thyroid Peroxidase A (<9) - 1

I appreciate all the help. My most recent LH/FSH etc is with my doctor and i’ll have to get it from her this week. I am do for more bloodwork tuesday or wednsday and would welcome any suggestions for what additional she may need to pull before another restart. I’d just like to get it right this time.

Thanks for everything.


#4

If you do not use iodized salt, you are deficient unless there is iodine in your supplements.

Do others in the house use iodized salt or are they iodine deficient?

Check oral body temperatures as per the thyroid basics sticky.
And your wife’s temperatures too.

Your thyroid labs are consistent with a lack of iodine.

Thyroid hormone fT3 controls the energy levels in all of your cells, and thus your body temperature and thus body temperature is a very good measure of overall thyroid function.

This is a better set of labs: TSH, fT3, fT4
T3 uptake is obsolete now that free levels of thyroid hormones can be directly measured.

T4=4.2 is bad.
T4, T3, fT3, fT4 should be midrange or a bit higher.


#5

I’ll send this to my doctor. We have iodized salt but do not use much salt period. My lack of colon and absorption problems it leads too causes me nutritional deficiencies in other areas. I did buy a new mouth thermometer and will take temperature as stated in the thyroid sticky tomorrow.

Can I do the home iodine test with the iodine painted square to test for absorption? Or would that screw the bloodwork assuming I can get it done in the next two or three days? Is that home test worth it?

Would the lack of iodine cause mild swelling and moderate constipation? What kind of test should they do? Urine or bloodwork?

Is it worth having them run a test for Pregnenolone as well?

If it is not iodine and I must continue on the TRT injections. Do I need to take an AI with the first injection? And what dosing would you recommend?

Thanks a ton. I am the sole provider for my family and I’m ready to get back in the game and have more to give them instead of expending it all at work and spending all night recovering.


#6

Morning temp was 96.6. Wife was 96.3

We did the iodine patch test and hers was completely gone. Mine is almost all gone with 3 hours left on the 12 hour test.

Thanks

Edit : afternoon temps were 97.4


#7

With low thyroid function, every cell in your body is running slow and you can expect many things to not be right.

You have reason to know that you are iodine deficient. You need to fix that.
Your wife probably has symptoms too.


#8

Here are my labs… Thanks!
Aldosterone 16 (3-16)
Renin 2.25 (.25-5.82)
Aldo/Pra Ratio 7.5 (.9-28.9)
Adrenocorticotropic 73 (6-50)
Iodine 56 (52-109)
Free T3 3.2 (2.5-4.3)
Coritsol 15.8 (6.2-19.4)
E2 15.6 (23.8-60.7)
LH 5.6 (1.7-8.6)
Prolactin 10.4 (4.04-15.20)
FSH 13 (1.5-12.4)
DHEA-S 112.3 (98.8-340)
Free Test 6.4 (1-26)
Total Test 248.8 (249-836)
TSH 1.83 (.27-4.2)
Free T4 1.13 (.93-1.7)

Again thanks for any and all input.

They mentioned cream again but I do not absorb well. I also believe once your body sees a slight increase it tapers off productions and forces you to use more cream or add in injection. I would like to just do the injections again. With my E2 so low would I need to add in an AI blocker anyway?


#9

Bump for KSmans reply

Thanks.


#10

Hello again y’all.

Talked my doctor into giving me an AI blocker finally. I started sq injections to great results. I inject .25 every 3 days. I was going to add in the blocker .25mg twice a week to match the test dosing following the 1ml/1mg protocol mentioned in the basics thread.

My TT was 496 (249-836)
FT was 143 not sure the scale. She said it was excellent. I was driving and didn’t write down her scale on that on.

E2 was at 44.

Hoping this helps. The fatigue has been awful. Does this sound like a good avenue in yalls opinion?

Thanks


#11

Body temperatures were low.
Need AM and mid-afternoon temperatures. Wife’s PM temp?
FT3=3.2 is not bad, but then why are temperatures low? That could be rT3 elevated by stress, see the thyroid basics sticky. rT3 was OK in February.

Have you done anything to increase iodine intake?
Please note that you should have selenium+iodine in your vitamins.

Cortisol is OK, but DHEA is not. In USA, get 25mg DHEA from vitamin shelves. Progesterone would seem to be ample.

If you no longer have a lower intestine, there are many possible absorption deficiencies.

T cream non-absorption is a symptom of low thyroid function.

All TRT is Replacement, never additive.

TT seems too low, or SHBG is very low, test that.
Please get FT range.

1mg AI per 100mg T

Fatigue may be thyroid and body temperatures. You can’t get out of the hole if thyroid function is low.

What meds are you using?: Rx and OTC


#12

We did run a full panel for my thyroid and it came back with a 12 on my fsh. My thyroid was at 1. This new doctor doesn’t post labs o line so it’s tough to get the numbers. We ran panels on iodine which was mid high. She was worried with my body temps low and checked everything she knew to check. I have to get them from her.

I take name brand test cypionate. I’ll be picking up the AI later today so I’m not sure the brand.

My TT is still lower than I want but I was unable to push more due to the massive estrogen spike. It was complete hell to go above what I’m doing now. My plan is to push more Test once we see if the AI blocker is doing its job. I want to increase both as we go up. I just couldn’t take the fluid and the massive anxiety response the days following my big IM injection. It is why I split the dosage and went SQ.

I will be adding in iodine supplementation after Mondays labs are run for my yearly physical. Glad to know you consider DHeA low. I can add that as well. I will ask for SHGB.

Over the counter is vitamin D. B12. Multi men’s vitamin.