Update - Grateful for Help After Following Stickies

Pharma / TRT Testosterone Replacement
1

Hello,

I have been here before and followed the stickies. The feedback I have received has been very helpful. I am looking to be certain i need TRT for life and want to try all reasonable approaches first before going back on .

I was on TRT for 2 years and have been off for 6 weeks. I am 35 and in recovery and sober for a little under 3 years now. Was in education for 13 years in the inner city and eventually left the field due to poor health (Stress - Chronic high morning cortisol). I used to be a heavy drinker and was addicted to opiates for many years but have improved my health with eating more balanced meals included protein carbs and fat. Lean on spirituality, 12 steps, helping others, meditation, etc. Eliminated gluten dairy and processed sugar this past year and do occasionally give in to temptation to eat them but maybe 1-2x a month at most. Was diagnosed with severe sleep apnea a year ago and use a CPAP every since. That has been controlled by my sleep is still a battle.

My 5 day morning temps are in between 97.0 - 97.5 and my five day mid afternoon temperatures are in between 97.0 and 97.8. I am 218 lbs, 6’1, and have about 14% body fat today (2 months ago at 10%).

Here are my blood results 6 weeks after my last TRT (50 mg two times a week) and HCG (250 mg every three days) shot

TSH 3.030 Range 0.450 - 4.500
Estradiol 17.7 Range 7.6 - 42.6
Prostate 0.3 Range 0.0 - 4.0
Triiodothyronine, Free Serum 2.5 Range 2.0 - 4.4

Total Testosterone 223 Range 348 - 1197
Free Testosterone 12.1 Range 8.7 - 25.1
LH 3.2 Range 1.7 - 8.6
FSH 2.6 Range 1.5 - 12.4

Thyroxine (T4) Free, Direct, S 1.31 Range 0.82 - 1.77
DHEA - Sulfate 213.2 Range 102.6 - 4163
Glucose, Serum 106 Range 65 - 99

Cholesterol , Triglyceride, HDL, LDL, VLDL all normal.

Any guidance, feedback, or recommendations would be awesome. I have been thinking of using Defy Medical in Florida to help as my next step. However, I know the knowledge in this forum is amazing.

2

If I need include anything else please let me know. Really desperate to get better. I have previous posts and have been helped before. Thank you for your time.

3

Did you go off of TRT totally cold turkey?

4

Please post total and HDL cholesterol.

Were you fasting for these labs?

Have you read the thyroid basics sticky?
Stickies are now via links in 2nd post of the first forum topic.
TSH too high
ft3 too low
With your history of stress, please test reverse T3 -rT3

Have we discussed iodized salt before?
Have you supplemented iodine?

Recap why you stopped TRT.

What supplements?
What medications?

Have you ever tested prolactin?

5

Thank you guys!

Lipid Panel (February 2016)
Cholesterol total 151 Range 100 - 199
Triglycerides 60 Range 0 - 149
HDL Cholesterol 65 Range >39
VLDL Cholesterol 12 Range 5 - 40
LDL Cholesterol 74 Range 0 - 99

I was fasting for the labs above

rT3 16.3 Range 9.2 - 24.1 June 2015
Prolactin 14.4 Range 4.0 - 15.2 July 2014

I did stop the TRT cold turkey.

I read the thyroid basics stickies and that is what led me to look at temperatures and look into Iodine.We did discuss this briefly before and because of that, I started using iodized table salt months ago and I also have gone back and forth the the IODORAL supplement. I went off for a few months and just started taking half of the tablet and within a few days I do feel a bit better and less " in my head". I have struggled with OCD intrusive thoughts most recently and nervousness and fatigue. Some days I have fears of things that are against my moral beliefs etc. but I recognize its not real. For example, I will get the thought “this struggle is too much so you should just end it” BUT I have dealt with that on and off for years and realize they are just thoughts and I am able to distance myself from it and get back in the moment. I am currently a personal trainer and am able to stay focused on my clients and help them which helps me at times. Any way here are my ZRT lab results from 4 months ago:

Iodine/Cr 43 LOW Range 100 - 380
Bromine 247 LOW Range 700 - 4800
Selenium 62 Range 34 - 220

Functional medicine doc did tell me that my TSH is high and that my ft3 is too low, you must have trained her lol for real. BUT I dont know what to do about those numbers and making them optimal.

I stopped TRT because i am 35 and thought the chronic drug use, long term ssri and benzo use in the past, poor nutrition and other unhealthy behaviors are now all long behind me (3 plus years). I feel like I wanted to give my body a chance to see if it can regulate itself and produce optimal or normal levels of necessary hormones now that my lifestyle is way healthier.

I take the following in the varied amounts indicated each day:
PURE ONE multi vitamin
Zinc piccolanate 20-60 mg ( 50 mg is in the multi)
Selenium 100 - 200 mcg (I also eat brazil nuts)
NAG 700 - 1400 mg
NAC 600 - 1200 mg
Vitamin E 400 mg
Kelp 600 - 1200 mg
Idoral (just started again at 3 - 12.5 mg) I have no idea how much to use based on my test result that is low
5-htp 50 mg in the morning
Inositol 1200 - 6000 mg (depending on the day and the intrusive thoughts)
Niacin 1000 - 4000 mg (depending on the depression) I dont really flush as I have built up a tolerance
Ashwaghanda 150-600 mg
Mood probiotic by Garden of life - I do rotate that 50 billion probiotic that you have recommended before by you made by ultimate flora and thank you for that.

Medication:
low dose naltrexone 1mg - 3 mg. I started this 5 weeks ago and have been dreaming more. Might be helping with the OCD. Hard to say.

6

Any suggestions on how to dose iodoral based on my results? Any chance my body can make adequate amount of testosterone? Like how do we know we have tried everything before going on trt for life? Thanks for your time! Ksman you are an amazing person. Also thanks to others who have the knowledge to help so many guys on here.

7

With no experience … I am concerned that any needless use of Naltrexone might be harmful as there are natural opioid neurotransmitters.

What is the endogenous opioid system?
Endogenous opioid peptides, produced naturally in the body, such as endorphins, enkephalins, dynorphins, and endomorphins. Morphine, and some other opioids, which are produced in small amounts in the body, are included in this category.

You could be causing mental problems by using Naltrexone. There might be a more appropriate way to manage OCD. ocd medication - Google Search

Bromine is low, that is good. No need for any of it in the body.

Niacin is lowering cholesterol too much. Try to get near total cholesterol = 180.

See the “thyroid basics explained” thread for suggestions re iodine supplementation.

rT3 is not a red flag, could be elevated a bit from stress etc.
prolactin would be better lower, but it is not at a level that explains low LH/FSH.

The only thing that stands out if TSH=3.0 and fT3=2.5
See what iodine can do. If that does not work, then do thyroid autoimmune tests then thyroid meds. When you get thyroid issues dealt with, LH/FSH may recover somewhat. But I suspect that you will be better off with TRT. And note that TRT will still require resolution of thyroid issues.

Do not take kelp and Iodoral at the same time.
Consuming Brazil nuts and selenium supplements at the same time

8

Thank you!

Do you think there will be withdrawal from coming off 1 mg of low dose naltrexone? Been using it for 7 weeks.

How do I raise cholesterol outside of lowering the niacin?

I will implement all other suggestions.

I feel the ocd is caused by major anxiety, and previous and current life stressors which I’m trying to bring under control in many other ways besides medicine. My past with medication made me feel worse and not better so I am not sure that is a road I want to take. Some of the Ocd medications in the list I have tried and they helped only a bit but caused other problems. Don’t you think they really screw up our brain chemistry and endocrine systems amongst other systems?

After reading the thyroid sticky I am still unclear about iodine dosages based on my test result. For now I’m taking a half a tablet a day. Does that seem ok?

9

It is very rare to have any negative effects taking larger iodine amounts for a while. One can have gut flora disturbed and if you get discomfort, reduce dose. 6.25mg/day will work, just slower. Your thyroid function may be a significant health issue for you. Can easily explain some of your fatigue.

One can make diet change to try to increase total cholesterol, but in your case, there it seems obvious that niacin is the cause.

What is your caffeine intake?

Have you tried any sleep aids/drugs?

Wellbutrin is an interesting AD drug. Does not have the spectrum of side effects of SSRI’s and related AD meds. And you can get off of it without problems of those other AD meds. It can help with OCD in a some cases, but most will not have that benefit. It is stimulating and might not be the best thing to do until you get some of your thyroid issue sorted out. Which leads us to the point that your thyroid labs are “normal” and many doctors will not do anything.

10

Coincidentally, this morning I took a whole iodaral pill and felt so aweful that I had to lay on the couch for about 90 minutes. But I took 1/2 teaspoon of himalayan salt and drank a lot of water and feel a bit better. So yes, I will stick with a 6.25 dose moving forward.

I do not drink coffee but have 2-3 cups of black tea a day.

In the past I have done remeron but that was an absolute nightmare as it worked for the first night and I gained 15 lbs in two weeks with the most ravenous appetite. I felt basically high on that drug. Never again.

I have tried wellbutrin a few different times in my life at a dose of 50 mg and 100 mg. Also did XR and SR of the release versions. It works for a few weeks and then becomes to stimulating and passes from helping anxiety and depression to then making the anxiety worse. Causing sleep issues at night.

The best success I have ever had was prozac but it pooped out. I was on it on and off for about 12 years.

I think you are spot on about the thyroid issue and at the least I feel like I am on the right track but just wish I could get some more relief from the low motivation, fatigue and lethargy and intrusive thoughts.

I also notice since coming off the test that when I workout I get exhausted fast so I am not even sure what type of exercise I should be doing to help the thyroid. When I was on trt this past year I was getting very strong and able to exercise for a while. However, I see what you mean about the underlying thyroid issue as fatigue and low motivation was still and issue.

I have had gut test (a year ago) and was low in good bacteria and positive for a form of dysbyosis. I have made progress there as I basically only eat whole foods and quality fats.

I do not know if this is in my head but at 1mg of LDN I felt a bit better. I was recommended the following links by my functional medicine doctor which led us to try the LDN. Seems there is research in the very early stages that LDN can actually help mental issues.

http://www.yasinskipsychiatry.com/low-dose-naltrexone-treatment-for-resistant-psychopathology/

11

How long could it take for the Iodoral to start working in terms of significantly helping my thyroid/adrenal issues? (Taking in between 6.25 - 9.50 a day)

I think i hit 98.1 today (11:30am EST) for the first time in a while. Something is working but the early morning fatigue, low motivation and nervousness is very difficult to deal with. I stopped the LDN about a week ago and I will say it feels like a bit of depression set in but who knows if it from that or just having a T level of 223. I am also gaining fat around my waist as the weeks go on and its very difficult to sustain the workouts I previously did.

12

You might be sensitive to increases in thyroid hormones with your “nervousness” as low thyroid might be dampening that down too.

LDN is a whole new aspect that I was never aware of. Perhaps my guidance was flawed for this.

Yes, Wellbutrin can be stimulating and that might wear you down if other systems are not able to keep up. I have notice this and have reduced dose at time. I do not use it regularity.

13

Update:

I have had my Total T hovering around the 220’s for the past five months. I wanted to see if the work I have done i the past year with cleaning my diet up, treating sleep apnea with cpap, being off all ssri’s for over a year, supplementing iodine, changing careers (lower stress), and a variety of other things would help without TRT. I am now working with Defy Medical and Dr. Chrisler and in the midst of a restart.

As far as Testosterone goes, I think I have to give in and go back on shots. I am still waiting on the LH FSH results from the three week clomid trial but my testosterone didn’t move. Interestingly enough, when I started the clomid and thyroid med it felt like a light went on. Not that i felt totally better but my anxiety has dramatically increased. I suspect it is the nature thyroid. Still struggling with energy ( Former teacher, but now a personal trainer in my 5th month).

5-13-2016
Three weeks on the following:
Pregnenalone 5-10 mg 5-6 days a week with a 1 or 2 day break a week
12.5 clomid with DIM 200 mg
1/2 grain Naturethroid

T4 1.46 0.82-1.77
DHEA sulfate 264.1 102.6-416.3
TSH 0.659 0.450 - 4.500
Thyroid peroxidase 7 0-34
Triiodothyronine free serum 3.2 2.0 - 4.4
Total testosterone 227 348 - 1197
Free Testosterone 7.6 8.7 - 25.1
Pregnenolone 88 Normal
Anti-thyroglobulin Antibodies <1.0 Normal
Estradiol, Sensitive 16.9 8.0 - 35.0
LH Waiting on results*
FSH Waiting on results*

3-18-2016
T4 1.30 0.82-1.77
DHEA sulfate 270 102.6-416.3
TSH 4.970 0.450 - 4.500
Triiodothyronine free serum 2.6 2.0 - 4.4
Total testosterone 220 348 - 1197
Free Testosterone 18.6 8.7 - 25.1
Estradiol, Sensitive 13.6 8.0 - 35.0
LH 3.1 1.7 - 8.6
FSH 3.0 1.5 - 12.4
Prostate specific AG 0.3 0.0 - 4.0

Total cholesterol 161 100 - 199
Triglycerides 45 0 - 149
HDL 65 >39
vldl 9 5-40
ldl 87 0-99

I am following the stickies as well as I can in terms of Iodine replacement but still unsure if I am doing it right. However, something is working. I do ensure I do the following in terms of IR:

Iodoral 1mg-6.5 mg
Selenium – 200 – 400 mcg per day
Magnesium – 400 – 1200 mg per day
Vitamin C – 3,000 – 10,000 mg per day
Vitamins B2 -100 mg
Vitamin B3 - 250mg
Unrefined Salt (Celtic) – 1/2 tsp. or more per day (This seems to help any detox symptoms)

The recommendations over at STTM (stop the thyroid madness) have been helpful for me. I have consumed 180 pills of the 12.5 mg pills of Iodoral since March of last year. So we are talking a bit more then 5 mg a day, so this is consistent with IR taking some people months to years to benefit I guess. My average daily temperatures have increased and on average are upper 97’s with a rare low 98 as opposed to upper 96’s and low 97’s. Morning temps recently have averaged about 97.2 and i still struggle with getting going early still.

A few months before this I have gotten a handle on the OCD symptoms (intrusive thoughts, anxiety, etc) in terms of managing them. It was so bad I couldn’t leave the house. I believe the iodine, targeted supplementation with a functional medicine doctor, elimination of gluten, meditation, therapy, new job and a few other things have helped with this but I am unsure. I am on no psych meds and feel better then I have mentally being on psych meds which I was on for over 15 years.

I have to wait two weeks to speak with Dr. Chrisler so I took a chance and gave myself a shot of test cyp as I do not want to wait at this low t level any longer and especially after seeing my testosterone didnt move at all after the three week clomid restart.

@Ksman I stopped the clomid after three weeks and took the shot today, anticipating Dr. Chrisler will see the clomid didnt do anything (testosterone wise, still waiting on LH). I hope I didn’t pull the trigger to soon. For example, if my LH comes back high or low will it matter in terms of the next step since the testosterone didnt move? I have done hcg montherapy in the past in it got my test to about 480 but my estrogen was in the 60’s during that.

I just feel like I want the normal -optimal t levels, especially since i have been going the past five months at a 220 ish level.

I am 35 now and was on trt from 32-34 and 1/2 (previous posts are here but not sure how to bring all together). Ultimately, trt worked in the past but the estrogen was to high (high anxiety from this i think) and i was scared to be on shots for life (want to have kids). It looks like the good old Testosterone, HCG, and AI is going to be my lot, WITH continuing treatment of thyroid and adrenals underneath that as well. Agree?

14

You have been beating the horse, but its dead. Saddle up TRT and your quality of life should be transformed.

You had good fT3 and body temperatures were still low?
That suggests elevated rT3 and adrenal fatigue.
In that case, T3 only meds may help, need time release and that is compounding pharmacy only.

Thyroid symptoms. Add this to the list, diminished or lost reflexes, knee and ankle.

Your hCG mono was causing high T–>E2 inside the testes and AI can’t fix that.
What was your hCG protocol then? This may affect T+AI+hCG

15

With the good ft3 leave the temps improved but I will record them more diligently this week to get a good average.

I have only been on the naturthroid for three weeks and feel better but not fully, is it reasonable to suspect I can continuously improve before going to the T3 only? In other words, give it a few more weeks especially since I am starting the Test cyp?

Why does t3 only get such a bad rap? I did however just read about the Wilson temperature syndrome issue and they recommended the same thing you did, time release from a compounding pharmacy

My Hcg mono in 2014 was:

Month 1 = 1,000 iu injections 3x a week.
Month 2 = 750 iu injections 3x a week.
Month 3 = 250 iu injections 3x a week

August 1, 2014 (1 week on HCG)
Testosterone, Serum 279 348 - 1197
TSH 1.810 0.450 - 4.500

September 1, 2014 (6 week after starting HCG)
Testosterone, Total 349 348 - 1197
Testosterone, Free 119.4 35.0 - 155.0

Very very very interesting you bring up the thyroid symptoms and the diminished or lost reflexes! I was a college football and baseball player and have always been quite athletic and still am. However, the past two years I was like “wow i really am getting old because I cant do this or that etc” I was chalking it up to getting old. I feel like something as simple as catching a pop fly which i have done hundreds of thousands of times feels weird now. Also, my hand eye coordination seems off. Can you tell me more about this?!

16

I doubt you will have any withdrawal coming off naltrexone. I briefly did the “sinclair method” to stop drinking with naltrexone. It worked amazingly well, I now have no cravings whatsoever after about 10 pills.

In general, you should feel better the day after a nighttime LDN because you slightly supressed your natural opiates overnight. Outside of some cases, I’m not sure it’s as helpful as the LDN boosters say.

17

So after 4 weeks 1000iu and two weeks 750iu 3x/week you had TT=349 and TF=119.
FT has a short half life and your testes were making T nicely at this time. The reason that TT was low may be from low SHBG. You should get that tested. There can be different medical causes for that.

Need:
IGF-1
AM cortisol at 8AM please
A1C - fasting glucose=106 is a problem

18

@KSman

Igf-1 173…88-246 last March 2015

Shbg 15.2 in March 2015 16.4 in September of 2016 … Range 16.5-55.9 what could be the medical causes of this?

For cortisol test do you mean the saliva one? I dos hose and thy were high in the am and noon and normal in pm and night.

I think since being on cpap for over a year now some things are slowllyyyyyyyy improving. Any feedback on my thyroid questions?

Btw the three week clomid test raised my LH from 3.2 to 6.4 but my total testosterone went from 222 to 227. However I felt normal and even good on clomid in a weird way which is interesting since I have a history of anxiety Ocd and depression. How could that be? I stopped the clomid and started the t shots. Waiting my follow up appt with dr Chrisler which is next Wednesday. If you can give me your thoughts on what else to bring up with him for my future treatment I would really appreciate it.

Lastly, any possible reason for why I was feeling so calm and normal mentally on 12.5 clomid in only three weeks?

Thank you for your time.

19

You may have felt good with increased LH driven by Clomid.
Odd that TT did not improve. Nothing else tested? FT? E2? FSH?

Lower SHBG is good thing most of the time. Can be from lower E2.
Maybe TT did not improve and FT did.

20

FT 7.6…8.7-25.1. The month before the clomid and on nothing my FT was 18! It dropped significantly. What does that mean?
Estradiol 16.9…8.0-35.0 three points higher from the month before.
Pregnenolone 88…55 the last time tested. I don’t think there is a reference range for it.
Fsh improved one point but still lower normal range.

Just stared testosterone and feel more energy but not as good mentally. Super nervous in the am now and woke up feeling exhausted for two days. Is it possible I am super sensitive to estrogen rises and falls.

I took a 12.5 Iodaral this morning and feel better. Getting a zrt cortisol and iodine test again to see if re is improvement there.

This is so hard to mange but I’m doing what I can.

Is it possible that Hcg will improve my LH which will make me feel better and the arimidex I hopefully go on will control the estrogen? Doing so will have me feeling better mentally and physically? Bringing everything together.

I had the thought that being on testosterone with higher estrogen sucks too so I’ll just deal with a test level of 227, but I realized that would be crazy. I couldn’t function much then. All in all its about getting the adrenals, thyroid, test and estrogen in range?