T Nation

What Do I Do...


#1

Hello
My name is Jacob, Im 42 years old. Currently I weigh 185lbs and my height is 5'10"
End of 2011 I started going to my PCP to get my annual checkup. At that
time I had depression, was taking 60mg/day of cymbalta and my weight was 240lbs. My PCP
called me back to tell me that I'm overweight my TSH is high and my testosterone is very low.

At that time my total T was 87 to 97 with the scale of 255-1040. On top of all that I had what
may look like beginning of gynecomastia, so my PCP referred me to an endocrinologist.
The endocrinologist diagnosed me with "empty sella syndrome", and looked at my gyno condition.
Before the visit was done he told me that I should start taking thyroid pills and start taking
testosterone. He told me that will bring my gyno under control. So I did it not knowing that it
will be one of my biggest regrets. After some time I was able to stop taking the antidepressants,
and I was losing weight. About 7 months into my treatment I noticed that my gyno is getting
worst. This bothered me. When I talk to my endo about this he prescribed AI's but after taking them
I got depressed. I didn't know what to do. I was afraid of quitting the TRT, not knowing
what will happened to my body. I decided to use less testosterone and still get the benefits.

Fast forward to today. I lost about 55lbs. My left chastise is slightly bigger, and overall my gyno
looks worst. Few times I tried to quit, but every time I get depressed, I can't sleep, I eat a lot more.
Today I'm at a point where I really don't know what to do. I can't take a full advantage of the TRT
because it acts on my gyno.
On the other hand I can't quit either because when I do I will get right back to antidepressants before
my natural testosterone get to its optimal level.
Please give me some advice.
Thanks


#2

There is a lot that you need to know. Please start by reading these stickies:

  • advice for new guys
  • thyroid basics - pay attention to iodine, iodized salt and body temperatures
  • finding a TRT doc

You can’t be telling us that AI made you feel worse and not describe your medication protocol in detail if you want assistance.

Please post current lab work with ranges.


#3

At the time when I noticed that my gyno is being affected I was using 2 pumps of Axiron a day containing total of 60mg of testosterone. When I talked to my endocrinologist he prescribed Anastrozole to be taken 0.25mg a day. I need to mention this that before the uso of AI my E was 27 on a scale of 0-39 and my total testosterone was 506. Other medicine that I was (still am) taking is Levothyroxine 137mcg/day.

I thought taking AIs would solve my problem, but my mood worsened so I couldn’t take it for long. When I looked around for an answer I learned that estrogen is a natural antidepressant and when you lower it down it may affect your mood. I don’t take any other medication.
I would appreciate any advice on my situation.
Thanks


#4

[quote]Jacob313 wrote:

I would appreciate any advice on my situation.
Thanks[/quote]
Read the second post in this thread, follow it and provide the requested information.


#5

Testosterone, Bioavailable

279 ng/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range131 ng/dL - 682 ng/dL
Testosterone Male

474 ng/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range300 ng/dL - 890 ng/dL
Thyroid Peroxidase Antibody

402.6 IUnits/mL (High)
Date May 08, 2015 01:48 p.m. EST Reference RangeIUnits/mL - 34.0 IUnits/mL
% Free Testosterone

2.0 % (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range1.6 % - 2.9 %
BUN/CREAT Ratio

17.3 (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range12.0 - 20.0
Testosterone, Free Male

96 pg/mL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range47 pg/mL - 244 pg/mL
Sex Hormone Bind Glob

27 nmol/L (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range11 nmol/L - 80 nmol/L
Glycohemoglobin

5.5 % (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range4.0 % - 6.0 %
GFRA

60 (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range60 - 130
GFRC

60 (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range60 - 130
A/G Ratio

1.5 (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range1.0 - 2.4
Serum Turbidity

CLEAR (Normal)
Date May 08, 2015 01:48 p.m. EST Reference RangeCLEAR
Globulin

3.2 gm/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range1.8 gm/dL - 3.6 gm/dL
WBC

5.8 Thou/cu mm (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range4.0 Thou/cu mm - 11.0

Thou/cu mm
TSH

2.03 mcunit/mL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range0.27 mcunit/mL - 4.20

mcunit/mL
Triglycerides

120 mg/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range30 mg/dL - 149 mg/dL
Total Protein

7.9 gm/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range6.2 gm/dL - 8.1 gm/dL
Sodium Level

141 mmol/L (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range135 mmol/L - 145 mmol/L
RDW

14.9 % (High)
Date May 08, 2015 01:48 p.m. EST Reference Range11.5 % - 14.5 %
RBC

5.54 Mill/cu mm (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range4.6 Mill/cu mm - 6.2

Mill/cu mm
Potassium Level

5.1 mmol/L (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range3.5 mmol/L - 5.2 mmol/L
Platelet

254 Thou/cu mm (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range150 Thou/cu mm - 400

Thou/cu mm
MPV

8.7 fL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range7.0 fL - 12.0 fL
MCV

87.6 fL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range80 fL - 100 fL
MCHC

33.4 % (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range31 % - 36 %
MCH

29.3 pg (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range27 pg - 34 pg
Hgb

16.2 gm/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range13.5 gm/dL - 18.0 gm/dL
HDL Cholesterol

42 mg/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range40 mg/dL - 75 mg/dL
Hct

48.5 % (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range38.0 % - 54.0 %
Glucose Random

92 mg/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range70 mg/dL - 200 mg/dL
Estradiol Level

15.7 pg/mL (Normal)
Date May 08, 2015 01:48 p.m. EST
REFERENCE RANGES (pg/mL)
Male: Prepubertal: <5 Adult: 7.6-42 Female - Follicular: 12-166 Mid-Cycle:

86-498 Luteal: 44-211 Post-Menopausal: <55 Prepubertal: <6


CO2

28 mmol/L (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range23 mmol/L - 34 mmol/L
Cholesterol

193 mg/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range140 mg/dL - 199 mg/dL
Chloride

102 mmol/L (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range98 mmol/L - 109 mmol/L
Calcium

10.0 mg/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range8.4 mg/dL - 10.5 mg/dL
BUN

17 mg/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range8 mg/dL - 20 mg/dL
Bili Total

0.9 mg/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Rangemg/dL - 1.5 mg/dL
AST (SGOT)

147 IUnits/L (High)
Date May 08, 2015 01:48 p.m. EST Reference RangeIUnits/L - 45 IUnits/L
ALT (SGPT)

413 unit/L (High)
Date May 08, 2015 01:48 p.m. EST Reference Rangeunit/L - 45 unit/L
Alk Phos

69 unit/L (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range20 unit/L - 125 unit/L
Albumin Level

4.7 gm/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range3.5 gm/dL - 5.0 gm/dL
LDL Cholesterol Calculated

127 mg/dL (High)
Date May 08, 2015 01:48 p.m. EST Reference Range60 mg/dL - 99 mg/dL
AGAP

11 mmol/L (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range4 mmol/L - 14 mmol/L
Creatinine

0.98 mg/dL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range0.70 mg/dL - 1.50 mg/dL


#6

Thyroid Peroxidase Antibody
402.6 IUnits/mL (High)
Date May 08, 2015 01:48 p.m. EST Reference RangeIUnits/mL - 34.0 IUnits/mL

TSH
2.03 mcunit/mL (Normal)
Date May 08, 2015 01:48 p.m. EST Reference Range0.27 mcunit/mL - 4.20

Estradiol Level
15.7 pg/mL (Normal)
Date May 08, 2015 01:48 p.m. EST
REFERENCE RANGES (pg/mL) Male: Adult: 7.6-42

AST (SGOT)
147 IUnits/L (High)
Date May 08, 2015 01:48 p.m. EST Reference RangeIUnits/L - 45 IUnits/L

ALT (SGPT)
413 unit/L (High)
Date May 08, 2015 01:48 p.m. EST Reference Rangeunit/L - 45 unit/L

You have a thyroid autoimmune disease and need thyroid medication. Your TSH=2.03 suggests that you are under medicated. Many need to get TSH quite low before they feel better. Many docs do not understand this.

I said: "- thyroid basics - pay attention to iodine, iodized salt and body temperatures "
You need to check your body temperatures and post them here and also explain your past iodized salt use. You should seek to increase thyroid meds with body temperature as your dosing guide.

E2=15.7 is a bit low, but should not make you feel horrible. Change your dose by decreasing by a factor of 15.7/22

fT levels change fast with transdermal T. So you should be using TT as your guide. TT=474 is too low. This indicates that you are a poor absorber of transdermal T and that is common with hyperthyroidism. You can double your transdermal T dose or switch to injected T where absorption is not in doubt and this is also less expensive.

If you increases your T levels, you will need to also increase your anastrozole and seek to balance E2 near E2=22pg/ml

AST & ALT suggest that there is something wrong with your liver. This can be a disease or liver affected by drugs/alcohol or other substances or toxins. Do you work with chemicals or near fumes?

Summary:

  • you need more thyroid meds
  • you need to check and post body temperatures
  • you need less anastrozole with current T levels by factor of 15.7/22
  • you need to double your T levels with more transdermal T or switch to injection
  • above will require more anastrozole, perhaps by a factor of 2x15.7/22

Injections:

  • see advice for new guys sticky
  • see protocol for injections sticky

Where are you located?

Proper gyno management requires that E2 be managed, seek E2=22pg/ml
You also should test prolactin levels as that promotes gyno and can cause hypogonadism, depression etc


#7

Thanks. One more question. For the past 4 months I feel big anxiety through the day, and because of that I’m thinking about going back on antidepressants. The question is: is that gonna worsen my gynecomastia?

I know you may say to take more testosterone, but I don’t want to because that causes more anxiety for me and I have problems with sleeping. Also I don’t want to take AI’s because it makes me depressed. I feel that I need to resolve this problem, and move forward. Sadly, I think going on trt was a big mistake I have made.

Thanks.


#8

Some, a known problem, have problems with TRT if thyroid is not right.
AI’s make you depressed or getting E2 too low makes you depressed.
A few do not tolerate or get balanced on anastrozole, you could try low dose EOD aromasin. Living with high E2 is not a good option for your mood either.


#9

I was always wondering about antidepressants and TRT?
It is widely believed that anti depressants lower testosterone. What I’d like to know is if supplying testosterone from outside (as it’s done with TRT) will also lower ones testosterone level?
Other question is about 5-HTP. I struggle with sleep, did some reading and
learned that low levels of serotonin is connected with bad sleep quality. I found one study that indicates that L-tryptophan (ingredient of 5-HTP) does lower testosterone, but again will this be the same for people on TRT? When taking 5-HTP am I lowering my testosterone?
Thanks


#10

When drugs lower T levels: Drug competes for liver enzyme pathways that clear E2, E2 increases, LH decreases, T decreases. This is called an endocrine disruptor. SSRI’s are horrible for a few reasons, Wellbutrin is much better if it works for an individual.

TRT increases T levels while reducing whats left of your current production.

What I do for sleep:
5-6 mg TIME RELEASE melatonin, must be time release
trazodone, very inexpensive Rx drug, start at 50mg, get script for 150mg tabs and the are scored to break at 50 and 75mg


#11

I will try that. Thanks.