T Nation

Young & Would Like to Avoid TRT, Any Other Options? (Labs Included)


#1

Hello!

Firstly, this forum is amazing. I have learned so much thus far.

Recently I have been experiencing almost every symptom of low T. I crash mid day, I have been forgetting things, have a hard time staying awake, random joint pains, anxiety. I constantly back out of obligations just because I do not want to do anything. I’m sure some of this is to do with my weight. Even a lot of it. The problem is to get my weight in check, I need to get my T taken care of! I am overweight (250lbs). I have been attempting to get back into shape, and thus far have lost about 30 pounds just from diet modifications, cutting out junk etc. I have been seeing a PCP for treatment and he finally tested my T at my request. This is the second time its been tested. It was tested years ago and fell within range albeit just barely. In hindsight, I should have done something about it then. I was around 200 lbs at that time. The results of the last test were low and under range, 195 on a 348-1197 scale. He immediately prescribed a topical testosterone gel. I had my reservations and after reading more on it, have even more. I think other avenues should be explored first. I requested more labs and received them for the most part minus the E2. They came back and LH and FSH are both lower, which seems to indicate secondary hypogonadism? I pushed for HPTA restart, Clomid, or anything other that TRT and got nowhere. I have tried to find another doctor and saw a local Endo after doing some research and gained even less ground than with my PCP. There has got to be a cause that can addressed. I have had no testicular trauma or anything. I have no problem starting TRT, I just want to make sure it is 100% necessary.

I have been trying to find a doctor that will actually treat me, not blindly push TRT or write me off. It seems to be either extreme. If anyone can PM me a good doctor in the Houston area that actually knows his stuff, id love to have it. I have contacted a compounding pharmacy but they told me they couldn’t (or wouldn’t) tell me any doctors names. I will get the E2 test handled directly with a lab along with anything else, ill just have to pay out of pocket.

Age: 31
Height: 5’10"
Waist: 38"
Weight: 240lbs
Body/Facial Hair - Limited to moustache and patchy neck area. No stomach/back hair. Full head of hair.
Fat - I have been extremely obese for the last few years. Most of the fat is in the stomach and chest area.
Health conditions - High Cholesterol.
RX/OTC - Atorvastin to lower cholesterol. Started after first low T lab result.
Diet - I have recently cleaned my diet up (and lost over 30 lbs). Chicken / Red meat, leafy greens, whole grain rice, etc. I get sufficient iodine from my salt intake.
Training - I currently do no training. I lifted heavily in high school.
Testes ache, ever, with a fever? Nope
How have morning wood and nocturnal erections changed? I have not had morning wood in quite a few years. My libido has decreased as ive aged, but it is not yet nonexistent.

Lab Results (Afternoon draw)
Testosterone, Serum 195 348-1197 ng/dL
DHEA-Sulfate 323.8 138.5-475.2 ug/dL
Prolactin 6.0 4.0-15.2 ng/mL
Prostate Specific Ag, Serum 0.6 0.0-4.0 ng/mL
LH 3.1 1.7-8.6 mIU/mL
FSH 2.1 1.5-12.4 mIU/mL
TSH 2.070 0.450-4.500 uIU/mL
Estrogens, Total (Not E2) 75 (40-115 pg/mL)

New results - 8/16/2016 (Early morning draw)
Estradiol, Sensitive 22 (8-35 pg/mL)
Testosterone, Serum 240 (348-1197 ng/dL)
Testosterone, Free 11.6 (8.7-25.1)
SHBG, Serum 17.9 ( 16.5-55.9 nmol/L)

Metabloic Panel:
Glucose, Serum 91 65-99 mg/dL
BUN 12 6-20 mg/dL
Creatinine, Serum 0.94 0.76-1.27 mg/dL
eGFR If NonAfricn Am 108 >59 mL/min/1.73
eGFR If Africn Am 124 >59 mL/min/1.73
BUN/Creatinine Ratio 13 8-19
Sodium, Serum 140 134-144 mmol/L
Potassium, Serum 4.3 3.5-5.2 mmol/L
Chloride, Serum 101 97-108 mmol/L
Carbon Dioxide, Total 21 18-29 mmol/L
Calcium, Serum 9.7 8.7-10.2 mg/dL
Protein, Total, Serum 7.3 6.0-8.5 g/dL
Albumin, Serum 4.6 3.5-5.5 g/dL
Globulin, Total 2.7 1.5-4.5 g/dL
A/G Ratio 1.7 1.1-2.5
Bilirubin, Total 0.5 0.0-1.2 mg/dL
Alkaline Phosphatase, S 89 39-117 IU/L
AST (SGOT) 20 0-40 IU/L
ALT (SGPT) 20 0-44 IU/L


#2

TSH should be closer to 1.0
The lab ranges are useless

Please check oral body temperatures as per the thyroid basics sticky found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics
  • finding a TRT doc

Try other compounding pharmacies. Some will have referral pages. Explain from the beginning that you have low-T.

Low thyroid function can make you fat, so can low T. You have both and that is quite common with guys who end up here.

Are you sure that your package of salt states iodized? Do you take a vitamin product that lists iodine+selenium? Restaurants typically do not use iodized salt. Ditto for prepared foods.

Do you feel cold easily?
Outer eyebrows sparse?

We see that guys with low thyroid function do not absorb transdermal T; making that non-absorption a symptom of low thyroid function. So you may need to self-inject T.

You absolutely need to fix your low-T. Could you benefit from a HPTA restart [sticky] and avoid TRT? You can try, but good chance that it will not work. But we do see a pattern that suggests that low thyroid function may drive some of the secondary hypogonadism that we see here. So this is another factor not in your favor.


#3

Thanks KSman!

If restaurants are not using iodized salt, that could very well be an issue. I was making an incorrect assumption. My salt at home is iodized, but I using it sparingly. This may be an avenue I need to explore. No iodine-selenium supplement either.

Outer eye brows are very thick, i typically (due to being fat…) get warm or sweaty especially at night, however I have been getting cold lately oddly. That is a more recent phenomenon (since dropping the 30 pounds).

I will do the temperature logging and report back. I will also check with some other compounding pharmacies, perhaps wording it as a referral will be beneficial.

Thanks again for all you do on this board!


#4

To add, looks like the doctor did test my Estrogen, but not E2, ran total estrogen. Estrogens, Total 75 (40-115 pg/mL).


#5

I had to buy an oral thermometer. My temperature was at 98.7 yesterday afternoon. This morning it was actually 98.6 after waking with the oral, and 97.7 with the Braun in the ear style. I will get a few more measurements and report back.

Thanks again


#6

You need to get a more comprehensive estrogen test done and also include SHBG and free T. Your free T is what counts and if your SHBG is low you may not be horrible. Its definitely low though, but I would want to know those factors. Also, you really need to introduce some exercise my friend. Start slow and include resistance training. Resistance training (ie weight lifting) burns calories longer while your muscle are repaired. Cardio alone will strip muscle along with the fat. A good regimen is strength training 3x week and an hour walk 3x week. I recommend the hour walk because it burns 300-400 calories and doesn’t tear up your body with that excess weight you are carrying around like running/jogging would.


#7

E2, SHBG and Free T should be tested next week. Will report back. I have been walking about an hour and a half as many times a week as I can muster up the energy. I would love to add weight training back in I just dont have any gas in the tank. The problem is mainly I never start slow, I jump to where I was in High School and College and then regret it and dont touch anything for weeks or longer… Ill give it a shot. At this point, I would just like to not feel like a 100 year old man. I used to work 12 hour shifts, now I can barely make it through a full 8 hours of desk work


#8

Your total T is so low, it can be assumed free T is also very low.

Address all of the stuff KSMan brought up and find a new doctor who can get you on a SERM for your secondary hypogonadism.

Your level is about where I was at before I started clomid. If you start lifting again, I strongly recommend starting at the bar only. If you try to resume where you started, you will only hurt yourself. Increased T levels will make even lifting relatively light weights worthwhile and you can increase the weight rapidly.


#9

Thanks GonadTheBarbarian. Agreed on jumping back into it will only end up hurting myself. I just read through your log and it sounds very similar indeed. I also have horrid allergies as well. I did get a few names on some Endocrinologist that work with a compounding pharmacy that are about an hour away. My PCP referred me to another endo when I suggested SERM before TRT, saying it may be a good idea but that they wont prescribe it. Hopefully that appointment is not to far out.


#10

Yeah, 90% of my allergies are now gone.

Recently, a doctor friend of mine during a conversation said “I would never prescribe clomid to anyone with a penis.” So yeah, some docs just won’t do it, best to find someone who is familiar with low T issues… Not all endos are. You might do a google search in your area for docs that are familiar with TRT.


#11

Temps have been over 98 waking and 98.6-98.7 in afternoon.

Unfortunately docs are all booked for a few months. I set appointments with 2 different endos, one had no availability until October… Still waiting on the Free T / T / E2 / SHBG followup bloodtest.

Will report back when I get it!


#12

A bit of an update.

I met with a new endo finally (one that was booked far out), and it was another dead end. Doctor was not really interested in Low T as much as she was sending me on my way with some $500 weight loss pills. Was not alarmed by my numbers, didnt seem to think they were the cause for any of my symptoms etc.

I never started the prescription. I have an appointment with another endo that has TRT listed as a specialty. I booked this one well before the last one, but I am starting to lose hope. If its another dead end, I am just going to start the treatment. My weight loss has continued, albeit slower. I am beginning to plateau.

Latest test results (updating main post as well):
8/16/2016
Estradiol, Sensitive 22 (8-35 pg/mL)
Testosterone, Serum 240 (348-1197 ng/dL)
Testosterone, Free 11.6 (8.7-25.1)
SHBG, Serum 17.9 ( 16.5-55.9 nmol/L)


#13

Might be better to ask pharmacy references to GP’s. Endos and urologists simply fail as a group.


#14

The weight loss pills that work are all off patent and cheap I think. It’s basically legal meth, it’s lightweight amphetimines, been around since the 60s. At your weight you should be able to get some. I don’t think that’s the cause of your low T though.

Keep trying to find someone to correct your T. I also agree with KSMan that maybe you need to walk in and talk to a pharmacist who knows doctors that are prescribing T.


#15

As an update, I think I finally found a good Endo! Clomid was the first thing she suggested, and mentioned that we just need to watch the Estradiol. If we dont get results there, I’ll be doing an HCG, and lastly if all else fails ill start TRT. Its great to talk to someone that knows what they are talking about and isnt in it to push overpriced garbage I probably dont need. Ill be taking some more baseline labs and then starting Clomid. I will update when I have my followups in about 3-4 months!


#16

A good number of guys process Clomid differently and get nasty estrogenic side effects and generally feel like crap. If so, ask for Nolvadex that does not have that effect.

Docs typically dose these SERM’s too high and then very high LH causes high E2 levels from T–>E2 inside the testes. And that cannot be controlled with a competitive AI like anastrozole. You might have to print this for your doc if the problem occurs.

10-12mg/day Clomid or Nolvadex is often enough.

When on a SERM do these tests:
TT
FT
E2 - not total estrogens
LH/FSH <-- to see what is going on

See the advice for new guys sticky to understand unfamiliar terms.

Do not trust that this Endo knows enough, that would be a very rare condition.

More body temperature observations?

You really need to read the HPTA restart sticky if you think that you might be fixed.


#17

I have a doctors appointment next week, and have some intermediary results. I’ll have full labs done prior to that appointment.

E2 is high, total test has gone up and free test is in the top of the range. I feel no different, seems like this is common with Clomid. I have been having mood swings and been exceptionally angry, but thats about the only changes i’ve noticed. Still no energy, and heavy brain fog. I assume next step by doc will be starting an AI. Will update when I have follow up. I might suggest changing to Nolvadex. These 3 month follow ups kinda suck…

Testosterone, Serum 540 ng/dL (348 - 1197)
Free Testosterone 21.1 pg/mL (8.7 - 25.1)
Estradiol, Sensitive 54.1 pg/mL (8.0 - 35.0)


#18

As stated above:
Docs typically dose these SERM’s too high and then very high LH causes high E2 levels from T–>E2 inside the testes. And that cannot be controlled with a competitive AI like anastrozole. You might have to print this for your doc if the problem occurs.

What is your Clomid dose?

AI will not work.

Nolvadex may improve mood, but E2 may be the cause of your mood/anger.

Have you read the stickies?