23 Y/O After 1 YR TRT - Something Still Wrong

Pharma / TRT Testosterone Replacement
1

HISTORY:
I am 23 years old and starting experiencing symptoms of low T around age 17 or so; it was a gradual onset. By age 21 it had gotten so bad that I finally went in to get checked out by the doctor. At this point, these were my symptoms:
- slept 9-10 hrs/night yet was so tired I felt like I was in a waking coma
-brain fog, terrible memory
-freezing cold all the time

  • libido was about a 0/10. Did not even notice pretty girls. Erections never occurred spontaneously. No morning wood
    -worked out 3x/wk yet was gaining fat and losing muscle slowly but surely
    -had lost interest in everything I used to enjoy. Had no joy left in life, really
    -became so depressed that I struggled with very strong suicidal tendencies for the last 3-4 months before staring testosterone

Doc found T level of 280 ng/dL 1 year ago now and prescribed Test Cyp 120 mg/week (given bi-weekly). I soon felt markedly better than I had, but still lousy enough that I really didn’t have much joy in day to day life. Honestly, I still felt terrible; just less terrible than before. This doc referred me on to an endocrinologist for further treatment. I had reduced my Testosterone to 100 mg/week (50 bi weekly) at this point on my own because for whatever reason it improved my symptoms slightly.

The endo ordered a MRI to rule out pituitary tumor, which thankfully was negative. He also started me on Levothyroxine 50mcg/day for somewhat low thyroid levels, which warmed me up and ramped up my appetite but improved mood and energy only very slightly, which were the main concern. He next ordered a sleep study, which I just completed and am now waiting to consult with that doctor (a Pulmonologist) before seeing my endo again in 10 weeks. I and the pulmonologist are pretty darn sure I don’t have narcolepsy or sleep apnea; if there is actually a sleep cycle problem then it is something else.

CURRENTLY:
I am 5’11", 160 lbs., about 7% body fat. I have more body hair than most. I eat a healthy diet and weight train 3x/wk, run about 15 miles per week. I take no other medications besides the Test Cyp and Levothyroxine. Of possible note is that I have Tourrette Syndrome, which I have had since a young child. It is not bad enough that medication is necessary, however.

Most current labs:

TT: 635 ng/dL (241-827)
FT: not tested
E2: not tested
Prolactin: 6.7 (2.10-17.7)
Cortisol: 12.7 ug/dL (5-23)
TSH 2.12 uIU/mL (0.3-4.0) *all thyroid levels are before starting Levothyroxine
Free T3: 2.9 pg/mL (2.0-4.4)
Free T4: 0.71 ng/dL (0.8-1.8)
PSA: not tested
FSH/LH: my only records reported only that they were “in normal range” before starting TRT 1 yr ago

As far as the whole TRT thing, I honestly still feel terrible, something just is not right. This has gone on for years now and I’m really starting to lose hope of ever feeling well again and actually enjoying being alive .Here’s what I’ve got going on right now:

I feel sleepy/groggy nearly all the time despite sleeping 8 hours per night. I wake up feeling not-well rested and stay feeling tired throughout the day, and I really crash by late afternoon. I really don’t enjoy much of anything anymore, though I make myself do social things and get out even though I don’t feel like being social. I feel about 50% better mood (and energy somewhat) when I’m around other people.
The biggest thing is that I feel just downright depressed and very sad for no apparent reason; my life is honestly good besides all this. I do feel strangely close to crying often when I never would have before, but no gyno or anything like that.

I notice girls mostly like works of art. I do have nocturnal erections now but morning erections I’m not sure; I don’t think I usually have them. I will have to take note. I have very low libido; I have no desire to masturbate. If I make myself, the erection is weak, it takes awhile to ejaculate, and ejaculation amount seems pretty low in volume to me. Testes never ache and they are not retracted up close to my body. After 6 months of TRT, I asked my endo if I needed HCG to maintain fertility. He measured my testicles and said they were exactly average size for my age; said it is expensive and that we won’t mess with it unless we have to. So we have not.
Lastly, and I think importantly, I always feel my worst 2-3 days after my injections. If I try a higher dosage, all the symptoms worsen together quite dramatically. All the symptoms seem to peak out and wane out together, but they are always there. If I give my whole weekly injection in one dose, all symptoms are much worse within 2-3 days, lasting 1-2 weeks before leveling out to where they normally are. At the same time, why should I feel markedly better (nearly 50% I would say) when around other people if it were an E2 problem?

Questions:

  1. Could this simply be clinical depression??? Or does it sound hormonal?
  2. Is estradiol a big concern for someone like me? Is it very likely that with such a level of T (635 ng/dL), E2 will be excessively high?
  3. How essential are AIs and HcG for someone like me, and how expensive are they in the U.S.? If necessary, does anyone know of any literature that supports it that I could take to show my endo?
  4. What could I change right now so that I don’t have to live the next 2 1/2 months until my follow-up apptmnt) feeling absolutely terrible? Is it worth trying ing 3 injections per week and reducing to 80 mg/wk (as progressively higher T levels seem to make me feel worse?)

Thanks so much in advance, I really appreciate any advice anyone might be able to offer

2

testosteronewisdom.blogspot.ca/2012/04/how-to-prevent-heart-attacks-if-you-are.html?m=1

Yes e2 is a concern. Have you had your adrenals checked? Why no thyroid labs after trt and what were the lh and fsh numbers? You need more labs my friend.

Go to allthingsmale find an article called "trt a recipe for success " print that off and bring it to your endo. Problem is he may become offended as most of them think they are god.

3

[quote]iw84aces wrote:
testosteronewisdom.blogspot.ca/2012/04/how-to-prevent-heart-attacks-if-you-are.html?m=1

Yes e2 is a concern. Have you had your adrenals checked? Why no thyroid labs after trt and what were the lh and fsh numbers? You need more labs my friend.

Go to allthingsmale find an article called "trt a recipe for success " print that off and bring it to your endo. Problem is he may become offended as most of them think they are god.[/quote]

My follow-up to check the thyroid labs is July 25; this was the earliest follow-up I could get with my endo after starting the levothyroxine. I remember LH and FH being close the middle of the lab reported range before TRT, but can’t find those numbers anywhere in my labwork records, and it has not been tested recently while on TRT

4

Would not be tested while on trt. Lh and fsh would be very low as they would be shut down. Endo’s can be a real pain in the ass. The whole crying thing could be because t is being aromatased to E. E2 must be checked. I also see maybe thyroid or adrenal problems as having a role here. Have you any pain? Tingling in hands and feet? Excessive thirst or unrination? Do you have the means to order labs out of pocket? If so go to lef.org.
Read the stickies on the top of first page.

Advice for new guys

Thyroid basics

Lab testing

E2 why it matters.

Read them all and add in all labs you have. Even the ones you might think don’t matter. List when they were tAken and at what point I. The week I. Reference to your shot.

Good luck :slight_smile:

5

What medications are you on for the Tourettes? Your symptoms sound suspiciously like psych med side effects.

By the way, nocturnal erections/morning erections are the same thing. It just depends which stage of sleep you are in before waking up in the morning whether you’ll still have one, so if you have nocturnal erections, that’s enough.

6

np: Read thyroid basics sticky and come back with history of iodine intake from iodized salt and vitamins that list iodine. Post your oral waking and mid afternoon body temperatures. If you are not getting iodine from those sources, doc may be treating iodine deficiency with thyroid meds.

You may have ‘adrenal fatigue’. Get and read Wilson’s book on that. Need fasting cortisol.

More labs please, need total cholesterol.

Where are you located? This affects your options.

TRT can restore metabolic rates. But if you have thyroid and/or adrenal problems, TRT can make some feel worse or not feel better at all.

There is a big learning curve. Please read the suggested stickies and that book.

7

[quote]KSman wrote:
np: Read thyroid basics sticky and come back with history of iodine intake from iodized salt and vitamins that list iodine. Post your oral waking and mid afternoon body temperatures. If you are not getting iodine from those sources, doc may be treating iodine deficiency with thyroid meds.

You may have ‘adrenal fatigue’. Get and read Wilson’s book on that. Need fasting cortisol.

More labs please, need total cholesterol.

Where are you located? This affects your options.

TRT can restore metabolic rates. But if you have thyroid and/or adrenal problems, TRT can make some feel worse or not feel better at all.

There is a big learning curve. Please read the suggested stickies and that book.

[/quote]

Thanks much for your input KSman! I really appreciate your feedback. I have read all of the stickies a couple of times but still haven’t managed to figure my case out, unfortunately.

IONDINE/THYROID: I take a daily multivitamin which has 150mcg of Iodine but do not add iodized salt to my food. After starting Levothyroxine 8 weeks ago, my mood and energy changed very little. However, I warmed up dramatically and my appetite probably increased by 30%. I now dress the same as all the other guys my age and sweat during workouts that never used to make me even start to sweat.
I’m going to have to wait until July 25 to do my followup labs showing the new thyroid levels on Levothyroxine.
Also, my endo palpated my thyroid gland to help rule out goiter along with the TSH and said that it is normal size, there is no detectable enlargement.

Considering this, do you think it’s likely that thyroid problems are still the issue?

CHOLESTEROL LAB: 155 mg/dL (0-200 mg/dL)

ADRENAL FATIGUE: Fasting AM Cortisol was 12.7 ug/dL (5-23), which my endo was not concerned about. Do you think this level is a concern as far as adrenal fatigue? I will do some more reading into this subject

I am located in Chattanooga, TN; but travel to Knoxville to see the endo my doc recommended. I think he is a really intelligent and also nice doc, but TRT is probably not something he deals with mainly.

**What do you think the implications my be given the fact that I always seem to feel worst 2-3 days after injections (now bi-weekly) and that progressively higher doses given in one injection make me feel progressively worse??

8

I often need to ask for body temperatures a few times before there is any action.

You cannot get out of an iodine deficiency [ID] with 150mgc, that is treading water. For a IR of 750mg, that is 5000 doses of 150mcg! I would not assume that one does not need iodine if they are on a thyroid hormone med.

I often state that it is wrong to treat ID with thyroid hormones. Do you have ID plus an underlying thyroid dysfunction/condition? Not so easily determined. You might find that IR reduces your med needs. Best result would be not needing at all after IR.

Body temps are also your guide to thyroid med dosing.

We know that TRT can make some with low thyroid function feel bad as the thyroid is not able to support the restored metabolic rates created by TRT. So your problem may be a response to the T peaks after injections. So that is a plausible explanation.

9

[quote]KSman wrote:
I often need to ask for body temperatures a few times before there is any action.

You cannot get out of an iodine deficiency [ID] with 150mgc, that is treading water. For a IR of 750mg, that is 5000 doses of 150mcg! I would not assume that one does not need iodine if they are on a thyroid hormone med.

I often state that it is wrong to treat ID with thyroid hormones. Do you have ID plus an underlying thyroid dysfunction/condition? Not so easily determined. You might find that IR reduces your med needs. Best result would be not needing at all after IR.

Body temps are also your guide to thyroid med dosing.

We know that TRT can make some with low thyroid function feel bad as the thyroid is not able to support the restored metabolic rates created by TRT. So your problem may be a response to the T peaks after injections. So that is a plausible explanation.

[/quote]

KS Man,

TI will begin testing body temp. tomorrow morning and get back to you on that ASAP. I will also start Iodine supplementation to see if that solves this whole thing by any chance.

What do you think about the AM cortisol level of 12.7 mcg/dL? As I read more, this seems to become more and more suspect in my mind.

-npeters1989

10

Over the past 7 days I have now taken 350mg of Iodine (50mg/day). I’ve noticed no real difference that I can tell with the IR. For what it’s worth, I was and still do feel hot and my face feels flushed most of the time after starting Levothyroxine 50mcg/day 10 weeks ago. I sweat during workouts I never used to.

Here are my temperatures, measured by a cheap fever thermometer, beginning day 2 of the Iodine Replacement.

AM: 97.5, 97.5, 96.9, 97.2
PM: 98.1, 98.1, 98.2, 98.4,

However, I have reason to doubt the accuracy of the cheap $7 thermometer I bought (& recorded the above temps with). Checked with my mom’s old mercury thermometer, which she says she has found to be far more accurate over the years when comparing to more expensive thermometers. On this, she was 98.8 and I was 99.3 F mid-afternoon.

**Here are some additional labs that were done and could possibly be relevant:

Prolactin 6.7 (2.10- 17.70)
Ferritin 13, then 12(20-345 ng/mL)
Total Iron 79 (45-175 mcg/dL)
% Saturation 20 (20-50)
Iron Binding Capacity 399 (250-425)
Glucose 54, then 69(70-105 mg/dL)

***I will be seeing my endo next Friday. Basically, what should my biggest concerns to discuss with him i.e. what is most likely the chief cause of the symptoms I’m having???

  1. ESTRADIOL. When my E2 lab comes back (will be ready when I see the doc), what general range would concern begin at? In other words, how high would E2 need to be in order to be considered even a possibility for my symptoms?

  2. CORTISOL (12.7mcg/dL)Could this possibly a concern or is this pretty solid?

  3. FERRITIN/GLUCOSE- could these be significant?

And lastly, how much of a concern is it to be on only Test Cyp 100mg/wk, and not HCG or Anastrozole? Is there any solid literature out there that I could reference to support these so the endo could have something to go off of?

I know this is a whole lot of stuff. Thanks in advance to anyone willing to help out! I would appreciate any advice I can get from those of you who know much more than I do.
-npeters1989

11

[quote]iw84aces wrote:
Would not be tested while on trt. Lh and fsh would be very low as they would be shut down. Endo’s can be a real pain in the ass. The whole crying thing could be because t is being aromatased to E. E2 must be checked. I also see maybe thyroid or adrenal problems as having a role here. Have you any pain? Tingling in hands and feet? Excessive thirst or unrination? Do you have the means to order labs out of pocket? If so go to lef.org.
Read the stickies on the top of first page.

Advice for new guys

Thyroid basics

Lab testing

E2 why it matters.

Read them all and add in all labs you have. Even the ones you might think don’t matter. List when they were tAken and at what point I. The week I. Reference to your shot.

Good luck :)[/quote]

^
Great info in this post, very succinct and easy to absorb.

Thanks for sharing.

12

The time of day for cortisol is important. Typically it should be done at 8AM.

E2 needs to be in the context of FT or Bio-T. So can’t say much. Anything in the 30’s is an issue from a quality of life point of view. But most docs do not see a pathology so they will not intervene.

Would be good to see what that thermo reads for others as well.

You are on thyroid meds and that should be normalizing body temps and lowering TSH. TSH indicated not enough dosed. But your body says that you are overheated. Your thermo says that body is cool. Her thermo says that you are warm in the afternoon. IR is useful if deficient. and body temps would be expected to be driven by the drug, not the iodine.

How do your feelings of heat change during the day and how does that pattern match dosing?

Ferritin and iron:
Labs suggest possible chronic GI bleed. Any digestive issues or known food sensitivities. Would be good to have your CBC data, liver markers. DHEA-S and blood pressure. Low ferritin is associated with thyroid problems. Ask for an occult blood test kit. You take that home, smear some poop on the cardboard sample card and mail that off for analysis. There can be many different causes for problems of this nature.

For your thyroid labs: Was that before or after Levothyroxine?
Did you start to feel overheated with Levothyroxine or prior?
If you stopped Levothyroxine, what is your guess on how you would feel.
If you have adrenal fatigue with elevated rT3, Levothyroxine would make that worse.
If your feeling of heat was not related to body temperature and your body temperatures are low, this can make some sense. Not explaining the feeling of heat, but makes other things fit.

Did you read the stickies that I suggested? I feel like there is a lot more info that should be here.

13

TEMPERATURE: I measured temp on myself and my friend who has no health issues using the same cheap fever thermometer I used for the 1st 4 days I recorded on Iodine. Perhaps the iodine is in fact doing something as far as temperature. I’m now 98.6 F mid-PM on day 8 Iodine; my friend is 98.4 for comparison. Unfortunately, I’ve noticed absolutely no change in any of my symptoms besides the temp change with the IR.

LEVOTHYROXINE & LABS: the most recent labs I have had were done right before starting Levothyroxine. I will be getting more labs this Friday to assess the effect of Levothyroxine + to take a look at the other stuff. I’ve requested Free T, E2, & Cortisol to be included this time and my endo agreed to that.

After starting Levothyroxine on 3/15/13, I noticed a gradual but steady increase in both body temperature and also appetite, which increased by at least 25-30%. The effect on mood and energy was very slight, maybe 10% improvement at best. I haven’t noticed any type of temperature fluctuation throughout the day at present or in the past. I haven’t messed with the Levothyroxine dosing or the Iodine dosing so far. Before levothyroxine, I felt freezing cold all the time and dressed more warmly than most 8 year old girls (literally). Also much less appetite, and mood + energy just slightly worse.

FERRITIN AND IRON: I have never had any type of GI problems and have no food sensitivities that I know of. I eat and everything gets processed timely without incident.

And here is the most recent (pre-Levothyroxine) CBC:

Sodium (135-145 mEq/L) 139
Potassium (3.5-5 mEq/L) 3.9
Chloride (98-108 mEq/L) 100
CO2 (21-31 mEq/L 31
Glucose (70-105 mg/dL) 87 (non-fasting)
BUN (7-24 mg/dL) 17
Creatinine (0.6-1.35 mg/dL) 1.12
GFR (90-120) mL/min >60
Calcium (8.4-10.2 mg/dL) 9.5
Total Bilirubin (0.2-1.30) 1.6***
Total Protein (6.0-8.0 g/dL) 7.6
Albumin (3.5-5 g/dL) 4.7
AST (10-42 IU/L) 35
ALT (10-55 IU/L) 26
Alkaline Phosphatase (38-124) 53
WBC (4.6-10.2 K/uL) 6.1
RBC (4.5-5.6 M/uL) 4.7
HGB (14-18 g/dL) 16.3
HCT (42-52) 47.3
MCV (80-94) 100.8***
MCH (27-31.2 pg) 34.8***
MCHC (31.8-35.4 g/dL) 34.5
RDW (11.6-14.8 %) 14.1
PLT (142-424 K uL) 252
MPV (7.4-10.4) 8.4

That’s all the extra info I have right now, hopefully it will help. I will be getting more labs and will be discussing them with my endo this Friday, so I’m just trying to narrow down what I should discuss with him that day, i.e. what is most likely causing the bulk of my symptoms. Again, any additional thoughts on this would sure be welcome!

Thanks

14

Changes to waking temperature?

How does stress factor into your life? Any major stress events?

15

Waking temp is still around 97.2F by the cheap thermometer. Who knows whether Iodine actually increased the temp or not. It seems like afternoon temp did come up, but maybe it’s all just thermometer error. I do know, though, that the 2 more reliable thermometers I compared to in the past week both had me at or above 98.6 for PM.

I really don’t stress too much now and don’t tend to stress overt things by nature. However, I was pretty stressed for the past 4 years or so, especially before starting TRT. Mostly a worry issue. I felt horrible and it seemed like there was bad lead after bad lead and huge stretches of time involved in trying to get it all figured out. I did have high external demands at times but I don’t tend to worry about things I can do something about. I tried not to but did stress out for sure over my health, which I felt I had little to no control over and not much hope for fixing at times. Not sure if that’s what you’re looking for or if “worry type stress” would impact the adrenals…anyways, hope this helps.

16

Just got labwork back from my endo. Still waiting on FT

17

Just got labwork back from my endo. Still waiting on FT and TT

TSH 2.17 (0.49-4.67)
Free T4 0.75 (0.71-1.85)
Cortisol 8AM 19.55 (4.3-22.4)
Estradiol 43.9 (11.6-41.2)

I’m thinking Estradiol might be the main problem and Free T4 the second runner. Endo upped Levothyroxine from 50-75 mcg/day, but I’m not expecting that to do much as 50 mcg only increased free t4 from 0.71-0.75 (though I did warm up and notice increase in appetite, but not much in mood or energy). I asked about the estradiol and my endo was not concerned “mainly and issue with older, heavier guys”. I’m considering at least trying Arimidex to see if it helps if it is still available OTC. Any thoughts?

Thanks

18

Doc is way wrong re E2. Give anastrozole a try.

fT4 should be near 12.5. Suggest that you experiment with higher doses and watch your temperature. Would be better to have fT3 as that is what gets the job done. T4 is simply a reservoir to make T3.

Thermometer: No exercise, talking, eating or drinking 1/2 hour before measurements.

19

Did you ever find a good doc? I’m looking for one in the Chattanooga area as well.

20

Good day to you! I am so sorry to hear that you’re having such a hard time with your health. Your story struck a nerve with me because it sounds similar to mine. I have been suffering from being tired and other low-T symptoms for over ten years and I’m about to have my 32nd birthday.

Compared to me, you might actually be doing better because for the first five or so years, I listened to family and friends who told me that the illness was “all in my head”, which I tended to believe because I wasn’t handling stress well.

I have come to see low-T as the likely result of another illness as opposed to the root cause of the illness. I’m told that some pathogens have evolved to damage your hormones because the resulting lower body temperature makes your body a more hospitable environment for themselves. One doctor I saw recommended a test called “CD57” that is used to screen for Lyme infection. He subsequently recommended herbal antibiotics that helped, but didn’t completely fix the problem.

Another perspective I’ve been looking at this from is healthy sleep. As you may know, your body makes HGH, T, and all other kinds of good stuff while you are asleep. If you have an illness such as sleep apnea, upper airway resistance, or periodic limb movements, this can cause all sorts of hormonal imbalances. I’m told that sleep apnea can reduce blood flow to the testicles, and I get the impression that upper airway resistance is absolute murder to the adrenal glands. (The symptoms of upper airway resistance read almost exactly the same as the symptoms of adrenal fatigue.)

The above sleep disorders can be diagnosed by a good sleep lab. In my own research, one of the most prominent doctors I’ve come across for sleep is Barry Krakow. He has an excellent video blog, plus he’s written a book that will tell you all about the above illnesses. I would highly recommend looking in to getting a basic test done called an “overnight sleep study” or polysomnogram (PSG). When done well, these tests can screen you for these illnesses and lead to the prescription of appropriate treatment, but beware: as with endocrinologists, many sleep docs are idiots! Do you due diligence and find the best specialist you can! Any sleep doc worth his salt should be able to discuss the above three illnesses (and more) in great detail! There is also great variance in pricing and quality between different labs. Also, you may consider taking 10mg Ambien before your lab to ensure that they are able to actually observe you sleeping!

I’m not a doctor. This is not medical advice. Consult your health professional.

(Edited because I accidently left out the name “Ambien” after “10mg” near the end)