24, Low Free T. high SHBG, MRI found prolactinoma :: TRT log for icedtea1

Pharma / TRT Testosterone Replacement
1

I’m 24 years old. 6’3", 155 lbs. I just started T + hCG + Arimidex on Thursday.

My troubles with my hormones started when I was 13 – I had a clinically delayed puberty. Not terribly dramatic, but a look at my wrist growth plates and testicular volume indicated I was about a year behind. For the last decade I have chronically been underweight, low confidence, anxious, depressed, fatigued. My face looks like a teenagers. Consistent diet and strength training gives me some okay strength gains, but it is very difficult to put on mass, and it disappears as soon as I stop working out. My libido is okay, not as high as I’d like, and I don’t have ED, but I can’t keep up with my partner. I’ve never had a wet dream and rarely have a morning erection.

At 22 I requested a testosterone test from my PCP. The test came back at 400 NG/DL – well “within range” and he sent me on my way. No more in depth blood work was done and unfortunately I didn’t seek a second opinion.

I’ve since moved to a new state and decided to visit a testosterone specialist mens clinic. Here is my blood-work.

TESTOSTERONE 546 NG/DL 300-1080
SEX HORM BIND GLOBULIN 52.6 NMOL/L 16.5-55.9
CALCULATED FREE TESTOSTERONE 8.26 NG/DL 9-30
ESTRADIOL 20.5 PG/ML <=60.7
WBC 5.2 K/UL 4.0-11.0
RBC 5.75 H M/UL 4.10-5.70
HEMOGLOBIN 15.9 G/DL 13.0-17.0 MAIN
HEMATOCRIT 45.0 % 37.0-49.0
MCV 78.3 L fL 80.0-100.0
MCH 27.7 PG 27.0-34.0
MCHC 35.3 G/DL 32.0-35.5
RDW 13.0 % 11.0-15.0
NEUTROPHILS 39.5 L % 40.0-74.0
LYMPHOCYTES 46.6 % 19.0-48.0
MONOCYTES 6.9 % 4.0-13.0
EOSINOPHILS 5.7 % 0.0-7.0
BASOPHILS 1.3 % 0.0-2.0
PLATELET COUNT 192 K/UL 130-400
PSA, TOTAL 0.43 NG/ML <=4.00
PROLACTIN 16.8 H NG/ML 4.0-15.2
FOLLICLE STIM HORMONE 1.8 IU/L 1.5-12.4
LUTEINIZING HORMONE 3.8 IU/L 1.2-8.6
GLUCOSE 82 MG/DL 70-99
BUN 10 MG/DL 6-20
CREATININE 0.83 MG/DL 0.80-1.40
eGFR AFRICAN AMER. 143 ML/MIN/1.73>60
eGFR NON-AFRICAN AMER. 123 ML/MIN/1.73>60
CALC BUN/CREAT 12 RATIO 6-28
SODIUM 140 MEQ/L 133-146
POTASSIUM 4.4 MEQ/L 3.5-5.4
CHLORIDE 100 MEQ/L 95-107
CARBON DIOXIDE 27 MEQ/L 19-31
CALCIUM 9.7 MG/DL 8.5-10.5
PROTEIN, TOTAL 7.6 G/DL 6.1-8.3
ALBUMIN 4.7 G/DL 3.5-5.2
CALC GLOBULIN 2.9 G/DL 1.9-3.7
CALC A/G RATIO 1.6 RATIO 1.0-2.6
BILIRUBIN, TOTAL 0.5 MG/DL <=1.2
ALKALINE PHOSPHATASE 104 U/L 39-118
AST 22 U/L 9-50
ALT 18 U/L 5-50

My understanding of my results is that while my total T is somewhat low for my age, it is in a healthy range. However, the albumin and SHBG are both top of range, and so my actual free testosterone (8.26 ng/dishL) is too low for a person my age. That coupled with the low FSH and LH values indicates a diagnosis of secondary hypogonadism. Additionally the prolactin is slightly elevated, and will be monitored. If there is another elevated prolactin reading, he recommends an MRI. Otherwise, my numbers are fine, but we will be monitoring my blood (RBC, MCV etc.)

My current medication.

Testosterone Cypionate 150mg IM q 7 days
Human Chorionic Gonadotropin (hCG) 1000 IU q 7 days
Arimidex 0.5mg tablet q 7 days

We will retest in 4-6 weeks to see if these doses are working for me. He offered me hCG monotherapy but I decided to just go for T. I’m sick of feeling and looking like a man trapped in a child’s body. Thoughts on my results/regimen? Anything I should know? Did I make the right call?

Update to this post. Does anyone have some advice on these results? Does my current treatment regimen look okay? Will Defy or some other online service ship me meds with these numbers? I travel a lot for work and would rather be not bound to a local clinic if possible.

2

Your levels aren’t fine, you have the testosterone and SHBG of a much older person. Men at your age are usually at their peak testosterone levels before the gradual decline that happens past 30 years old. Men typically peak around 800-1000, your delayed puberty is likely the reason you are subnormal. Did you have IGF-1 tested?

Having a high RBC, Polycythemia can be linked to secondary causes, chronic hypoxia or tumors releasing erythropoietin. You also need to understand you shouldn’t be injecting more HCG than 500iu at a time, otherwise estrogen can become a problem.

3

Yeah, I understand. That’s why I’m starting TRT.
I reported all the values I have. Should I get more thorough blood-work done? Anything else to check?

As of now I am visiting the clinic 1/week for the injections, but I have requested that I be able to do at-home. They said it’d cost more but I don’t know, still figuring out my insurance. So at that point I could space the injections out at lower doses. Is that what you’d recommend?

4

That’s strange the clinic doing the injections, do you really want to be tied to the clinic for life? That’s 52 visits a year and over 10 years it’s 520 office visits. What are you going to do when on vacation? You can’t live your life tied to a clinic. We all self inject at home using insulin syringes in shoulders and outer quads.

Cost more to inject at home? These clinics are only interested in your wallet and they want you tied to their clinic. You should be injecting twice weekly to keep levels stable and to keep them from fluctuating.

You’re a paying customer, put your foot down and be firm or else tell them they aren’t the only game in town. They want to charge you to self-inject at home, it’s about time to end this abusive relationship.

5

Indeed, I travel 50% for work so it’s not even possible to stay attached to the clinic. They want to pay their nurses but not my problem. The doc already knows and we will be discussing options next visit.

6

Hi. I hope this is allowed but bump. I’d like some other advice/opinions if anyone is out there. :slight_smile:

Update to this post. Does anyone have some advice on these results? Does my current treatment regimen look okay? Will Defy or some other online service ship me meds with these numbers? I travel a lot for work and would rather be not bound to a local clinic if possible.

7

I would go with hCG every other day, or MWF, at 250IU. They probably go 1x/week because they make you go to the office for injections. I think 1000IU in one shot is too much.

I would go ahead and stay with the test dose and see how you feel with it.

Arimidex, I would stay with that as well, see how you feel and see how your follow-up labs look.

Going forward, they need to allow you to self administer injections. I don’t see how going into the office is cheaper for you, unless they bill your insurance for an office visit, and if you self injected they would bill you instead.

8

Ah, okay. What are the risks of 1000IU hCG?

Regarding the Test – I felt like I experienced some noticable acute effects. My libido and stamina is double what it usually is (my partner noticed and commented too), moderately higher energy and motivation. No idea if it’s placebo but my gut would tell me that it’s not. My understanding is that it’s supposed to take weeks to “feel it” – is that true? Weeks to feel the full effects would make sense, but some acute effects also make sense for a deficient individual…

My guess would be that in-office treatments can be billed differently than “prescribed” treatment, as you said. But I will put my foot down when we talk on Thursday…

9

That dose of hCG will increase E2. I had a similar experience, noticeable increase in energy and libido in about two weeks. Full effects, which would include five inches off my waist, took about six months.

10

not that i know off but maybe you need to gain weight?

11

Have you analyzed your diet from those days? Did you eat a lot of junk like most kids do today not looking at nutrient values? One of my sons has a small amount of pubescent gyno. No one in my family has this and I believe it is from him not eating the majority of his calories from animal protein and fats. He was a carb junky. Low Cholesterol intake leads to Low T. Try eating “Keto”. Looking back as I am old I came from large family.

When I was at home and young food then was what Mom made and you were restricted to it. Always had Some sort of meat and a lot of fats in every meal. Today meat and fat are out of school lunches and breakfast is not eaten at all- Low Cholesterol. You will get people saying that you need carbs for muscle growth. Yes if you have GH and testosterone with it but on a so called “clean” diet there is not enough.

People using gear take it orally, patch or by needle. But naturals have to get it from foods and that is not plant based foods. My experience : Contest prep doing lowfat being natty at 35 I experience ED. Total Cholesterol was 144. Put fat back in and on and it went away in about 2 mos. So how stupid is it to be on lowfat diet without PED’s? Now I keep it above 200 and preps no less than 110 grams of fat and no low T symptoms and this was at mid 50.

12

I definitely need to gain weight. Hard gainers are somewhat of a myth but I have always been chronically skinny. Even when I consistently do TDEE+300 kcal with 3-4 days/week in gym, I gain weight very slowly and most of it is fat… and I’m really not trying to become skinny fat. Not sure what else to say. I don’t think a BMI of 19.5 should be putting my body in starvation mode, even if I do look like a twig.

Believe it or not, my parents were professional athletes, a long line of them… My childhood diet was quite good and always protein oriented. Now, even as a kid my appetite was always low, but most of what I ate was good stuff. Now, if it what I choose to eat at the time affecting me now, well that would just be frustrating.

13

I find this very interesting as I have the exact same problems, apart from my libido is fairly normal but I have erectile disfunction to some extent where I cannot maintain an erection 50% of the time before I ejaculate which can make me extremely anxious and make matters even worse for the issue in its self. NEVER experienced a wet dream, and dreams in general are extremely rare. I was not clinically approved as having a slow puberty, but my genitals are much smaller than the normal, also my nipples are extremely small, and I have gyno too. my testosterone serum was 8.4nmol/L which in America would calculate to 264ng/dL. Extremely low for a 26 year old at the time! yet to receive any sort of treatment as the NHS is full of S***. NHS ranges are so wide with patients having diabetes and other issues and of ages 18-100 they cannot possible rule an age out.

14

Here is some of my results. till this day I have never received any treatment nor any feedback from my doctors as they send me away everytime I turn up to a point I gave up.

LH Serum 2.8 u/L range (1.5-18.1u/L)
FSH Serum 4.9u/L range (1.4-18.1u/L)
SHBG 20nmol/L no range given
TT Serum 8.4nmol/L range (8-27nmol/L)
TSH serum 2.0mu/L (0.5-5.5)
Plasma glucose level 5.2mmol/L (3.0-6.00mmol/L)
Potassium 4.5mmol/L (3.5-5.3mmol/L)
Creatinine 71umol/L (59-104umol/L)
Red blood count 5.76 (4.2-6.5)
White blood count 6.4 (4.0-11.0)
haemoglobin concentration 170g/L 130-180g/L
Plasma c-reactive protein <5mg\L (00-10mg/L)
Albumin serum 46g/L no reference
HDL 1.1mmol/L
LDL 3.5mmol/L
Cholestrol ratio 4.6mmol/L (<7.5mmol/L)
AST 24u/L (0.0-35.0u/L)
Triglyceride serum level 1.2mmol/L (0.4-1.8mmol/L)

Free testosterone calculated via
TT- 8.4nmol/L
Albumin- 4.6g/dL
SHBG- 20nmol/L

Free T - 0.202nmol/L - 2.41%
Bioavailable T - 5.06nmol/L

Androstenedione 6.3nmol/L (2.1-10.8)
Oestrodiol 106pmol/L (upto 191pmol/L)
Serum TSH 0.75mu/L (0.3-5.5)
Vitamin D 25-hydroxy 53nmol/L (24.0-167.0)

White blood count
Neutrophil count 2.8 (2-7.5)
Lymphocyte 1.7 (1-4)
Monocyte observation 0.6 (0.1-1.5)
Eosinophil observation 0.2 (0.04-0.4)
Basophil 0.1 (<0.15)

Full blood count

Haemoglobin concentration 161g/L (130-180)
Total white blood cell 5.3 (4.0-11.0)
Platelet count observation 192 (150-450)
Red blood cell 5.42 (4.2-6.5)
Haematocrit 0.530 (0.4-0.54)
Mean cell volume 98fL (84-102)
Mean cell Haemoglobin level 29.7pg (28.0-33.0)
Mean cell Haemoglobin concentration 304g/L (300-350)

Overnight dex cortisol and urine sample was carried and came back normal, as of prolactin.

15

It’s the same here, there’s some sort of conspiracy going on regarding TRT here in the US. A lot of guys that should be getting it are being denied, it really has to do with fear of the unknown. The last 70 years doctors have been taught that TRT cause cancer, so it’s taboo and frowned upon.

Studies are showing the opposite to be true, hormones being out of balance are showing way more diseases than those whose hormones are balanced. Prostate cancer is typically an old mans diseases when testosterone is lower, a man with prostate cancer in his 20-30’s is unheard of and isn’t even expected until much later in life.

TSH shouldn’t be trusted, I’ve seen too many with normal TSH and low thyroid hormones. Your testosterone levels are in the basement, 90 year olds score there. NHS isn’t the answer, going private is the answer. If you can get diagnosed outside the NHS, you can use that diagnosement later to get treatment with the NHS 20 years later when they get their act together.

16

Hello, I have updated bloodwork from last week. This was after 6 weeks of therapy, on my trough day in the morning right before my injection. Protocol is once a week 150 mg T. cyp IM, 1000 iu HcG, 0.5 mg Arimidex. I’d like some input on the results and feedback on the shift in medication.

TESTOSTERONE 958 NG/DL 300-1080
FERRITIN 82 NG/ML 30-400
IRON BINDING CAPACITY AND IRON AND % SATURATION
IRON, SERUM 182 H UG/DL 59-158
UNSATURATED IBC 174 UG/DL 112-347
CALC TOTAL IBC 356 UG/DL 250-450
CALC % IRON SAT 51 H % 20-50
SEX HORM BIND GLOBULIN 48.1 NMOL/L 16.5-55.9
ESTRADIOL 44.6 PG/ML <=60.7
CBC W/AUTO DIFF WITH PLATELETS
WBC 4.9 K/UL 4.0-11.0
RBC 6.36 H M/UL 4.10-5.70
HEMOGLOBIN 17.2 H G/DL 13.0-17.0
HEMATOCRIT 51.7 H % 37.0-49.0
MCV 81.3 fL 80.0-100.0
MCH 27.0 PG 27.0-34.0
MCHC 33.3 G/DL 32.0-35.5
RDW 13.2 % 11.0-15.0
NEUTROPHILS 40.4 % 40.0-74.0
LYMPHOCYTES 44.9 % 19.0-48.0
MONOCYTES 9.3 % 4.0-13.0
EOSINOPHILS 3.5 % 0.0-7.0
BASOPHILS 1.9 % 0.0-2.0
PLATELET COUNT 274 K/UL 130-400
TSH, THIRD GENERATION 0.935 UIU/ML 0.400-4.100
LIPID PANEL
CHOLESTEROL 196 MG/DL <200
TRIGLYCERIDES 263 H MG/DL <150
HDL CHOLESTEROL 38 L MG/DL >39
CALC LDL CHOL 105 H MG/DL <100
RISK RATIO LDL/HDL 2.77 RATIO <3.55
PROLACTIN 19.2 H NG/ML 4.0-15.2
NOTE: Methodology is Roche Cobas Electrochemiluminescence Immunoassay (ECLIA).
FREE T3 4.5 H PG/ML 2.2-4.2
FREE T4 (THYROXINE) 1.27 NG/DL 0.80-1.90

Notes on my bloodwork changes

  • TT 546 ng/dl → 958 ng/dL 300-1080 - Looks good!
  • cFT 8.25 → 17.8 9-30 - Looks good, but my doc wants to get me to ~20 on my trough day, so he is increasing T cyp. dose by 10 mg to 160 mg.
  • SHBG 52.6 nmol/L → 48.1 nmolL 16.5-55.9 - Down slightly which is good. This is what I can expect with weekly higher doses of T, right?
  • “Estradiol, Male: CPL” 20.5 pg/mL → 44.6 pg/ml 17-60.7 - Doc says this is not too bad, but he is increasing my arimidex to 1.5 mg/week at injection as he’d prefer me to be in the twenties. I am not sure which testing methodology this is using. Anyone recognize what “CPL” means?
  • Prolactin 16.8 ng/mL → 19.2 ng/mL 4.0-15.2 - Since I have been out of range twice, he had me get an MRI today to look at my pituitary gland. Any input on this number?

Subjective feelings:

  • I’ve been on TRT for ~ 6 weeks now. I have noticed definite improvements in my musculature (finally filling out and looking ‘manly’ in my frame for the first time in my life) and libido. I woke up twice this morning with a raging erection. :slight_smile: My outlook is better and my confidence is up – of course this is due in part to the improvements in my physical form. My squats/DL/bench are reliably going up every lift!
  • Been slightly disappointed in the impact on my energy levels. I still feel fairly fatigued in the morning through mid-day. Not as strong impact on my work ethic as I hoped. But TRT can’t fix everything. Could this be related to my other numbers? Am I hoping for too much or is something else off? My T seems to be in a good range now!
  • He was not super happy with my cholesterol and triglycerides for now. We will monitor, but for now he just told me to eat better.
  • I’ve seen on here that I should consider reducing my HcG dose or spreading it out to 2-3x per week. Should I really push this with my doc? He seems to know what he’s doing… but a couple things are off e.g. the hcg dose and 1/week protocol. I’ve also read that dudes with “high SHBG” can benefit from one large weekly dose of T, so I don’t mind sticking with that part of the protocol.
  • I’m concerned about my estrogen, prolactin, and energy levels.
  • We did a phlebotomy to bring my hematocrit down.
  • When discussing self-injection, the doc indicated that he wants to get me “dialed in” first. I self administered once when I was on a 2 week work trip, and it was quite easy. I’m not super happy about this, but did not push the issue… maybe I should.
    Overall I have been satisfied with my progress. Someone I saw this weekend for the first time in a year commented on how different I look. :slight_smile:
    We have changed my protocol slightly and will do more bloodwork in a month.

Current protocol:

T. cyp 1/week 160 mg IM
HcG 1000 iu 1/week IM
Arimidex 1.5 mg 1/week @ injection

Advice, comments?

17

The problem with injecting one large injection weekly is the larger the dosage, the high estrogen will peak and the more estrogen you produce. Some guys do well injecting once weekly, you really haven’t been on TRT very long.

Your body will be going through changes over the next several months and you dosage and injection frequency will likely need minor adjustments.

Your doctor seems to think he can dial you in on one weekly injection and take the AI once weekly. Taking the AI once weekly is not idea, the half life is 2 days and by the end of the week it’s cleared out of your system causing estrogen to possible rise later in the week.

Your doctor seems like he’s only beginning to get his feet in relation to TRT, experience is gained by trial and error.

18

It is a bit frustrating as he runs a men’s t-health clinic and seems to know what he’s talking about… He is at least monitoring my SHBG and free T not concerned with the TT. I guess some of his information is off. I will compile what I know and talk to him next week.

As far as the Arimidex goes, I can simply spread the dose out over the week so that is easy to personally adjust for.

In other news, the MRI confirmed a 3.5 mm pituitary microadenoma on the left side. He is referring me to a nuero for a consultation… Any input on this? How will this affect my treatment?

19

I find that I over respond to anastrozole, I’m dissolving the anastrozole in 1ml of vodka and dosing half. My advice start low because my second E2 test shows a sensitive E2 of 7.8 on only .250 EOD (1mg weekly) and I have high aromatase activity.

Sat down today and went to get up and my knees are feeling it.

20

Okay. Next week I will spread out my anastrozole dose to EOD. Thanks for the advice.