26 Considering TRT Replacement

Pharma TRT
1

A lurker, now first time poster as I was prompted to get some testing done while reading through your website. It’s funny but I always knew my testosterone was low: decreased libido, low amount of hair, erectile dysfunction during intercourse, delayed healing. Finally got it tested and it is low.

-age: 26
-height: 6’0
-waist: 32"
-weight: 175
-describe body and facial hair: Shave stubble once every three days, light hair everywhere else.
-describe where you carry fat and how changed: 11% body fat, carry fat around abdomen in love handles but far from overweight.

-health conditions: Beginning after 18 getting worse last three years: erectile dysfunction during intercourse (rare), low libido (sex x1 week with wife), delayed healing, moods seem okay although I’m a little OCD overly anxious type.

-Rx and OTC drugs: Fish oil, Vit D 5000 I.U. (just started), multivitamin, melatonin 500mcg

-lab results with ranges:
Testosterone: 379 (241-827)
FSH 3.6
LH 1.7 (1.5-9.3)
Cortisol 18.6 (3.1-22.4)

CBC:
WBC 5.4 4.0 - 10.0 X10’3 Final
RBC 5.21 4.31 - 6.40 X10’6 Final
Hemoglobin 16.1 13.6 - 18.0 gm/dL Final
Hematocrit 45.4 39.8 - 52.0 % Final
MCV 87.1 80.0 - 97.0 fL Final
MCH 30.9 26.0 - 34.0 pg Final
MCHC 35.5 32.0 - 36.0 gm/dL Final
RDW 12.2 11.5 - 15.0 % Final
Platelet Count 199 140 - 440 X10’3 Final
MPV 10.3 6.5 - 12.4 fL Final
Auto ABS Neut 2.01 1.50 - 8.00 X10’3 Final
Auto ABS Lymph 2.58 0.80 - 4.00 X10’3 Final
Auto ABS Mono 0.69 0.00 - 1.20 X10’3 Final
Auto ABS Eos 0.13 0.00 - 0.30 X10’3 Final
Auto ABS Baso 0.03 0.00 - 0.30 X10’3 Final
Auto % Neut 36.9 L 37.0 - 80.0 % Final
Auto % Lymph 47.4 16.0 - 51.0 % Final
Auto % Mono 12.7 H 0.0 - 12.0 % Final
Auto % Eos 2.4 0.0 - 8.0 % Final
Auto % Baso 0.6 0.0 - 3.0 %

Lipid Panel
Cholesterol 123 108 - 199 mg/dL Final
Triglyceride 48 26 - 149 mg/dL Final
HDL 50 40 - 125 mg/dL Final
Chol/HDL Ratio 2.5 0.0 - 5.0 Final
LDL 63 0 - 99 mg/dL

Vitamin D: 36 (32-100)
TSH: 2.484 (0.400-4.000)
T4Free: 0.97 (0.84-1.51)

Metabolic Panel
Sodium 136 136 - 145 mmol/L Final
Potassium 4.4 3.6 - 5.0 mmol/L Final
Chloride 103 98 - 107 mmol/L Final
Carbon Dioxide 28 22 - 28 mmol/L Final
BUN 22 H 6 - 20 mg/dL Final
Creatinine 0.89 0.70 - 1.30 mg/dL Final
Glucose 103 H 74 - 100 mg/dL Final
Calcium 9.4 8.6 - 10.3 mg/dL Final
Total Protein 6.7 6.0 - 8.3 gm/dL Final
Albumin 4.7 3.5 - 5.0 gm/dL Final
SGPT/ALT 16 10 - 35 U/L Final
SGOT/AST 20 14 - 50 U/L Final
Alkaline Phosphatase 89 53 - 128 U/L Final
Total Bilirubin 1.2 0.3 - 1.2 mg/dL Final

Update: 5/10/13
Estradiol 17-B 21 0 - 40 pg/mL
LH 1.5 1.5 - 9.3 IU/L
Prolactin 4.1 2.1 - 17.7 ng/mL
FSH - 4.8
Testosterone 372 241 - 827
Ferritin 102 22 - 322 ng/mL
Total Iron Binding Capacity :286 220 - 390 ug/dL Final
Iron Percent Saturation :45 15 - 50 % Final
IBC Unsaturated 158 130 - 300 ug/dL
Iron 128 35 - 140 ug/dL

-describe diet: Weight lifted in winter with gallon of milk a day diet 6000-10000 calories gained 35lb mostly muscle. Decreased intake to 3000-5000 calories high protein for endurance sports dropped 30lb in less then two months. Same body fat% :frowning:

-describe training: Triathlete. Swim Bike Run 10-16 hours per week. Lift heavy 2-3x week reduced volume during competitive season.

-testes ache, ever, with a fever: nope
-how have morning wood and nocturnal erections changed: rarely occurs.

Saw primary care md referred to endo. Saw endo and she ordered in addtion to above prolactin, total t, free t, fsh, lh, prolactin, IGF-1, iron panel. She is willing to work with me however i wish and will put me on testosterone replacement if she finds that pituitary not a problem (prolactin), iron not a problem. She has however recommending against treatment related to fertility.

So my wife and I would like to have children in about 4 years. We discussed this together and she feels treatment may be beneficial if we can still have children later. So wife is on board tentatively. I’m the last one that needs convincing. My quality of life is quite good and as an athlete I am pretty strong and competitive. I feel like a sexual dud though and that hurts the self esteem. I’m worried about being stuck on medications for life, infertility, ball shrinkage!

Now for the questions. For those of you, especially younger males, was testosterone replacement worth it to you? Did you find that the benefits outweigh the risks or if you had to do if over would you live with a suboptimal T? Anything jump out at anybody about my labs or have further suggestions for my treatment?

KSman is Here
2

I’m interested to see what your prolactin levels are. Difficulty maintaining an erection during intercourse is a red flag for elevated prolactin and possibly a prolactinoma.

I’m 31, but I can tell you right now that if you can find the cause of your lower T and fix that, life will be much easier on you. TRT is not a fix-all. You’re going to be battling doctors and insurance companies and trying to find the nuances that work best for you if you DO go on TRT. I think any younger male on this forum would tell you if we had a choice to be healthy and happy without TRT, then we most definitely would choose that route. Your LH and FSH are low, which would indicate you have a degree of secondary hypogonadism. This can be corrected sometimes.

Post all your labs with ALL the ranges. You can edit your post at the bottom right to add in stuff.

Bottom line up front, if you can avoid TRT, do so.

3

I definitely would not do TRT if I were you with an LH level that low. I would test for estradiol and free T and then hop on clomid (or some other have found Tamoxifen better)…

4

With TRT, you do not need fertility treatment, you need fertility maintenance.

  • TRT + 250iu hCG SC EOD
  • TRT + SERM
  • TRT hCG and periodically switch to SERM for a month
    Your doc is probably narrow minded and attaches voodoo to drugs instead of practising functional medicine.

Read the stickies like I advise in most posts here:

  • advice for new guys, be open minded to causes, low-T is not a cause, it is an effect
  • thyroid basics
    – post history of iodine intake
    – post waking and mid afternoon oral body temps

You have a degree of hyperthyroidism. Subclinical. May be iodine deficiency. If so, that is easily fixed. Your wife may share your iodine status.

Take 20,000iu/day vit-D3 for a week then 5,000iu/day after that.

Cholesterol is low. See advice for new guys for cholesterol info, you need to eat cholesterol rich foods/fats

Labs: see the first sticky
TSH, fT3, fT4
E2
prolactin

0.5mg melatonin does what? Seems like a dose that would do nothing for most people.
Do you have a sleeping problem?

Suspect over training.

Sodium low: you avoid salt?

What about a history of symptoms and what were things like with high milk intake?

5

Iodine: I do avoid salt. At first it was for “health reasons,” then it just became lifestyle. Now I hate the taste of salt. I read the iodine article and attempted to use table salt for the first time in 15 years and couldn’t even eat 1/4 tsp with my soup. I also sweat a lot from cardio workouts. I have a 12.5 mg iodine supplement that I am willing to try. I will start monitoring my temps. Spot check at 3 was 98.2.

Low cholesterol is hereditary in my family. However i will look into trying to improve it.

Will up the vit D for a week. Felt small amount of improvement in training recovery when I started it.

500mcg of melatonin is what nearly everyone should be on. I cannot link “up to date” articles (medical research) because I only have access to in the hospital setting. I work night shift. Not sure why i did not mention this before, doh! The three years of worsening symptoms of course started when i began nightshift, this shouldn’t surprise anyone. The symptoms were there before that though. melatonin simply helps me stay asleep when I sleep during the day. I would rate my sleep quality 7/10.

I do not think over training as I built to that volume carefully and slowly. I am overreaching at times but I am able to recover athletic abilities quickly with rest days. Training is probably a small part of the picture though.

When I was drinking a gallon of milk I gained weight and muscle but was also doing starting strength. I am a triathlete in spring, summer and I have to cut some of the bulk. I noticed a very small improvement in libido when doing strength training and drinking a lot of milk.

Updated original post with some labs, will be a few days before I get the follow up ones. Will post when I get them.

Edit: I will look into clomide and suggest it upon our next meeting. I will also see if I can get E2, estradiol added to next lab draw. I would really like to avoid trt.

6

You definitely do NOT need TRT. My guess would be your sleep schedule has contributed to this. The clomid should work well for someone like you.

7

Please check out the update in my original post. Prolactin is not elevated, estradiol is a reasonable number, T came back the same, Iron within reasonable limits… Still waiting on free t IGF-1. Thoughts or suggestions? Cannot imagine clomid would work with a fairly normal e2.

8

If he was using clomid, how would he dose it and how long would he run it?

Would he use an AI with it?

9

Don’t listen to this clomid crap… Receptor has no business saying this … Trt will not fix all your problems. Clomid at the wrong dose can ruin lh and fsh receptors desensitizing them and leaving you will problems for life. Fix cholesterol find out more about your thyroid and adrenal fatigue. What time were these labs taken? Cortisol is on the high side? Google adrenal fatigue test and see how you do. If your doc doesn’t know how to help see a naturalpath , sometimes doctors and natural docs are working together to provide the best care. Most times we have to pay out of pocket for this but it is an option when all else fails. I know how frustrating this all is but hopping on something as a quick fix in most cases is not the answer. I made this mistake and I have t levels above range and still feel like shit so let’s not assume that testosterone is your problem. Please research thoroughly and educate yourself with your own condition and do what feels right for you. After all it is your body and you will have to live with the outcome of whatever you decide. Hematocrit and hemoglobin are on the higher end. My hematocrit was also on the high side and after trt is out of range. Cholesterol will most likely drop with trt so you may end up with more issues then you began. Get all of these things under control before even considering any kind of trt as once you start you may not be able to tell what symptoms or lab changes are because of what you have changed or what trt has changed. Please take it from me, an average guy with troubles the quick fix is not the answer to your problems!

Best regards, iw84aces

10

Thanks for everyone’s help! I wish there was an easy solution here but apparently not.

Anyone have suggestions for the cholesterol issue. There is a family history of low cholesterol. I don’t really see much of a thyroid issue here. Perhaps slightly hyper, will try the iodine supplementation. These labs were taken during my morning, about 7:00 pm after waking up at 5:30 pm. I’m not surprised cortisol is on the high side given the demands of endurance training and stressful job/night shift.

The plan: Talk to endo and see what suggestions she has. No longer very seriously considering trt, sounds too scary. Alternative therapies are not out of the question though. Continuing to work on vitamin D levels and I think i will see a positive benefit here. Iodine replacement in the works. Improving amount of sleep.

If anyone has additional suggestion I am all ears, and thanks again!

11

What about Novaldex? Anyone had success using Novaldex over clomid, all reports I can finds show demonstrate it to be a better drug long term. Keeping my options open for my next appointment with my endo.

12

You’re going about this wrong. Jumping on a serm is not going to fix things for you… You’re lh is on the low side but fsh is a better indicator as lh moves around a lot and has a short life. Fsh is not that low that I think you are deprived. If you do the serm what is your plan? What do you think will happen when you come off of the serm? You are not listening. At least listen to ksman if not me.

13

I am listening but it hard to include you on my inner monologue through a chat board. I simply wanted some additional opinions. In fact I have begun to work on everything you both suggested. I have improved my sleep. I am working on my cholesterol with more olive oil, fish oil, six eggs a day. finished 1 week of high vitamin d and now maintenance of 5000. Taking iodine. Slightly backed off my training. Added multivitamin. I have an appointment with my endo soon and I wanted any additional thoughts. I am in fact very wary of medical therapy but it doesn’t hurt to keep additional options open.

14

If u ever do anything like that make sure you are monitored and comfortible that the doctor who is taking care of you is competent. My thing is I don’t understand the end plan with serms unless it’s to taper off steroids or trt orrrr to try to induce fertility while on trt. I have heard of some people cycling serms to make gains. This is risky business to me and if you had a chance to not be on trt that just went right out the door with desensitized receptors. Lots of people use serms in dif ways and sometimes even both Nolva and clomid at the same time but this is just insane if u ask me. I won’t say anything else and I hope you find the answers your looking for!! Sorry if I sounded rude. That wasn’t my intent. Cheers and good luck

15

Melatonin: I often suggest 5mg in a time release form.

I recommend Nolvadex over Clomid all of the time and state reasons, in the stickies too.