26 YO Needs Help. Lots of Help

Pharma / TRT Testosterone Replacement
1

-age 26 years old

-height 6ft

-waist 34

-weight 237

-describe body and facial hair Athlete in college, always have been a big/strong kid! Facial hair grows in full and fast ever since I was 15 years old

-describe where you carry fat and how changed Fat is in my stomach and chest, chest is always last place to go first place to come

-health conditions, symptoms [history]
Gastrointestinal issues, low test, depression, ADD/ADHD

-Rx and OTC drugs
Adderall, Zoloft, Wellbturin, Seroquil sometimes, and Suboxone (recovering addict)

-lab results with ranges

Name
Standard Range

Percent Testosterone Free (2.0-4.0%)
2009- 4.2
2014-3.3

Testosterone Free (8-30ng/dL)
2009- 2.0 one test other test 0.5
2014- .09

Testosterone Total (240-950 ng/dL)
2009-48 one test other test 12
2014- 21 one test 26 other test
2016- 151

On the latest test I had done here are the results 8/16/16
SHBG 14 nmol/L (11-80nmol/L)
Free test 4.23 ng/dL (4.7-24.4 ng/dL)
Testosterone total 151 (240-950 ng/dL)

Cortisol Serum 3.3 (4 - 22 ug/dL)
Prolactin 17 in 2011 it was 23 (2 - 18 ug/L)
FSH 2.0 in 2014 it was 0.3 (1.4 - 18.1 IU/L)
Lutropin (1.5 - 9.3 IU/L) 2009 <0.1 2014 1.9 2016 1.1
T4 Free 0.92 2014 it was 0.52 (0.76 - 1.46 ng/dL)
Free T3 3.3 (2.3 - 4.2 pg/mL)
TSH 1.91 (0.40 - 4.00 mU/L)

Sodium 140 133 - 144 mmol/L
Potassium 3.8 3.4 - 5.3 mmol/L
Chloride 109 94 - 109 mmol/L
Carbon Dioxide 23 20 - 32 mmol/L
Anion Gap 8 3 - 14 mmol/L
Glucose 89 70 - 99 mg/dL

Urea Nitrogen 16 7 - 30 mg/dL

Creatinine 1.07 0.66 - 1.25 mg/dL
GFR Estimate 84
Calcium 9.2 8.5 - 10.1 mg/dL
Bilirubin Total 0.5 0.2 - 1.3 mg/dL
Albumin 4.1 3.9 - 5.1 g/dL
Protein Total 7.8 6.8 - 8.8 g/dL
Alkaline Phosphatase 123 40 - 150 U/L
ALT 71 0 - 70 U/L
AST 36 0 - 45 U/L

-describe diet [some create substantial damage with starvation diets]
Typically clean, have always followed John Meadows and done a lot of his meal plans/tips lately I have got off track a bit due to having no drive or motivation to do anything anymore… its insane… I go from a person who couldn’t be in the gym enough and extremely active to not wanting to do anything… I have started and stopped typing this post several times now and debated just stopping because I am so upset with everything and not being able to figure out what the hell is going on

-describe training [some ruin there hormones by over training]
Could have over trained in college but really ate a strict high in protein diet and always supplemented aminos, plazma, mag-10 and a few others

-testes ache, ever, with a fever?
Yes a lot, and have ever since I was 16 or so I don’t know with a fever or not but I do get random hot flashes where I start sweating and almost look like I had a niacin overdose, but I don’t take niacin

-how have morning wood and nocturnal erections changed
Used to in highschool, I don’t have shit anymore…no desire unless a girl is down there and has to be an absolute 10 otherwise Im not going

2

Check your E2, Prolacin, and LH next time. Have you been to a urologist about your aching testes? Hard to say without those tests although low FSH is present. Your definitely low in T but need those tests to help pinpoint why. Could be s result of all the meds and past narcotics use too.

3

He had LH this time, present as “lutropin”, which is very low.

l9stbo: I bet you got secondary hypogonadism. Narcotics increase prolactin. Do you have a CBC?

4

My LH and Prolactin are both posted! I will have my E2 test

5

Component Results
Value Std Range
WBC
7.3
4.0-11.0
RBC Count
5.95
4.4-5.9
Hemoglobin
17.6
13.3-17.7
Hematocrit
51.4
40.0-53.0
MCV
86
78-100
MCH
29.6
26.5-33.0
MCHC
34.2
31.5-36.5
RDW
14.5
10.0-15.0
Platelet Count
259
150-450
Diff Method
Automated Method
% Neutrophils
60.4
% Lymphocytes
30.5
% Monocytes
5.8
% Eosinophils
2.6
% Basophils
0.6
% Immature Granulocytes
0.1
Absolute Neutrophil
4.4
1.6-8.3
Absolute Lymphocytes
2.2
0.8-5.3
Absolute Monocytes
0.4
0.0-1.3
Absolute Eosinophils
0.2
0.0-0.7
Absolute Basophils
0.0
0.0-0.2
Abs Immature Granulocytes
0.0
0-0.4
Result status: Final result

6

Also I want to say narcotics and Meds have only been an issue since last year my low test started in 2009

7

Yes but prolactin was from 2011 and already elevated. Need recent

8

Nevermind, I misread. Very confusing they way you inset various years. Probably not high enough to create issues with FSH and LH that low, def secondary.

9

So what do you recommend?! I’m at a loss

10

You have deep secondary hypogonadism.
Prolactin interesting but probably not causative.

You need a MRI to see if pituitary or hypothalamus look abnormal.

Hematocrit and RBC are high with low T. This is VERY unusual.
See if you can donate blood with those medications, bit you are near limit where they will reject based on blood thickness. Then you ask for therapeutic blood removal. Meanwhile, stay hydrated for your lab work and also at all times. Take baby aspirin every day to improve blood flow. Avoid iron fortified foods - bread, pasta, cereals etc.

You need TRT and your high HTC will continue to be a problem as it will get worse.

Check all pituitary regulated hormones: - fill in the blanks
LH/FSH
TT
FT
E2
prolactin
IGF-1 - proxy for GH
AM cortisol - at 8AM please
ACTH
ACTH challenge injection and cortisol test
TSH
fT3
fT4
rT3 - if body temperatures are low

Cortisol Serum 3.3 (4 - 22 ug/dL)
This is very low. You want to be over 10 at 8AM. Levels typically drop from there during the day.
At this point at 8AM you would repeat/verify cortisol and check ACTH. Then they would inject ACTH and you hang around and they check cortisol later. ACTH should increase cortisol strongly and low cortisol can be attributed to lack of ACTH from hypothalamus or lack of cortisol response from pituitary.

Could AST/ALT be increased from recent training or sore muscles?

TSH should be nearer to 1.0
fT3 is good, should be midrange or a bit higher
fT4 is good, over mid-range

Need you to check and post oral body temperatures as per the thyroid basics sticky. This will help paint the thyroid pictures.

Thyroid related:
Explain how stress shapes your life now, in past and major stress events. Can fatigue adrenals, increase rT3 that blocks fT3, lowering body temperatures and causing/contributing fatigue and mood/depression issues.

Odd: When young guys mature really early with strong virtualization, T–>E2 can close growth plates and lower stature or reduce length if long bones. Your development seems to fit into your current issues with pituitary at center stage.

You will be transformed with TRT. We do not know what a MRI will disclose.

If pituitary is enlarged with an adinoma, it can press on optic nerves. Note if your width of peripheral vision is not near 180 degrees. Loss of width is a symptom. A prolactin secreting adinoma can be shrunk and managed with 0.5mg/week Dostinex.

Pituitary can be damaged from a blow to the head or strong whiplash, leading to secondary.

Tell us where you are - affects medical options.

AD meds can create hormone and sexual problems. Wellbutrin is a good drug.

Sorry for the overload! Go through the issues and see if you can get your doc to play this game.

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