32 Year Old Diabetic. To TRT or Not?

Pharma / TRT Testosterone Replacement
1

So I recently went to a functional medicine doc with complaints of low energy, low motivation and mental fog. They ran a bunch of tests which can be seen below. I have been hypothyroid for awhile but on my 75 mcg of hypothyroid my TSH was still quite elevated. My total testosterone was 516 ng/dl which the doc said was low and put me on 100mg/wk test cyp with no AI or HCG.

Based on reading all the stickies and other posts on here jumping to a TRT protocol in my case may have been premature. Below are my results. I also had a few tests done 6 years ago so I will post those as well. In contrast ever since I was maybe 17-18 I have had a tough time putting on muscle, never been able to squat or bench over 200 lbs. Always pretty weak and not so masculine.

-age: 32
-height: 5’10
-waist: 30"
-weight: 155 lbs
-describe body and facial hair: Very light facial hair on face, cant grow a beard really at all. Light hair on chest
-describe where you carry fat and how changed: I have always carried fat in chest region and stomach and ass most.
-health conditions, symptoms [history] I have Depression, Diabetes type 2, Hypothyroid, 15 year history of alcoholism sober now 1.5 years, Mild sleep apnea (which is well treated)
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Remron, Prestiq, levothyroxin, Metformin (feel better off, considering controling with diet only)

-lab results with ranges
This first one was when I was 26 and I believe I was on a pretty restrictive diet. Mostly lean meat and vegetables. No clue on training or sleep, can’t remember. Blood was drawn in AM

Cortisol Morning: 2.2Low ng/ml (3.7-9.5)
Cortisol Noon: 2.1 ng/ml (1.2-3.0)
Cortisol Evening: 2.8High ng/ml (0.6-1.9)
Cortisol Night: 0.5 ng/ml (0.4-1.0)
Estradiol: 40 pg/ml (12-56)
Total T: 430 ng/dL (400-1200)
SHBG: 37nmol/L (15-50)
Ratio T/SHBG 0.4Low (0.7-1.0)
DHEA: 199 ug/dL (70-325)
PSA: <0.5 ng/ml (<0.5-4)(optimal 0.5-2)
Free T4: 1.6 ng/dL (0.7-2.5)
Free T3: 3.3 pg/ml (2.5-6.5)
TSH: 2.2 uU/ml (0.5-3.0)
TPO: 6 IU/ml (0-150) (70-150 borderline)

-lab results with ranges
This was the most recent lab. I had not been sleeping particularly well before this draw. 6 weeks prior I started a 4 week cycle of trandermal DHEA and that seriously messed up my sleep. This was not resolved at the time of draw even after 2 weeks of being off.

Also I should note I was also trying to resolve some gyno from puberty with 60 mg a day rolaxifine that I had been running for 8 weeks. I found out later this can scew TT and FT up 20% or so. Regardless below is the results of my latest labs. There were a lot more tests run than I will report here as much of it is not applicable to TRT. This was 3:00 PM blood draw.

25-hydroxy-Vitamin D: 95 ng/mL (30-100)
Homocysteine: 8 umol/L (<11)
Vitamin B12: 1555 pg/mL (>400)
RBC Folate: 1510 ng/mL (>750)
Albumin: 4.8 g/dL (3.5-5.2)
Iron: 55Low ug/dL (59-158)
Ferritin: 67 ng/mL (30-400)

TSH: 3.42 uIU/mL (0.27-4.2)
Free T4: 1.47 ng/dL (0.93-1.7)
Free T3: 2.6 pg/mL (2.0-4.4)
Reverse T3: 17 ng/dL (8-24)

Estradiol 16.8 pg/mL (7.63-42.6)
Estrone: 52 pg/mL (12-72)
FSH: 2.3 mIU/mL (1.5-12.4)
LH: 2.9 mIU/mL (1.7-8.6)
Progesterone: 1.35 ng/mL (0.2-1.4)
SHBG: 50 nmol/L (10-80)
Testosterone: 516 ng/dL (280-800)
Free Testosterone (calculated): 8.33 ng/dL (4.7-24.4)
Cortisol: 18.9ug/dL (2.3-11.9)

We are going to test the adrenals soon also.
Interestingly enough my bioavailable testosterone levels with respect to both tests were virtually identical.

-describe diet [some create substantial damage with starvation diets]
I had recently been incorporating intermittent fasting to try to reduce fat. I was up to 170 lbs and my face was quite puffy which I didn’t like at all. That is way better now at my current weight of 150-155. I have a very small frame so this weight isn’t quite as light as it would otherwise seem. I’m like 15% bf. I would cycle high carb training days with low carb low intensity cardio days.

Training days: 2250 cal, 240g carbs, 160g pro, 72 g fat
Rest days: 1804 cal, 50g carbs (green veggies), 160g pro, 110g fat.

Diet was paleo so meats, eggs, vegetables fruits and sweet potatoes. I did throw in a few non paleo foods like white rice and whey protien.

-describe training [some ruin there hormones by over training]
Was doing compound lift weight training 3 days a week. Workouts were 40-50 min in length. On off days about 50% of the time I would walk an hour or so.

-testes ache, ever, with a fever?
Not that I recall but I guess I could not I have a varicocele which is bothersome if when I notice it. Most of the time my brain ignores it.

-how have morning wood and nocturnal erections changed.
Rarely do I get these. When ever I do I seem to always need to pee really bad.

So anyhow my current thought is that testosterone injections may have been prescribed too soon before resolving other issues. I see the doctor again in 3 weeks to get new blood work. I am trying to figure out my best path forward at this point. My current thought is to maintain the 50mg bi weekly injections until I go back to the doc to get blood work to at least see what effect that had.

There is a notable difference in the volume of my muscles when compared to 2 weeks ago so I know it is doing something. However I do feel a bit edgy, possibly just getting used to it. At that point I think I am going to suggest that I go off T injections for now and work on getting my thyroid and adrenals situated (if I have an adrenal issue).

Do to my lowish FSH,LH levels I am also considering running the HPTA restart protocol that KSman laid out using Nolvadex and Arimidex for 6 weeks using research chems. Also I’m going to try to up calories to maintenance and up carbs on rest days to 50-75 from starchy sources. BTW the doctor also took me off levothyroxine and put me on T3 only to resolve my reverse T3 and high TSH. After awhile we will be switching to Nature throid.

Or I could just be way over thinking this and should stick with the T injections as my bioavailable testosterone and free T seems sub par at best and has been for 6 years at least.

Any advise or related experiences would be greatly appreciated.

2

Have you read the tyroid basics sticky? !!!
Your fT3 and fT4 should be mid range, both are low. TSH agrees.
In any case, body temps can be a guide to thyroid med dosing. I think that you are quite under-medicated.

Check your body temperatures as per the sticky.
Have you been using iodized salt long term? If not, you are probably iodine deficient.

Try to eat more iron rich foods. If you have been, if you have digestive problems, get an occult blood test to see if you have a mild GI bleed. Low ferritin reduces T4–>T3 conversion and low ferritin can increase rT3 that can block your fT3 at the receptors.

Tyroid problems create mental fog and lack of energy. Your problem is more than low T.

Try a good probiotic as some adverse gut flora can do strange things with reabsorption of metabolized estrogens. I can’t recall if that had a specific effect on estrone.

3

Thanks for the quick reply. I have read the thyroid sticky and that opened my eyes to how testosterone can be affected by thyroid, and how that might be more of my problem. I will implement all your suggestions, I have been using sea salt as I thought it was healthier, which I guess it is in some ways, it just lacks iodine. Either way I will start eating iodized salt and also start trying to eat more iron rich foods. I have been using a probiotic and have noticed astonishing improvements to my digestion but this has only come about in the last two months so the rest of my body could still be catching up.

In light of all this I am leaning towards holding off on TRT (after I get blood tests in two weeks) and fixing the thyroid and adrenals first. It does seem a bit unscientific to start mucking around with two major variables at once (thyroid and testosterone) as the two have been know to influence each other.

Do you think a SERM restart would help at all if I decide to quit TRT for now?

4

I thought my seasalt wasn’t iodized but it is otherwise it would be a clump. Yours probably is too. I think most people do a little less sprinkling of salt than we used to.

5

So that little two week experiment went in a word “poorly” The increased T caused me to become agitated, it clearly raised my cortisol and other fight or flight hormones through the roof as indicated by my blood sugars and just general sense of well being. Long story short think I better work on my clearly weak metabolism and hold off on T injections.

6

Clearly “weak” metabolism? What are you talking about?

You eat 2300 calories and maintain a 155 lb relatively lean frame, right? That sounds rather healthy to me.

So you don’t have the genetics to build huge amounts of muscle? So what? Play to your strengths.

7

Well I guess all i really meant by that is that since i just got done cutting for 4 months, my thyroid and adrenals seem to be down regulated as indicated by my thyroid labs and adrenal symptoms once starting TRT. Basically after a week I started waking up at 3AM in the morning which is a sign that my adrenals cant keep up with what I was doing.

Not to mention my my heart was racing much of the time. Regardless maybe weak metabolism wasn’t the right choice of words, but my body certainly wasn’t ready for that much test. I personally think after I start eating more and get my thyroid sorted the testosterone will raise, at least that’s what I am hoping. My FSH and LH numbers seem to indicate my pituitary is perfectly happy with the 516 TT number.

8

Subscribed…
Where is KSMAN’s Restart posted ?

9

Not a sticky. When you start TRT, many systems are adjusting and you cannot assume that anything good or bad will be sustained.

Iodine has nothing to do with salt clumping. If iodine deficient, you cannot get out of the hole with the maintenance levels in iodized salt or vitamins that list iodine.

There is nothing healthier about sea salt VS iodized. I don’t understand where these notions come from. Common salts come from ancient dried sea beds. There is iodine in sea water, but that gets lost when the crystals form. The iodine levels promoted in some “mineral salts” are trace levels that are not sufficient to sustain life.