34 Y/O on TRT (and Anaztrozole)

Pharma TRT
1

Hello. I have some concern over my current treatment protocol and my concerns led me here.

I was hyperthyroid at a young age due to (Grave’s Disease?). It’s hereditary and 2 of my siblings have thyroid issues. I managed my hyperthyroidism but years later it started going hypo. I was at 88 mcg Levothyroxine and was just bumped to 100 mcg as recent labs were:

T4 5.9 (6.1-12.0)
T3 Total 74 (87-178)
TSH 2.34 (0.35-4.0)

I also mentioned lack of energy to my doctor, also having trouble putting on muscle, so yes I mentioned to get T tested. He said he would do a full T panel but the only result he gave was my total testosterone at 444 which he said was mid-range but low for my age. He said I should be 700+.
I figured ok I’ll try some TRT. From my understanding it wasn’t permanent and I could drop back off it at a later date to see if it stays at a higher number or at worst it would go back to mid 400’s. Is this incorrect?

He gave me an injection of 300 mg every 2 weeks. At my last visit I told him that I didn’t really notice much of anything- good or bad. He tested my estrogen and it came back as:

Total Estrogen 35
Estradiol 15
Estrone 20 (not sure what Estrone is but that’s what it said in the email)

He said this was on the higher side of normal and he put me on 1 mg/daily of Anastrozole.
I got a bit concerned and did some homework and it sounds like this is a really high dose… but he responded that this is a common initial dose to see how I respond. Also, 15 Estradiol doesn’t sound high… I don’t know what my current T level is as he says he will test me for it next time I come in.
I also questioned him about taking the shots every 2 weeks instead of once a week like people seem to do here, but he insisted that the testosterone he uses is specifically formulated to be injected once every other week.

Any thoughts?

2

You need more labs and you need to provide ranges with your estrogen labs. If they are labcorp then your Estradiol is actually on the low end. TRT is permanent, it is a lifelong committment. When you introduce exogenous T you run the risk of your testicles shutting down, which means when you stop TRT they will no longer function and you won’t be able to make T.

You should read the stickys first, and provide more info. Read the thyroid sticky, you should get FT3, FT4, RT3 labs done to assess the current situation of your thyroid. You probably need to medicate with T3 instead of T4 (you have very low Total T3) but, unable to determine without more info (need FT3 or RT3 labs).

3

Thanks for the reply. I will try to get a range for the estrogen labs. He just sent me the numbers in an email. It’s a bit hard getting copies of the lab work from the doctor sometimes and it’s giving me a bit of a red flag. For instance, when he first tested my Testosterone he mentioned running a full panel of Free/Total/Growth Hormone, etc… but when I asked him for the results all he showed me was a single printout with just my Total T.
I’ve read through the thyroid sticky- perhaps I should study it a bit better. I’ve been on Levothyroxine for years, though. Would supplementing with Iodine really help me at this stage?
Also, I have only taken 2 injections and am due for another one Monday (I have a take-home shot I was going to administer). I’m worried about the scenario you state about testes no longer functioning permanently. Do you feel I would be better off by not taking any more injections and seeing if I can find an alternate way to get my T up a bit? Or did I already mess things up by taking the 2 injections?
I’ll read through the rest of the stickies and provide any more info. As far as symptoms: Low energy, trouble putting on muscle even though I eat and workout like crazy, libido hasn’t been the best but not horrible. I had heard years ago that thyroid issues could lead to testosterone issues so that was why I jumped to the low-T conclusion initially and I wasn’t thrilled with the 444 number.

4

-age
34

-height
5’10"

-waist
32

-weight
185

-describe body and facial hair
Very little hair. Joke around that I still can’t grow a real beard.

-describe where you carry fat and how changed
Upper thighs and stomach a bit but not too bad

-health conditions, symptoms [history]
Hypothyroid. Started hyper in early 20’s and started going hypo about 6 years ago

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
None
– real dangers! see this http://propeciahelp.com/overvi…
-lab results with ranges

Comp Metabolic Panel

Glucose 95 (65-110)
Blood Urea Nitrogen 14 (6-20)
Potassium 4.4 (3.5-5.3)
Bun/Creat ratio 12.7 (12-20)
Sodium 135 (135-145)
Creatinine 1.10 (.5-1.5)
Chloride 102(98-108)
CO2 26 (24-32)
Anion Gap 7 (3-11)
Calcium 9.8 (8.6-10.6)
Total Protein 7.3 (6-8)
Albumin 4.5 (3.4-5)
Bilirubin, total .6 (0-1.2)
Alk Phos 51 (40-125)
AST 33 (10-40)
ALT 29 (10-50)

Blood Count

WBC 8.9 (3.9-12)
RBC 4.84 (4-6.1)
HGB 15.4 (13.2-18)
HCT 46.4 (38-55)
MCV 95.9 (80-99)
MCH 31.8 (26-35)
MCHC 33.2 (32-37)
RDW 12.4 (11.6-15)
PLT 251 (150-450)
MPV 8.7 (6.5-11)

Iron 93 (49-181)
Total Iron Bind Capacity 291 (250-450)
Ferritin 77 (10-259)
Folate >25.0 (>5.8)
Vitamin B12 1279 (180-914) I was told not to worry about this? Prob high because I take supplements?

T4 5.9 (6.1-12)
T3 Total 74 (87-178)
TSH 2.34 (0.35-4)

Total Testoterone 444 (300-1080)
Estrogen 35 (15 Estradiol, 20 Estrone) I will try to get a range for this

That’s all I have for now.

-describe diet [some create substantial damage with starvation diets]
I eat pretty healthy. I eat a lot of fruits, veggies, and fish and try to stay away from too much sugar. However, I don’t eat a lot of meat. I was on a pescetarian diet for years and just recently started eating poultry again. I haven’t had red meat in years. I get most of my protein requirements from dairy (organic whole milk, cheese) and whey protein.

-describe training [some ruin there hormones by over training]
I do an upper/lower split currently. 2 days on, 1 day off.

-testes ache, ever, with a fever?
nothing too horrible. can’t say they don’t ever ache though

-how have morning wood and nocturnal erections changed
Less frequent for sure

5

Sorry, with Regards to Rx drugs- just Levothyroxine at 100 mcg currently. Other than that antibiotics/antifungals here and there as I have chronic left ear issues.

I do take supplements:
Orange Triad Multi
Fish Oil
Pre-Workout
BCAA’s
Whey

6

Found another set of labs:

Differential

Neutrophil 75.3 %
Lympocyte 15.1 %
Monocyte 7.7 %
Eosinophil 1.2 %
Basophil .7 %
Neutrophil 6.7 (1.3-7.5)
Lympocyte 1.4 (1.3-4.2)
Monocyte 0.7 (0.2-1)
Eosinophil 0.1 (0-0.5)
Basophil 0.1 (0-0.15)

When I asked about the high Vitamin B12 I was told my liver enzymes were fine and my liver felt fine when he pressed on it.

7

Get the thyroid labs suggested above.

fT3 is what gets the job done and it needs to get into the cells. fT3 regulated mitochondrial activity and the end result is the management of body temperature.

When some take Rx T4, they are not able to properly convert fT4–>fT3 and suffer hypo symptoms. So you need to check fT3. We are interested in free thyroid hormone levels as these hormones bound to thyroid binding globulin are not active.

You may need Rx T4+T3. The dedicates thyroid products may be better for you.

You can evaluate your thyroid function by checking your body temperatures as per the sticky and can use temperatures to adjust your Rx thyroid doses.

So those labs and your body temperatures will be very informative.

Have you been iodine deficient for years?

Your doctor is an idiot. You did not get LH/FSH done to determine if your testes are the problem or your hypothalamus-pituitary function.

You need to:

  • self inject 50mg T twice per week [total 100]
  • take 1/2mg anastrozole at that time
  • if you want to preserve your testes you will need to inject hCG - is fertility a concern at your age?

Read these stickies:

  • thyroid basics
  • advice for new guys - basics you need to know
  • protocol for injections
  • finding a TRT doc
8

Yeah, I will work on getting further labs. I am reading through the stickies now. I appreciate the help. Would it be okay if I just stopped the testosterone shots cold turkey when I’ve already gotten 2 300mg shots? I’m thinking right now that I want to find a different doctor, get a whole panel of suggested labs, and then see if I can get my T back up some other way rather than rely on Testosterone permanently at a young age.
So my main question - is it going to be a bad idea for me to not take my shot Monday?

9

I also don’t know about my iodine levels/intake. I never considered it until reading the thyroid sticky earlier. Do you recommend me buying some iodized salt and/or iodine supplement even though I was diagnosed with Grave’s Disease years ago and have been taking levothyroxine for years?

10

Okay, Estrogen:

Total 35.6 (19-69)
Estradiol 15.3 (10-42)
Estrone 20.3 (9-36)

11

Iodine has different roles in the body. You still need some.

“”"
You can evaluate your thyroid function by checking your body temperatures as per the sticky and can use temperatures to adjust your Rx thyroid doses.
“”"

Can you report temperatures?

Your TSH is indicating that your levothyroxine dose is insufficient.