I finally had labs done & saw some doctors. This is more like a first post even though its not.
Age: 40
Height: 5’11"
Weight: 183
Waist: 31.5"
Body Hair: Plenty, but none on back and thinning on ankles.
Facial Hair: Medium thickness & speed of growth.
Head Hair: Mostly bald on top & advancing male pattern baldness. Who cares really now because I shave my head & am done with bad hair days forever.
Carry fat mostly around lower abdomen. Probably around 12-15% bodyfat currently. When training I am around 10-11%. Normally I am a gym-rat weight-training with heavy weights & regular aerobic exercise, but now recovering (doing PT) from shoulder & knee surgeries late last winter, still. No exercise induced endorphin rush in almost six months!
Symptoms/health conditions: Low energy/ easily fatigued, depression, terrible short-term memory, avoid social situations, and low libido & ED. Eventually stopped dating because of low-T.
Rx & OTC drugs: Lithium, trazadone, Geodon, Cymbalta (all for Bipolar Type II disorder). I will stop the Cymbalata when I can get a regular/daily solid workout again. Just started Test. Cyp. 50mg IM X2 weekly and Armour thyroid 2 grains (60 mg)/day (Armour now discontinued). Will be starting rhCG (Ovidrel) in three to four weeks (when it arrives mail order - due to high cost domestically). I have liquid anastrozole on hand in case gyno becomes an issue before my next Dr. visit in three months. I took propecia for nine months in 2001-2002. I tried a Nolvadex reset/restart (detailed in an above posting) which yielded no noticeable change in libido or anything T-related. The restart was after my first T lab and before my most recent T lab. That said, along with consideration of the labs I would surmise that I am primary hypo.
Lab Results: (Labs presented in reverse chronological order (most recent is first))
5/15/2012 Labs (Hormonal/Thyroid):
Total Test.: 346 ng/dL [300 - 890]
Bioavailable Test.: 176 ng/dL [131 - 682]
Free Test.: 58 pg/mL [47 - 244]
% Free Test.: 1.7 % [1.6 - 2.9]
SHBG: 35 nmol/L [11 - 80]
Estradiol (E2): 27 pg/mL [0.0 - 56]
FSH: 3.4 mIU/mL [0.7 - 11.1]
LH: 4.9 mIU/mL [0.8 - 7.6]
TSH: 6.34 uIU/mL [0.4 - 5.00] HIGH
T3, Free: 3.4 pg/mL [2.2 - 4.0]
T4, Free: 1.27 ng/dL [0.8 - 1.6]
Thyroid Autoantibodies:
Thyroid Peroxidase AB: 28.5 units/mL [<60]
Thyroglobulin AB: 35.6 units/mL [<60]
03/06/2012 Labs (Lipids, TSH, Complete Metabolic (Fasting)):
Cholesterol: 173 mg/dL [100 - 200]
LDL: 114 mg/dL [<130]
HDL: 49 mg/dL [>39]
Triglyceride: 51 mg/dL [<150]
Non-HDL Cholesterol: 124 mg/dL [<190]
Cholesterol/HDL: 3.5 [<4.5]
TSH: 5.730 mcUnits/mL [0.350-5.000] HIGH
Sodium: 141 [135 - 145] mmol/L
Potassium: 4.1 [3.4 - 5.1] mmol/L
Chloride: 106 [98 - 107] mmol/L
Carbon Dioxide: 30 [21 - 32] mmol/L
Anion Gap: 9 [10 - 20] mmol/L LOW
Glucose: 96 [65 - 99] mg/dL
BUN: 23 [10 ? 20] mg/dL HIGH
Creatinine: 1.3 [0.5 - 1.3] mg/dL
GFR Est. African Amer.: >60 [>59] mL/min./1.73m2
GFR Est. Non-African Amer.: >60 [>59] mL/min./1.73m2
BUN/Creatinine Ratio: 18 [7 - 25]
Calcium: 8.6 [8.4 - 10.2] mg/dL
Bilirubin Total: 0.4 [0.2 - 1.0] mg/dL
GOT/AST: 21 [<38] units/L
GPT/ALT: 51 [<66] units/L
ALK Phosphatase: 64 [50 - 136] units/L
Protein, Total: 7.0 [6.4 - 8.2] g/dL
Albumin: 3.8 [3.4 - 5.0] g/dL
Globulin: 3.2 [2.0 - 4.0] g/dL
A/G Ratio: 1.2 [1.0 - 2.4]
Lab 11/28/2011:
Total Testosterone: 376.4 [280 - 1100]
Lab 05/10/2011:
TSH: 2.711 mcUnits/mL [0.350-5.000]
Diet: I’m very aware of body fat & weight and eat high protein, moderate fat, low carb diet with whole grains, lactose, green vegetables, & sparse fruits as only carbs. I eat plenty of fish (wild-caught & farmed), along with poultry and once (no more than twice) per week red meat. I eat whole foods & prepare meals & avoid most processed foods (excepting cheese). I take a daily multivitamin, B-complex, 4000IU vitamin D, 50mg zinc, fish oil 720mg EFA/Omega 3’s, 1000mg vitamin C. I have experimented with 25mg DHEA in the past with almost no result on low T symptoms.
Describe Training: Right now my training consists of knee & shoulder physical therapy exercises using three & five pound dumbbells for injured left arm. I was curling 45-60 pound dumbbells before surgery. I had a SLAP tear caused by impingement of the clavicle. Arthroscopic surgery removed bone spurs & performed a biceps tenodesis (reattach the long-head biceps tendon to bicep groove on humerous). Arthroscopic knee surgery to correct Hoffa’s Syndrome (enlarged & frayed fat pad in left knee) causing patello-femoral pain whenever I would try running. The jury is out on both surgeries yet, but my progress is slow & steady. I currently walk 30 min per day along with the PT knee & shoulder exercises.
My usual exercise routine is three days in the gym (up to two hours each day, because I really love what lifting heavy weights does mentally first, & physically second) and the fourth day is running/biking (a four day program that I repeat). Two gym days - upper body and one gym day - legs/abs. I live to be physical, workout, & especially body-build. I have had no problem building & keeping muscle despite low T levels. This might be due to muscle-memory as I weight-trained heavily from age 12-18. As an adolescent & 20-something I surmise that I had very high testosterone levels (easily build muscle, very high sex drive & almost annoyingly high if it can be said, great performance, never an issue with ED or libido). I was (in high school) and still am accused of juicing because of muscle mass.
Testes ache ever with fever? Not aware of having a fever but for about the last seven years my right testicle would ache very uncomfortably, sporadically for no apparent reason and usually last a few days. I always chalked it up to potential slight torsion that I myself would try to correct by coughing & repositioning. In 2010 it even landed me in the ER twice because of the pain. Had an ultrasound done on it & no cause was found for this pain. Referred to urologist, but never followed up on it. My symptoms of low T coincide with the past seven years during these same episodes of pain.
Morning wood/nocturnal erections: Practically non-existent for last seven years. Had my first strong morning wood the morning after my first injection, but nothing since then. I’ve only had three shots so far.
My first Dr. appt for low T treatment was on May 15 and my most recent labs were on the same day. I gave my doctor some material from this website on the suggested protocol of treatment and asked if it was possible. My doctor read the material and responded with a letter stating that she was not the right doctor for me considering the hCG, AI, and home injections, all of which she was uncomfortable with. Unfortunately, she billed the appt for the following three reasons; 1.ED, 2. Thyroid function/needed treatment, and 3. libido. If you mention either ED or libido in regard to testosterone therapy to my insurance company, coverage is automatically denied. I am appealing her stated reasons (codes) for the appt considering I gave her printed materials stating my primary reasons (energy, depression, social withdrawal, etc.) but am not hopeful (she’s with a large hospital conglomerate that is very inflexible) as we only discussed ED and libido in regard to symptoms. I allowed her to do the diagnosing rather than me trying to prove I have low T by stating all my symptoms. Most of my questions were in regard to testing & treatment, not how she would code the appt. Ultimately, this is my fault because when I asked if they took my insurance for what they were seeing me for and they said “Yes,” I made the assumption that the professionals would know how to code the appt properly in order for the claim to be accepted. Obviously, that was a terrible assumption. $300 for nothing you could say, or at least almost. The labs were paid for & accomplished.
My second appt was completely the opposite of the first. Actually, I hit the jackpot. My new doctor is 100% on-board with home injections, has Rx’d me 100mg/week T in two divided doses, 250IU hCG MWF, and starting an AI after my second appt, if necessary. I even bought some vitamin B-12 to use periodically (SC) with the hCG, although I’ve never had my B-12 levels tested. I’ve had my first three 50mg T injections so far, and hopefully will start the hCG in around three weeks or so. Even though I pay may own insurance I am also paying 100% of the cost (visits, meds & future labs) for low-T with this new doc because he’s not covered by my insurance. I see it as money well-spent though because he’s likely the only physician in my area who will even consider this protocol. His office visits are reasonably priced unlike some other well-known docs in this field. It’s nice to be treated as an adult as far as my treatment is concerned.
The stickies here answered a lot of my questions so thank you guys for those. I am posting my case mostly in case of future issues/questions, but I do have some questions now regarding thyroid. A little background first.
In September 2009 I started taking Lithium which dramatically altered my life for the better, being bipolar (since age 9). At age 37, I finally found the right meds (listed above) which I am still on. One side-effect of lithium in 10% of people who take it is hypothyroidism. It has something to do with speeding up the metabolism of the thyroid which then loses some of its needed iodide (replaced by lithium). I recently began supplementation of potassium iodide to see if this makes any difference. I already have been eating lots of fish which are supposed to be a good source of iodide I have heard. All of that aside, my TSH has been on the uptick since at least May 2011. I get a TSH reading once a year because of the Lithium. May 2011: TSH: 2.711, March 2012: TSH: 5.730, and May 2012: TSH: 6.34. Keep in mind my symptoms of low T far pre-date my starting lithium (at least four years prior to 2009) when my thyroid was functioning normally. My shrink has been testing my TSH yearly since 2009 and hasn’t raised a red flag until March 2012. I am going to get TSH numbers prior to May 2011 when I see her in two weeks. I am not convinced that the recent elevated TSH has had much additional significant impact on my T levels.
Now the first doc Rx’d me levothyroxine (Synthroid) 50mcg which made me feel like I was being poisoned after one or two days. I couldn’t sleep, became anxious, depressed, and even paranoid while on it for five days. I am not kidding when I say if the choice was suicide or life on Synthroid I would choose the former after not very long. I quit the Synthroid and she Rx’d Armour Thyroid 60mg (2 grain) which I recently started after a week away from the Synthroid. For the first two days on Armour I felt better. The third day depression, fatigue, anxiety all crept back in and now I have also stopped the Armour. The Armour was better in that at least I could sleep while on it. Even though I was very easily fatigued before both thyroid meds, that fatigue is better than having all the additional sides, plus fatigue, experienced while taking these thyroid meds.
My intolerance for the thyroid meds along with climbing TSH numbers prompted me to try stopping the lithium which likely is causing the elevated TSH. After five days I found that quitting was easier said than done. My quality of life deteriorates quickly without the lithium so I begrudgingly went back on it. I will discuss options with shrink in two weeks, and my shrink knows NOTHING about thyroid medications, not that the MD’s do either.
The first TRT doc thinks I need thyroid replacement due to my high TSH, but my new doc doesn’t think I need a thyroid med yet. He cites my normal labs for T3, Free & T4, Free, and normal thyroid antibodies. He says T3,Free & T4,Free are much more important indicators than TSH.
My theory & questions: What I probably need next is a reverse T3 test (for more insight into thyroid issues) and also an 8am cortisol to check for adrenal fatigue as that could also be causing my fatigue. Does anyone else here concur with this? Do I really need thyroid treatment with these numbers or not? I already have two doctors who disagree on this. Continuing on thyroid replacement will cause my own thyroid to shut down completely after some time I am assuming. How difficult is it to re-boot a shutdown thyroid if need be? If anyone can help on this I would be grateful.
Now I know some of you will say I am on TRT prematurely due to elevated TSH, but as I said my low T symptoms far predate my recently elevated TSH numbers. There is no history/precedent of hypothyroidism in my family. I have been tested for thyroid issues periodically since age 9 because of my struggle with unrelenting depression and the doctor involved has always reported a normal TSH. Only after starting lithium three years ago has my TSH recently become elevated, which is a known side-effect of lithium. Oh, and I already know about stopthethyroidmadness.com. I also for a six-month period of time in 2006 was off all psych meds which for me is all prescription meds, and my low-T symptoms remained the same.