Thanks to everybody who contributes on this board. I absorbed all the great stickies information AFTER starting TRT unfortunately - this post is very long because my entire known history is here and I figure the more information, the better. If you make it all the way to the end I’d surely appreciate any comments/advice. Again, thanks to all contributors for this priceless information, what a lifesaver!!
-age: 41
-height: 5 11
-waist: 32
-weight: 182
-describe body and facial hair:
Most of body has hair except for underside of arms, delts, flanks
Facial hair grows back quickly - 5oclock shadow for sure - it’s prickly by 8pm
-describe where you carry fat and how changed:
Fat is primarly in the belly area. It has always been this way, though there has recently been more in this area than 10 years ago
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
20mg Adderall (amphetamine salts)
300mg Wellbutrin (buproprion)
6.25mg Iodoral EOD
200mg selenium EOD
400mg chelated magnesium
8000IU vitamin D
OneADay multivitamin
10mg Ambien (zolpidem) typically 2 or 3x/week
never any hairloss/prostate drugs
-describe diet [some create substantial damage with starvation diets]
No seafood ever. No iodized salt in the house, only non-fortified sea salt. I don’t plan meals but have been avoiding simple carbs for a few months. I do regularly eat red meat and chicken. Lots of salads with extra-virgin olive oil. 2-3 whey isolate protein shakes/day.
-describe training [some ruin there hormones by over training]
Been lifting weights with variable consistency for 15 years. Have been much more diligent/regular in last 2 years. I always lift with intensity and limited rest between sets (30sec min up to 2min, depending on muscle group). Also a regular biker, 15mi/3x/week. Yes my bike seat has a hollowed out section.
-testes ache, ever, with a fever?
Never.
-how have morning wood and nocturnal erections changed
I can not recall the last time I had either one. Further I’ve not had a spontaneous erection that I can remember. These days all erections are in response to physical stimulus, however once “rolling” I’m able to maintain and orgasm. That said orgams have been lacking intensity for a long time. Also have noticed drop in ejaculatory amount and pressure for several years - sorry to be graphic, but my “output” just kind of bubbles out these days. Sometimes urination can be slow/dribbly, but other times it’s just fine.
-health conditions, symptoms [history]:
1/1992: At age 20 and after 2 years of severe ulcerative colitis flareups and up to 60mg/day of prednisone, I had 2 surgeries. Proctocolectomy (removal of large intestine and rectum) with ileal pouch-anal anastomosis and temporary ileostomy. 4 months later finished up with “takedown” procedure and ileostomy reversal. That’s a pile of awful sounding words but in summary, since then I’ve been able to eat anything (though some things cause more “trouble” than others) and have pooped like anybody else except with greater frequency. I think this med episode is worth detailing because the surgical action was near and adjacent to the prostate area and I had been warned about the potential for erectile side effects. No libido nor ED issues following surgery, luckily. Also significant is physical inability to have a DRE due to “restructuring” down there.
4/2005: After about 10 years of increasingly chronic sinusitis, underwent functional endoscopic sinus surgery to remove polyps (turbinectomy) and correct deviated septum (septoplasty). This was successful and helpful. I begin wondering about generalized inflamation between this episode and chronic colitis 15 years prior.
-lab results with ranges
Full history below…
1/2010: For historical reference - this was a routine physical and blood test at GP. Afterward I started taking vitamin D3 2000IU/day.
----1/13/2010 blood test, LabCorp----
3PM draw, non-fasting
Glucose, Serum 101 High (65-99 mg/dL)
BUN 12 (5-26 mg/dL)
Creatinine, Serum 1.03 (0.76-1.27 mg/dL)
eGFR >59 (>59 mL/min/1.73)
BUN/Creatinine Ratio 12 (8-27)
Sodium, Serum 139 (135-145 mmol/L)
Potassium, Serum 4.3 (3.5-5.2 mmol/L)
Chloride, Serium 101 (97-108 mmol/L)
Carbon Dioxide, Total 24 (20-32 mmol/L)
Calcium, Serum 9.7 (8.7-10.2 mg/dL)
Protein, Total, Serum 7.3 (6.0-8.5 g/dL)
Albumin, Serum 4.4 (3.5-5.5 g/dL)
Globulin, Total 2.9 (1.5-4.5 g/dL)
A/G Ratio 1.5 (1.1-2.5)
Bilirubin, Total 0.6 (0.1-1.2 mg/dL)
Alkaline Phosphatase, S 75 (25-150 IU/L)
AST (SGOT) 22 (0-40 IU/L)
ALT (SGPT) 17 (0-55 IU/L)
Cholesterol, Total 182 (100-199 mg/dL)
Triglycerides 172 HIGH (0-149 mg/dL)
HDL Cholesterol 47 (>39 mg/dL)
VLDL Cholesterol Cal 34 (5-40 mg/dL)
LDL Cholesterol Calc 101 HIGH (0-99 mg/dL)
LDL/HDL Ratio 2.1 (0.0-3.6)
TSH 1.240 (0.450-4.500 uIU/mL)
T4 6.3 (4.5-12.0 ug/dL)
T3 Uptake 34 (24-39 %)
Free T4 Index 2.1 (1.2-4.9)
Vitamin D, 25-Hydroxy 11.0 LOW (32.0-100.0 ng/mL)
10/2001: successfully impregnated spouse on 3rd or 4th try. Libido and erections both good.
2000-2012: Over the decade I’m regularly physically active, 5-7 lbs. overweight. Regular weight lifting never yields gains though workouts are always intense. Waist-area flab seems to remain no matter how much lifting and cardio I do, although I could have been eating better in general.
9/2012: I visit my GP, complaining of general depression, inability to focus, lack of enthusiasm for things I used to be into, brain fog, low libido, bit of ED. He says “we should check your thyroid, if all good you should see a psychiatrist” With test results below, GP says my thyroid is OK, sends me on to psych.
----9/20/2012 blood test, LabCorp----
1130am draw, non-fasting
TSH 1.160 (0.450-4.500 uIU/mL)
T4,Free(Direct) 1.08 (0.82-1.77 ng/dL)
Triiodothyronine, Free (FT3) 3.1 (2.0-4.4 pg/mL)
11/2012: I recap my history and current issues to the psych who starts me on Wellbutrin, 300mg. I notice a fleeting energy boost from it, not much more.
3/2013: I tell the psych the Wellbutrin brings some energy but focus/mood/enthusiasm issues remain. Lousy libido and some ED at this pointhowever worth noting that Wellbutrin gives me a noticable libido boost. Psych and I decide to wean off Wellbutrin and try Adderall, 20mg IR, 30mg if needed. I have not used more than 20mg/day more than 4 times. Adderall works indeed, but seems to enable mental focus and motivation alongside a sluggish overall body feeling and wavering libido/erectile function.
4/2013: No real core improvement via the Adderall. I go back to my GP and say I want a testosterone lab. Sure enough it comes back low @ TT 216 (348-1197). I return days later for a proper fasting/early-AM test: TT 286. WHY didn’t the GP run a T test in the first place, arrrgh… GP sends me to urologist.
----4/16/2013 blood test, LabCorp----
1030am draw, non-fasting
Glucose, Serum 120 High (65-99 mg/dL)
BUN 16 (6-24 mg/dL)
Creatinine, Serum 1.02 (0.76-1.27 mg/dL)
eGFR 91 (>59 mL/min/1.73)
BUN/Creatinine Ratio 16 (9-20)
Sodium, Serum 141 (134-144 mmol/L)
Potassium, Serum 4.8 (3.5-5.2 mmol/L)
Chloride, Serium 104 (97-108 mmol/L)
Carbon Dioxide, Total 23 (20-32 mmol/L)
Calcium, Serum 9.3 (8.7-10.2 mg/dL)
Protein, Total, Serum 6.7 (6.0-8.5 g/dL)
Albumin, Serum 4.4 (3.5-5.5 g/dL)
Globulin, Total 2.3 (1.5-4.5 g/dL)
A/G Ratio 1.9 (1.1-2.5)
Bilirubin, Total 0.5 (0.0-1.2 mg/dL)
Alkaline Phosphatase, S 65 (25-150 IU/L)
AST (SGOT) 19 (0-40 IU/L)
ALT (SGPT) 17 (0-44 IU/L)
Testosterone, Serum 216 LOW (348-1197 ng/dL)
----4/22/2013 blood test, LabCorp----
9am draw, fasting
LH 3.2 (1.7-8.6 mIU/mL)
FSH 3.2 (1.5-12.4 mIU/mL)
Hemoglobin Alc 5.1 (4.8-5.6 %)
Free Testosterone (Direct) 8.1 (6.8-21.5 pg/mL)
Testosterone, Serum 286 LOW (348-1197 ng/dL)
5/8/2013: Urologist does physical exam, talks about hypogonadism, TRT options, draws a graph showing how AndroGel, pellets, and injections lead to differently fluctuating T levels. Sends me to endocrinologist.
6/17/2013: Endo, armed with 6/5/13 test results (below) showing safe PSA result, starts me on 2 pumps/day AndroGel 1.62% (40.5mg @ ~10% absorb). This was a very short appointment - only later after learning a lot more, did I realize it was also rather disappointing and unfortunate that we started TRT without further exploration of potential thyroid and adrenal issues and without a starting E2 reading.
----6/5/2013 blood test, lab unknown----
815am draw, fasting
LH 2.8 (1.2-9.0 mIU/mL)
PSA 0.77 (0.00-4.00 ng/mL)
TESTOSTERONE 2.39 (2.00-8.00 ng/mL)
7/12/2013: Follow-up blood test to check T levels.
----7/12/2013 blood test, Quest Diagnostics----
900am draw, fasting. 24 hours since last AndroGel application
Testosterone, Total 299 (250-1100 ng/dL)
Testosterone, Free 62.7 (35.0-155.0 pg/mL)
Estradiol 32 (<57 pg/mL)
7/24/2013: 1 month into the 2-pumps AndroGel regimen, a follow-up 10am fasting blood test shows TT=2.20 (2.00-8.00). Would have been nice to see LH/FSH numbers here – I am hypothesizing transdermal absorbtion issues, and it’s right about here I started reading this forum and the stickies. I learn that poor absorbtion may be a hypothyroid symptom. I keep reading forum posts and other articles, also STTM. I read all about ID. No iodized salt in the house, I never eat seafood, and initial body temp tests show 96-96.5 waking temp, 97-97.5 daytime. hmmÃ?¢?Ã?¦
Follow-up appt. with the endo to discuss results turns out to be with his resident assistant. While she thinks this is a test result with an AndroGel application the same morning, I did NOT actually apply the gel prior to this test – my understanding is that you want to measure during lows, not highs. She doesn’t seem to understand male hormones - she says we don’t need to test E2 since my original test showed the level was fine (sigh…) She also says they don’t like to prescribe anastrozole because it has a lot of side effects (like what, making me feel better? yeesh…)
----7/21/2013 blood test, lab unknown----
1030am draw, fasting. 24 hours since last AndroGel application
TESTOSTERONE 2.20 (2.00-8.00 NG/ML)
8/1/2013: Consistent 96.5 waking temp (CVS digital thermometer). I begin Iodoral 12.5mg daily.
8/8/2013: FAR more educated now (and irritated), I decide to get a complete panel via lef.org out of pocket. This is 12 days into 4-pumps/day of AndroGel 1.62%. I did not apply gel the morning of this test, and I also stopped taking Iodoral 48 hours prior.
----8/8/2013 blood test, LabCorp / LifeExtension----
930am draw, fasting. Also 230pm draw for 2nd cortisol, non fasting
Glucose, Serum 78 (65-99 mg/dL)
Uric Acid, Serum 5.4 (3.7-8.6 mg/dL)
BUN 19 (6-24 mg/dL)
Creatinine, Serum 0.93 (0.76-1.27 mg/dL)
eGFR 102 (>59 mL/min/1.73)
BUN/Creatinine Ratio 20 (9-20)
Sodium, Serum 141 (134-144 mmol/L)
Potassium, Serum 4.0 (3.5-5.2 mmol/L)
Chloride, Serium 102 (97-108 mmol/L)
Carbon Dioxide, Total 22 (19-28 mmol/L)
Calcium, Serum 9.4 (8.7-10.2 mg/dL)
Phosphorus, Serum 2.8 (2.5-4.5 mg/dL)
Protein, Total, Serum 7.2 (6.0-8.5 g/dL)
Albumin, Serum 4.7 (3.5-5.5 g/dL)
Globulin, Total 2.5 (1.5-4.5 g/dL)
A/G Ratio 1.9 (1.1-2.5)
Bilirubin, Total 0.7 (0.0-1.2 mg/dL)
Alkaline Phosphatase, S 63 (44-102 IU/L)
LDH 185 (0-225 IU/L)
AST (SGOT) 25 (0-40 IU/L)
ALT (SGPT) 21 (0-44 IU/L)
Iron, Serum 85 (40-155 ug/dL)
Cholesterol, Total 176 (100-199 mg/dL)
Triglycerides 89 (0-149 mg/dL)
HDL Cholesterol 46 (>39 mg/dL)
VLDL Cholesterol Cal 18 (5-40 mg/dL)
LDL Cholesterol Calc 112 HIGH (0-99 mg/dL)
T. Chol/HDL Ratio 3.8 (0.0-5.0)
Estimated CHD Risk 0.7 (0.0-1.0 times avg.)
WBC 6.5 (4.0-10.5 x10Ee/uL)
RBC 5.15 (4.14-5.80 x10E6/uL)
Hemoglobin 15.0 (12.6-17.7 g/dL)
Hematocrit 45.3 (37.5-51.0 %)
MCV 88 (79-97 fL)
MCH 29.1 (26.6-33.0 pg)
MCHC 33.1 (31.5-35.7 g/dL)
RDW 13.5 (12.3-15.4 %)
Platelets 368 (140-415 x10E3/uL)
Neutrophils 51 (40-74 %)
Lymphs 27 (14-46 %)
Monocytes 12 (4-13 %)
Eos 9 HIGH (0-7 %)
Basos 1 (0-3 %)
Immature Cells
Neutrophils (Absolute) 3.4 (1.8-7.8 x10E3/uL)
Lymphs (Absolute) 1.7 (0.7-4.5 x10E3/uL)
Monocytes (Absolute) 0.8 (0.1-1.0 x10E3/uL)
Eos (Absolute) 0.6 HIGH (0.0-0.4 x10E3/uL)
Baso (Absolute) 0.1 (0.0-0.2 x10E3/uL)
Immature Granulocytes 0 (0-2 %)
Immature Grans (Abs) 0.0 (0.0-0.1 x10E3/uL)
Testosterone, Serum 424 (348-1197 ng/dL)
Free Testosterone(Direct) 14.9 (6.8-21.5 pg/mL)
Pregnenolone, MS 28 (Adults: <151 ng/dL)
Dihydrotestosterone (DHT) 123 HIGH (Adult Male: 30-85 ng/dL)
Estradiol 31.0 (7.6-42.6 pg/mL)
Roche ECLIA methodology
Cortisol - AM (serum) 6.9 (6.2-19.4 ug/dL)
Cortisol - PM (serum) 13.0 HIGH (2.3-11.9 ug/dL)
LH 0.1 LOW (1.7-8.6 mIU/mL)
FSH 0.2 LOW (1.5-12.4 mIU/mL)
TSH 2.470 (0.450-4.500 uIU/mL)
Thyroxine (T4) 5.3 (4.5-12.0 ug/dL)
T4,Free(Direct) 1.06 (0.82-1.77 ng/dL)
Triiodothyronine, Free (FT3) 3.9 (2.0-4.4 pg/mL)
Reverse T3 (RT3) 12.9 (9.2-24.1 ng/dL)
Thyroid Peroxidase (TPO) Ab 7 (0-34 IU/mL)
Antityroglobulin Ab <20 (0-40 IU/mL)
Siemens (DPC) ICMA Methodology
SHBG, Serum 20.4 (16.5-55.9 nmol/L)
DHEA-Sulfate 205.7 (88.9-427.0 ug/dL)
ACTH, Plasma 17.6 (7.2-63.3 pg/mL)
(ACTH reference interval for samples collected between 7 and 10 AM)
PSA 0.7 (0.0-4.0 ng/mL)
Roche ECLIA methodology
Vitamin D, 25-Hydroxy 38.3 (30.0-100.0 ng/mL)
Magnesium, Serum 1.9 (1.6-2.6 mg/dL)
Observations/questions from this test:
LH/FSH show that I’m absorbing some T via the gel.
E2 is too high but I have no pre-TRT reference to know if it has risen, very unfortunate. TT improved, but again- with no E2 history, I may well have a worse T:E ratio now than pre-TRT. FT looks good but DHT is very high (typical with transdermals) - is DHT typically behind acne breakouts? Low in range SHBG may support hypothyroid theory?
Cortisol: the serum test shows large swings from low AM to high PM - unsure how useful/accurate serum cortisol tests are though. Data point: I took my daily Wellbutrin and Adderall doses shortly after the AM blood test - wish I hadn’t. Thinking to get a 4-sample saliva test. If cortisol levels are indeed swinging wildly (while off all stimulants), is this an adrenal fatigue indicator? And would that be connected to thyroid issues? STTM’s adrenal page talks about estrogen dominance messing up adrenal function…
Not sure what to make of thyroid panel other than I don’t seem to have Hashi’s - numbers seem OK? I’m looking good on the STTM rT3 calculator (my ratio=30.2, with “good” numbers being >20)
Vitamin D level low - I bumped from 2000 to 8000 IU/day. Magnesium level disappointing as I’ve been taking 400mg/day cheleated magnesium since starting the Adderall in March 2013.
Subjectively I’m not feeling much different at this point - some more energy in the gym and it seems better gains. Libido is OK however ED as bad as it’s been. It’s as if I can’t get a mechanical/erectile response when the brain is going HELL YEAH. Pretty frustrating. Still no morning nor spontaneous erections at all. I’m able to perform alone and in the bedroom with steady stimulation, however it’s easy to lose an erection quickly. Frustration/exasperation with current docs growing - how can an entire industry be so clueless about male hormones? Boggles my mind.
8/12/2013: I increase Iodoral to 25mg daily as I’m tolerating it fine but not seeing a bump in waking body temp. It is about here that I start seeing significant acne on upper back. Am wondering if it’s from high DHT and/or the Iodoral.
8/29/2013: Endo’s resident assistant calls with 8/21 blood test results (below). This was to measure T level following 1 month on 4 pumps of AndroGel 1.62%. After seeming reluctant to tell me the E2 result, she does and then tells me it’s in range. When asked, I reply that I’m not feeling a lot better re: libido/ED/mood/brain-fog. Resident assistant asks if I’ve had my thyroid checked - I reply that my GP did so last fall, and said that I’m fine. Resident says 100mg/wk self-injections are an option, make an appt. to come and see how it’s done and try one to see how you feel on it. Needless to say I made this appointment immediately. Two days prior, (correctly) anticipating these test results, I ordered a packet of generic anastrozole 1mg tabs online. It’s going to be really tough waiting for it to arrive in “7-15 days” – I’m hopeful that my rising E2 level explains why I’ve felt progressively, although slowly, more crappy since starting on 4 gel pumps and that a split does of 1mg/wk will fix me up.
----8/21/2013 blood test, lab unknown----
1030am draw, fasting. 24 hours since last AndroGel application.
TESTOSTERONE 6.00 (2.00-8.00 ng/mL)
ESTRADIOL 45 (<57 pg/mL)
Body temperatures:
CVS digital thermometer
waking temp:
8/1/13: start Iodoral 12.5mg
8/10/13: 96.6
8/12/13: increase Iodoral to 25mg
8/22/13: 96.2
8/24/13: 97.1
8/27/13: 96.8
8/29/13: 96.8
mid day temp:
8/1/13: start Iodoral 12.5mg
8/10/13: 97.3
8/12/13: increase Iodoral to 25mg
8/22/13: 97.7
8/24/13: 97.8
8/27/13: 98.2
8/29/13: 98.2
8/31/13: At this point, having just started T cyp injections, my question is regarding AI given my very limited E2 historical data: Having just come off the max dose AndroGel and showing a high-in-range E2, do you think I’m on the right track in starting 1mg anastrozole in split doses? How long to wait before getting an E2 reading via lef.org so that I can adjust the AI dosage if necessary? Am really hopeful that high E2 is the final piece of the puzzle - I’m sure my TT is plenty high now but I’m still not feeling great, libido/ED/fog all still there.
Also seeking opinions on thyroid & adrenal function. After 3 weeks on Iodoral 25mg, I’ve reduced to 12.5mg as temps seem to have stabilized.