44 Y/O Male With Low T

Pharma / TRT Testosterone Replacement
1

My story is like many here.

Age:44
Height 6’1"
Weight 270
Body: I am a big boned hairy guy, I can grow a beard in week. I am balding.
Fat: I carry alot of fat around my middle. I always have.

Health conditions: I have sleep Apnea, Diabetic on a normal diet, started feeling tough a couple of years ago.

RX drugs: Using nasonex for sinuses. Used Rogaine for 3 weeks in the 90’s

Labs Results:

10-11-12
Total T 367 Quest Valencia, CA Range 250 to 1100
TSH 1.84 Mercy Hospital lab Range .27 to 4.68

1-28-13 Fasting 9am
Total T 493 Quest Valencia, CA Range 250 to 1100
Free T 65 Quest Valencia Range 35 to 155
Estradiol 36 Quest Wood Dale,IL Range < or = 39
Prolactin 2.7 Quest Wood Dale Range 2 to 18
FSH Serum 3.5 Quest Wood Dale Range 1.6 to 8
LH 3.8 Quest Wood Dale Range 1.5 to 9.3
T4 Free 1.06 Mercy Range .85 to 1.76
TSH 1.24 Mercy Range .27 to 4.68
Ferritin 302 Mercy Range 30 to 400
Hemo A1C 5.9 Mercy Range < 5.7
Cortisol Total 11 Mercy Hospital Lab Range AM 6.2 to 19.4
Cholesterol 208 Mercy Range < 200
Triglyceride Mercy Range < 150
HDL 37 Mercy Range <39
VLDL 19 Mercy Range 2 to 45
LDL 152 Mercy Range <100

Diet: Following a very low carb diet. Cheat a couple times per month.

Training: I walk 30 minutes 5 to 7 days per week. I lift weights 3 times per week.

Testes: I did go to the Dr. 2 years ago with pain in my left testesicle. Dr. told me it was my vasectomy.

Morning Wood: Still have wood every morning. It was softer before I started supplements in December.

I decided to get checked last fall because I was feeling really poor and having mild ED during sex. I tried to start lifting weights in July and I got no where. I hurt all the time and saw no gains in strength or size.

After getting the results of T = 368, I was rejected by my health care insurance for Androgel because I needed to be below 300. I decided to look around for any supplements to boost T.

I am currently taking:
D - Testosterol 3 pills
Boron 12 mg
GNC mega men vit
Vit d3 10,000 IU
Fish oil
DIM 400 mg
CoQ10
ZMA 3 pills at night

After 45 days on these supplements I was rechecked and got the results shown on 1-28-13.

I started lifting weight when I started taking the supplements and have put on some muscle. I have more energy, but I can’t seem to shake any weight at all.

I took 2 weeks off of the cycle of D Testosterol and crashed pretty hard.

My ferritin level is 2x the optimal range so I have just started giving blood. Hemochromotosis runs in my family.

I notice that my Estradial is 36. Should this be lower?

Any thoughts would be great.

Regards,
SMG

2

Check processed foods/breads for iron fortification and avoid.

E2 is way too high. T is been converted to E2 and E2 lowers LH/FSH, lowering T while increasing SHBG that lowers FT. And E2 interferes with the action of FT at T receptors.

Your fat is contributing to T–>E2. The more fat, the more E2 and less T. That makes you fat and creates a situation where you cannot loose weight.

TSH does not look bad, but T4 is low and should be near mid range. Suggest that you do labs:

  • TSH
  • fT3
  • fT4

T3 and T4 bound to binding proteins is not bioavailable. Thus the need to see the free levels. If you have subclinical hypothyroidism, that will promote fat gain and impede fat loss.

So you can see the implications of estrogen dominance and thyroid problems.

Many are iodine deficient and iodine replenishment can solve some problems.

Read these stickies:

  • advice for new guys
  • thyroid basics
    – check oral body temp when you wake up and mid afternoon, report
    – describe history of iodine intake from iodized salt and from vitamins if iodine listed [typ 150mcg]

With your E2=36, I recommend that you try 0.5mg anastrozole per week in EOD divided dosing. You will need a liquid product to dispense by the drop. Read the estradiol sticky. Understand ‘anastrozole over-responder’.

Total cholesterol would be good, except HDL is too low.

Lower E2
investigate thyroid hormones and iodine
dump iron and watch for fortified foods

Arteries:

  • CRP lab results?
  • homocycteine lab results?
  • if blood pressure increasing, use Ubiquinol 50 or 100 instead of CoQ10
  • vitamins should be high potency B-complex, with trace elements and iodine
  • vit-C, natural source Vit-E
  • 5000 iu vit-D, in tiny oil based caps
  • 25mg DHEA, later test DHEA-S, get somewhere above mid range

Cortisol is too low. Possible adrenal fatigue. See advice for new guys sticky.

  • describe stress levels and how your body reacts to major stress

What was:

  • hematocrit HTC
  • albumin
  • ALT
  • AST

Lower E2
investigate thyroid hormones and iodine
dump iron and watch for fortified foods
cortisol is too low, read up on adrenal fatigue

3

KSMAN,

Thanks for the fast reply.

My basic diet is meat,cheese,eggs,veggies and salad. I will snack on smoked almonds but have cut them lately to try and lose weight.

I have started intermitent fasting in the last 3 weeks to keep my blood sugar lower longer. I really don’t miss eating breakfast. I eat lunch and dinner and may snack in between. My blood sugars have gone done quite a bit doing this.

I use some salt on veggies but that would be limited. I eat very little processed foods because they have too many carbs.

My vitamin has 150 mcg Potassium Iodide. Should I take more?

My blood pressure is in the 130’s over 80 area. I will change out the CoQ10.

My stress levels are moderate. I have been much more stressed in the past.

I will see Dr. next week for thyroid tests. Any thing else while I am there?

1-21-13
Comprehensive Metabolic Panel Mercy Hospital Fasting 9 AM

Sodium 139 Range 133 to 146
Potassium 5.4 Range 3.5 to 5.1
Chloride 102 Range 98 to 107
Carbon Dioxide 30 Range 22 to 29
Urea Nitrogen 21 Range 6 to 20
Creatine Serum 1.0 Range .6 to 1.3
BUN/Cret Ratio 21 Range 7 to 28
Glucose 90
Calcium 10.3 Range 8.6 to 10.5
Albumin Serum 4.9 Range 3.5 to 5.2
Protein Total 7.2 Range 6.3 to 8.5
Globulin 2.3 Range 2.4 to 3.9
A/G ratio 2.1 Range .7 ro 2.5
AST/SGOT 28 Range 0 to 40
ALT/SGPT 36 Range 0 to 41
Alkaline Phosphatase 74 Range 40 to 129
Bilirubin Total .04 Range 0 to 1.2
eGFR Calc =/> 60 Range >59

Regards,
SMG

4

Read these stickies:

  • advice for new guys
  • thyroid basics
    – check oral body temp when you wake up and mid afternoon, report
5

Temps

2-11-13 9pm 96.6
2-12-13 5am 96.3
2-12-13 10am 98.3 After walking for 35 mins and lifting weights for 1 hr.
2-12-13 2pm 97.6
2-12-13 9pm 96.8
2-13-13 5am 97.6 Up from 3 to 4:30am
2-13-13 2pm 96.7

I have ordered Lodoral 50mg tabs and Anastrozole.

I am seeing my doctor on Tuesday next week.

Any more Thyroid tests?

6

If you are iodine deficient and iodine replenishment will restore temperatures, more detailed thyroid labs might show something interesting. But all of that might change. When I went through this, I decided that whatever lab work would have shown really was not going to be of much value.

Other things: see my 02/11

7

More Labs
10-15-12 Mercy Hospital
CBC W/Auto Diff Fasting AM

WBC 9.7 R 4.5 to 10.8
RBC 5.09 R 4.7 to 6.1
HGB 15.7 R 14 to 17.4
HCT 47 R 41 to 52
MCV 93 R 80 to 94
MCH 31 R 27 to 31
MCHC 33 R 32 to 36
RDW 14.6 R 11.5 to 14.5
Platelet Count 157 R 130 to 400
Lymphocytes 2.4 R .9 to 5
Monocytes .7 R 0 to .8
Neutrophils 6.5 R 2 to 8
Eosinophils .1 R 0 to .7
Basophils .1 R 0 to .2
Iron total Serum 89 R 49 to 181
Total Iron binding cap312 R 261 to 497
Unsat iron Binding calc 223 R 185 to 245
Transferrin Sat Calc 29 R 20 to 50

8

More Test Reasults

Testing from 11/14/12 I did not receive these results before.
Quest Valencia,CA
Total T 391 Range 250 to 1100
Free T 114.3 Range 35 to 155

Testing on 2/19/13 2:30 PM
Mercy Hospital
T3 Free 3.1 Range 2.3 to 4.2 Quest Wood Dale
T4 Free 1.02 Range .85 to 1.76
TSH 1.51 Range .27 to 4.68
PSA .27 Range .01 to 4
Vit D, 25 oh 57 Range 30 to 100 Quest Wood Dale

My doctor could not order tests for rT3 or DEHA-S. Told me that I’d have to go to an ENDO for that.

Temps
2-14-13 96.1 3am 96.5 5am
2-15-13 96.5 5am 97.8 7am
2-16-13 97.4 7am 96.3 2pm 95.9 10pm
2-17-13 96.1 3am 97.1 7am
2-18-13 96.6 4am 98 3pm 96.7 9pm
2-19-13 96.1 3am 98.2 9am 97.9 2pm This was a heavy weight lifting day.
2-20-13 96.8 5am 96.9 2pm
2-21-13 96.9 5am 97.7 9pm
2-22-13 97 6am 97.3 2pm

I started taking 50mg lodoral and anastrozole on 2-20-13. Also quit caffeine that day.

Is it okay to take anastrozole every day?

Thanks much!
SMG

9

No need to take anastrozole every day, EOD works well with its half life. ED dosing is OK if you want to do that, but will make dosing difficult in some cases. I have not reviewed what you are doing.

fT3 is good, fT4=1.02 should be closer to 1.3 and TSH=1.5 is not inconsistent with iodine deficiency.

With fT3=3.1, might be better at 3.3, your low temperatures are not explained. A possible explanation is elevated rT3 blocking some fT3 action.

Temperatures are low. Now you want to make sure that we are not looking at a measurement error. It is good to have someone else get a 98.6 for reference with the same thermometer. But note that when someone is iodine deficient, often others in the same home can also be iodine deficient.

Getting to see an endo can be difficult, slow and $$$. You might want to do DHEA-S and rT3 on your own.

10

K Sman,

Who do I have draw the blood if I where to send in the samples on my own?

Will lowering E2 with anastrozole be all that is needed to help cut belly fat?

Thanks,
SMG

11

LEF.com | products | blood testing
cheaper for members, good sales prices in May
Labs are via Labcorp, you go to there lab sites. See where they are at labcorp.com

Major influences for fat gain/loss

  • testosterone levels
  • estradiol levels
  • thyroid function
    – iodine
    – mid range on fT3, fT4
    – rT3 can block fT3
    – rT3 can result from starvation diets or adrenal fatigue
    – stress, injuries, infections, inflammation can contribute to adrenal fatigue

General heath and vitality is important. One has to have a good metabolic rate, so things that hamper that will cause issues. Sleep and nutrition are important. Some meds can cause problems.

The above is very general, not directed at your situation specifically.

12

K Sman,

Do I have my doctor draw the blood for the LEF labs?

SMG

13

“Labs are via Labcorp, you go to their lab sites. See where they are at labcorp.com”

Not your doc.

14

Follow up tests: Testing done on 4-15-13
Iron Total serum 66 range59-158
Ferritin 138 range30-400
Estradiol <15 range<or=39
T3 3.1 range2.3 to 4.2
Total T 460 range 250 to 1100 Quest
Free T 62.5 range35 to155 Quest

Since my last tests in Jan. I have lost about 33 pounds.
I started taking Anastrozole and thought it was not working so I added more in and experienced overload. The results shown were 5 days after I experienced overload. I have backed off my dosage and my knee pain went away.

I quit taking my temp because they were so consitantly below 98.6.

It look like I got no response from the AI towards increasing T levels. My free T is the same as my last test.

My weight loss has been very sporadic. I will go three weeks with no loss then drop 8 to 9 pounds one week.

I really dont feel better even though I have not been this light for years.

Does it take time for lower E2 levels to have an effect on T levels?

Thanks,
SMG

15

How your HPTA responds is up to your HPTA. TT increase has not been much so far. FT is released in surges and with a short half life, FT has limited diagnostic value.

16

So do you feel it’s time to goto trt?

17

KSman,

I have been taking topical progesterone to help me fall asleep for a few months. I’ve read that this lowers estrogen levels. Would this change the amount of armidex that I should take every week?

18

Update with labs to follow:

After a long struggle with my PCP who told me there was nothing he could do for me, I found a nurse practitioner that starts with supplements then moves to the stronger stuff if needed.

I started TRT on 8-2-14.
My current protocol is:
100 mg Tcyp / wk given Subq on Monday AM and Thursday PM. Watson 200mg/ml
I give 250 iu of HCG given Subq on Monday, Thursday and Saturday. Componded HCG
I have not started Armidex yet.

I also take:
Fish oil, Pregnenolne and DHEA Sublingual, 20,000 iu Vit D3 per day, GNC Vitamin.

I use progesterone cream to help with sleep issues.

Here are my labs starting in January and ending today 9-15-14

I am confused why my TT came back so low.

1-3-14
Pregnenolone <5 Range 13 - 208 ng/DL Quest
Estrone 53 Range Male 12 - 72 PG/ML Focus
SHBG 21.9 Range 16.5- 55.9 Lab Corp
T3 free 3.2 Range 2.0 to 4.4 Lab Corp
DHEA - S 100 Range 34.5 - 568.9 MCG/DL Lab Corp
T3 Reverse 8 Range 8 - 25 NG/Dl Quest

6-18-14
Albumin 4.6 Range 3.2 - 4.8 g/dl Access Medical Labs
E2 17.1 Range 7.6 to 42.6 PG/ml Access
DHEA-S 229.3 Range 44.3 - 331.0 ug/dl Access
DHT 20 Range 11.2 - 95.5 ug/dl Access
Testosterone Total 253 range 280 - 1100 ng/dl Access
SHBG 15 Range 10- 80 umol/l Access
Free Testosterone 6.81 1.9 - 27 ng/dl Access
Cortisol 15.1 ug/dl Morning 6.2 - 19.4 ug/dl Access
Pregnenolone <5 13 - 208 ng/dl Quest

7-15-14
Iron 121 40 - 200 Mcg/dl Quest
FSH 4.1 1.5 to 12.4 miu/ml Quest
LH 2.9 1.7 to 8.6 miu/ml Quest
Total T 297.9 249 - 836 NG/DL Quest

Started TRT on 8-2-14 8am

New Labs on 9-8-14
Total T 437 Range 250 to 1100 Quest
Free T 112.4 Range 95 to 155 pg/ml Quest
Vit D3, 25-OH 77 range 30 to 100 ng/ml Quest
SHBG 16 range 10 to 50 nmol/l Quest
DHT 58 Range 16 to 79 ng/dl Quest
E2 Checked the wrong test
Ferritin 37 Range 30 - 400 ng/ml Quest
cortisol 14.71 range 6.2 to 19.4 AM Quest

Is my SHBG to low and burning up my T to quickly?

I feel OK. Better than I did no doubt. I am lifting weights and gaining strength and muscle but no weight loss at all. My testicles have stayed the same size.

I have strong morning wood but limited libido in the evening.

My brain fog is a little better but not gone.

The final test was taken on Monday morning before my injections for the day. So I should be at my low point after injection. I just didn’t thing it would be that low.

Any help would be great

SMG

19

Lower SHBG means more FT and bio-T. Can see that in your labs.

Lower SHBG can lead to lower TT, but that is not a problem as T+SHBG is functionally inert and it a transport method to eliminate T from your blood by metabolization of T+SHBG in the liver.

Progesterone does not lower estrogens when on TRT. It does block some of the effects of estrogens. That is the case in cycling women where estrogens are much higher than males. With lower estrogen levels in males, that effect is minor. In males, higher levels of T block effects of estrogens and one of the outcomes of that is reduced SHBG levels.

LowSHBG does not burn up T! - quite the opposite.

Based on what you have reported, suggest that you ask for 200mg T per week. You are a hyper metabolizer. Inject T every other day and you will have to dose AI EOD as well if needed.

Get E2 tested first.

What is going on with your IR and body temperatures?

Ferritin should be around 80 to support T4–>T3 conversion.
What happened re iron intake etc?
Donating blood.
You are not testing hematocrit [HCT], that is very important.

Do you think that progesterone improved sleep. We know from women, that it can sometimes increase cortisol that definitely would interfere with sleep.

Your cortisol labs were done at 8AM?

20

KSman,

They checked the incorrect box on the E2 test. I have called to see if they can still run it.

I gave blood on 7-15-14 Hemoglobin was 15.5. I am O negative so they call me all the time to donate.

I eat a lot of meat on my low carb diet and have a history of Hemochromatisis in my family. Hematocrit was 46.5 RR 42 -52 on 7-9-14 Ferritin was 94.9 on same day.

The progesterone works wonders to help me fall asleep. I have tried to discontinue using it several times and I can not fall asleep.

Yes Cortisol test taken at 8am.

I have not taken temps since early 2013. I will start that.

I will start EOD injection of Testosterone and HCG.

I will stay at 100mg / wk to start. I am not sure my Dr. will up the dose till I prove I need it. I don’t want to run out early.

Thanks.