45, Tired a Lot, Hard to Make Gains in Gym. Looking for Info

Pharma / TRT Testosterone Replacement
1

Hello gang, I am a 45 year old male, 6’1, 180, in pretty good shape that has fatigue issues and difficulty making gains in gym and looking for help. Let me preface this with my lifestyle and eating habits. My life is pretty cush due to my career. I have A LOT of time off so therefore my sleeping/stress habits are awesome. I sleep 8 hours no problem (I’ve always done this). When I wake up, though, I’m not totally refreshed and getting out of bed is a slow process. I yawn a lot throughout the day and will be fatigued by 2pm. My energy levels go up in the evening. Rinse and repeat.

I DO NOT drink at all (haven’t in over 20 years). I DO NOT smoke or do any drugs, and never have. I work out 4-5 times a week lifting weights and have since I was in college. Stress in my life is very low due to an awesome career, no kids, being single, financially fine, etc.

My diet on average is either steel cut oats or eggs in morning. Lunch is usually some form or protein, carb and veggies like cod, red potatoes, asparagus. Dinner is usually the same. I’m not much of a foodie so my meals are usually very similar. Snacks are usually pistachios, protein bars, etc. But I do have a sweet tooth and will have a soda once a day and maybe some kind of small chocolate candy but I really don’t eat a lot of garbage. I take Vitamin D3 5000iu every day, Zinc, Vitamin C, DHEA 25mg, Magnesium and Krill Oil.

I’m pretty consistent on working out but have noticed over the 5-6 years that my recovery from working out sucks. I’m tired the next day from lifting and sore for much longer and my gains just suck. I can’t get above 180lbs (I’m 6’1) no matter how many protein shakes, how clean I eat or how hard I work out. I just don’t get it. I have a lean build and don’t carry a lot of fat but I’ve noticed fat around my gut harder to control and some fat around my pecs that I don’t like.

Sex drive has faltered as well as erections. Morning wood is rare and getting hard for sex isn’t easy unless I take cialis. And I’ve always had a very high sex drive so I’m really missing that part.

On to lab results. I’ve had my T tested over the last few years and it’s always been 700+ for total. But only last fall did I get a lot more tested. Since I’m waiting on Defy Medical I’m going to post my lab results from Sept of 2017 as my symptoms are essentially the same from that time and will help any of you who can help me until I get the most current lab results:

Total T: 737 ng/dl R: 250-1100
Free T 81.6 pg/ml R:35-155
Estradiol, Sensitive 17.7 R: 8.0-35.0 pg/mL
Total Cholesterol 226
HDL 47
LDL 156
Tri 112
CHOL/HDLC RATIO 4.8
NON HDL 179
FSH 8.7 mlu/ml R: 1.6-8.0
LH 6.9 mlu/ml R: 1.5-9.3
DHEA, LC/MS/MS 128 ng/dl R: 61-1636
Vitamin D 25 54 ng/ml R: 30-100
Cortisol Total 14.2 mcg/dl 4-22 (for 7-9am which is when mine was)

Just recently due to this site I figured I’d get my thyroid checked and did that 4/10/18 and here are those results:

TSH: 1.190 UIU/ML 0.400-4.100
FREE T4 1.49 NG/DL 0.80-1.90
FREE T3 3.2 PG/ML 2.2-4.2
rT3, LC/MS/MS 24 8-25 ng/dL

Obviously my rT3 is high and my ratio to T3, when converted is 13.2. Also, I’m cold a lot and my morning temp is 96.9 and afternoon temps are around 97.5 or so.

Anyway, hope this info helps and would appreciate any feed back. Thank you all.

2

Thyroid speeds up every cell in your body, if it isn’t function optimally midday tiredness is expected. High rT3 is causing problems, confirmation is do to your temperatures. Testosterone levels look great except you’re missing the single most important test, SHBG. SHBG tells us how well you hold onto your testosterone and it also regulates free testosterone which then converts into estrogen.

SHBG is might to be causing problems, low estrogen could be confirmation. Defy Medical is the right call, they will straighten you out, no doubt.

3

Have you looked into cold showers? Anecdotal evidence (I am sure there is empirical evidence from studies) suggests that cold exposure on a regular basis improves gonad function: https://www.drelist.com/cold-showers-testosterone-levels/ plus it feels great. I find I sleep really well (as well as I can with a young baby in the room!) if I have a cold shower about 20-40min before going to bed.

Also, without finding any evidence of this, they say “a change is as good as a rest” - have you considered changing your macros to include more fats to support hormone production? Even just a change for the sake of it may be beneficial. Just change one thing at a time and see what happens.

4

Got blood work done today that was ordered from Defy. I will post the results as soon as I get them.

Can anyone say what is considered high E2 or low E2? I see references to this all the time but nothing referring to numbers.

5

Hey my symptoms are very very similar to yours. My main concern is that I am so tired by mid day. Its starting to mess with my life because I cane even get things done that i need to do because I have to stop to sleep. Also no morning wood neither. My sex drive was considered very high and not it has basically diminished and im only 29 yrs old.

My biggest question for you and me is what is causing us to be so figatiged by the middle of the afternoon. If i could fix any of my symptoms its would be tackilng the fatigue first. @systemlord so are you saying that the fatigue is correlated with the thyroid and if so is it also possible that these other symptoms could be correlated with the thyroid as well.

My question is how would we fix this thyroid problem. And if we do fix it will it fix all of these symptoms. Would we no longer need TRT or anything the helps boost testosterone. If we just take thyroid medicine could we manage everything with just that???

@trifive i have read mutilple times that when it comes to E2 you want to get as close as possible to 22 pg. Rite now I am at 24 pg on my current protocol but I still feel tired as shit so I know the fatigue had nothing to do with E2

6

Alos I have one more question. Through out this journey I have been scared of hair thinning. Especially rite now because I am trying to grow my hair out. Can anyone give me any advice on how to prevent hair thinning or hair loss and what should I look for in Labs the could be correlated to things like that.

My father is 70 and has a full head of hair so I don’t not think I am genetically pre disposed to that?

7

Thyroid hormones and testosterone are two different systems all together, thyroid hormones are produced in the thyroid gland and testosterone is produced in the testicles. If you require TRT now and you fix your thyroid you will continue to need TRT.

Thyroid problems can cause hair loss and dry skin and low energy midday.

8

Lots of good stuff above, also try changing up your training maybe its no longer right for a guy in his 40s try something different from this site -either of these work great and are relatively easy to recover from…

9

Is High or Low E2 responsible for belly fat and pec fat? The last two years I have noticed that, while I’m still fairly lean, I have this layer of fat around my mid section and just under my pecs that I can’t make go away no matter how healthy I eat and how I work out.

10

Your DHEA was low. Assume that 25mg DHEA started after that lab result.

Middle ground FT, high LH/FSH. This suggested that testes not working well and hypothalamus and pituitary are making a valiant effort. Perhaps with DHEA supplement, DHEA–>T will improve inside the testes if process was rate limited by low DHEA.

DHEA status was unknown, do not test DHEA directly, test DHEA-S which is also cheaper. DHEA changes a lot over time and a single lab result is not your status. DHEA-S levels are quite steady.

DHEA is hydrophobic and hard to absorb. Do not take with high fiber foods, oats would be the worst. Take with higher fat meals. Ditto for Vit-D3, fish/krill oils etc.

See below to eval overall thyroid function via oral body temperatures and note that temperatures at two different times of day are needed.

In the thyroid basics sticky, note references to:
rT3
stress
starvation diets
infections acute and chronic
adrenal fatigue
Wilson’s book

AM cortisol is OK as and adrenal hormone, adrenal hormone DHEA was not.

Are you taking any medications? Cholesterol drugs?

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

11

I’m not sure why you feel fatigued because you have great stats and conditions not to mention lifestyle habits but I feel fatigued when I least expect it. it could be due to addiction to dopamine high. I laughed when I read your post, you seemed to know what you are doing (no smoking/no drinking etc.) so I suggest looking into psych-up articles and make it a pre-workout routine. I used to do that to great effect (cardio workouts).

12

With regards to your thyroid list my rT3 is high…see the test results in first post
My stress is very low and has been for years.
Never starved myself. I’ve always been lean, slender build and eat all the time.
Healthy with regards to infections and such.
Not familiar with Wilson’s book…will check it out.

Doing cortisol saliva tests today and Physical Exam tomorrow for Defy Medical. Waiting on labs from Defy…as soon as I get them I will post them.

Thank you for your help.

13

You have low energy and feel cold easily. That suggests low thyroid function. Oral body temperatures are a window into that. And yes the question about cholesterol medications is applicable.

Your low body temperatures are indicating that your fT3 is not working as expected, even though fT3 is otherwise ideal. Your high rT3 is the obvious problem, but now you need to find what has made that high and what do do about it. You cannot take T4 medication because that will just increase fT4–>rT3. You will not find any mainline doctors who will see any problem. T3 medication can drive down TSH so less T4 is produced in the thyroid. In USA you can only get a time release T3 from compounding pharmacies. Based on what info we have now, you will need some thyroid medical intervention. See the finding a TRT doc sticky re getting references from compounding pharmacies, often there is a web form to get started and you can refer to these concerns.

While your life style is relaxed, perhaps there is an adverse background problem going on and that itself can also reduce your vitality while creating the secondary problem of high rT3.

Thyroid and related systems are a lot more complex than the sex hormones. We see so many thyroid issues in this forum that thyroid is a dominant concern.

Along with feeling cold, have a look to see if your outer eyebrows have become sparse.

What has been your history of using iodized salt?

Have these labs?: CBC, hematocrit, RBC, hemoglobin, AST/ALT

Energy levels have these major factors:
fT3
rT3
CoQ10
mitochondrial function
cortisol

14

Thank you KSman. The info is appreciated. The only medication I take is Cialis, 5 mg daily. I take NO other medications. My primary doctor tried to put me on statins and I refused to take them.

I couldn’t tell you much about how much iodized salt I consume as I’m no chef and eat out a lot (healthy eating only…fish, veggies, brown rice, chicken, etc, not junk).

I have these labs from 9/17:

AST 19 10-40 u/l
ALT 19 9-46 u/l
RBC 4.94 4.2-5.8 million ul
Hemocrit 43.0 38.5-50%
Hemoglobin 14.3 13.2-17.1 g/dl

As stated earlier, my symptoms are the same then as now and as soon as I get the lab results that Defy ordered I’ll post all that current info.

Thank you!

15

Thanks for your feed back. So I defiantly need to have my thyroid checked out more in detail. Because what is sound like is that I could possibly have a thyroid problem. If I fix my thyroid problem would it make me feel better while on TRT???

16

My thing is I’m wondering what if I never had a testosterone issue to begin with. What if I had a thyroid problem this whole time. I mean when they tested my TT it was 317 pg and I’m assuming that’s pretty low for a 29yr old. But hopefully I just have a thyroid problem. Rite now my doctor took me off of TrT and I’m just on clomid for now. But respond great to clomid but still feel like shit. Maybe it’s just my thyroid

17

You need to expect that prepared foods and restaurant meals are not made with iodized salt. So your only expected source is iodized salt that you use at home plus any iodine listed in multivitamins.

In USA, iodized salt is sold beside non-iodized salt in containers that look mostly identical. Look at what you have in your kitchen.

As you eat out a lot, you need to get a multivitamin that lists 150-170mcg iodine and 150-200mcg selenium.

While body temperatures indicate current metabolism, sparse outer eyebrows indicate that the problem has been long duration.

18

KSman,

Did physical today and sent that off to Defy…waiting on the blood work. As soon as I get that I will post. Sent off saliva cortisol tests today. I read a lot of your thyroid info and started taking iodine(about 500 mcg) in droplet form in my morning OJ as well as eating 5-6 Brazil nuts daily for the selenium. How long does it take for one to notice effects from iodine and selenium?

19

Depends on multiple factors. Best case is 5-7 days and then what you would notice is improved energy and clarity of thought.

20

Got my labs back today, although waiting on the E2, but here’s everything else. Looks like SHBG is way high and FT is way low.

Thinking back I have been on Accutane when I was in my 20’s, not sure if that helps and also was on Avodart for about a month 7 years ago when Dr. thought I had some prostate issues. Not sure if those 2 medications have any impact this far down the road but all my symptoms I have, I’ve had for a long time.

Waiting on the consultation with Defy Medical. So what do you guys think of my labs?

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