Age 32, Low T/DHT, Midrange LH/FSH?

Pharma / TRT Testosterone Replacement
1

-age: 32
-height: 6’4"
-waist: 34
-weight: 215

-describe body and facial hair: hair on forearms, legs, stomach, chest. facial hair on chin&mustache, but patchy on cheeks/sideburns. Hair on head getting thinner on top since age ~26.

-describe where you carry fat and how changed. fat seems normally distributed, maybe a bit extra on stomach, butt, thighs. Somewhere around 15-20% body fat (no visible abs)

-health conditions, symptoms:

Decreased sex drive. Difficulty maintaining an erection. Decreased energy. Tried to get back in to weight lifting in the last few years, but am weaker now than when 18 (and wasn’t that serious about training as a teen), even though I’m 30lbs heavier with similar body fat %. Takes longer to recover from training.

Small gynocomastia since puberty, hasn’t gotten worse (looks worse when my BF% is high, better when it’s low). Weighed as high as 275lbs 6 years ago, lost weight when started biking, running, stopped drinking soda. Sex drive seemed okay during the weight gain (was married then), and haven’t tested it out much during/after the weight loss until a few weeks ago, with disappointing results. Cold hands and feet, especially in morning. Feel very cold all over in morning, moreso in the last few years.

Difficulty falling asleep and waking up (but that’s been the case since childhood). Testicular varicoceles (larger on left). Difficulty concentrating, lousy short-term memory.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever. None.

-describe diet. trying to keep carbs <=100g/day lately, but not too rigorous about it (lots of ‘cheat’ days/meals). Eat fatty foods (eggs with yolks, bacon, whole milk, ribeye steak) without regret.

-describe training. Last 4 months have had rugby practice T&Th and games Saturday. Lifting weights only sporadically since rugby started, and running outside of rugby has stopped completely (can’t recover in time). Used to lift 2-3 times a week, run 2-5 times a week.

Would have stretches of months where I’d work out regularly, then months when I’d work out only sporadically. Post workout recovery seems poor (both now during rugby, and for last several years during other activities).

-testes ache, ever, with a fever? Don’t recall.

-how have morning wood and nocturnal erections changed. Almost completely absent the last few years.

-lab results with ranges:
LH 4.5 mIU/mL 1.7-8.6
FSH 5.8 mIU/mL 1.5-12.4
Testosterone, Serum 342 ng/dL 348-1197
Free Testosterone(Direct) 10 pg/mL 8.7-25.1
Dihydrotestosterone 23 ng/dL 30-85
Estradiol 13.8 pg/mL 7.6-42.6

Glucose, Serum 78 mg/dL 65-99
Albumin, Serum 4.4 g/dL 3.5-5.5
TSH 1.39 uIU/mL 0.450-4.500
Thyroxine(T4) 8.9 ug/dL 4.5-12.0
T3 Uptake 33 % 24-39
Free Thyroxine Index 2.9 1.2-4.9
Hemoglobin 13.5 g/dL 12.6-17.7
Hematocrit 39.7 % 37.5-51.0
Cholesterol, Total 186 mg/dL 100-199
Triglycerides 62 mg/dL 0-149
HDL Cholesterol 53 mg/dL >39
LDL Cholesterol Calc 121 mg/dL 0-99
T. Chol/HDL Ratio 3.5 ratio units 0.0-5.0

Thyroid looks okay? I read cholesterol could be related to lowT, so included those results (which are fine?). Only included hematocrit because I’m at the low end of normal even though I live in Colorado above 5000ft, and exercise somewhat regularly, and thought I’d be at the high end rather than the couch potato end. Wish I would have had cortisol tested, but I did not.

Thanks for any advice. I had the above tests done under my own initiative. I have an appointment for a ‘complete physical’ in 1.5 weeks, and figured I’d take results to the doc and see what they think. And that if anything was funny in the results, then having them early would expedite a 2nd round of tests if the doc wants to do them.

Hadn’t talked with doc about getting Test tested, but the upcoming physical made me think I ought to see if I’ve got low testosterone. I’ve been wondering for several years, never did anything about it.

PS: I don’t see a link for formatting, or I’d have prettied my post up somewhat. If anyone gives a pointer on how to do tables, bold, bulleted lists, etc., I will make the above more legible.

2

please report body temperatures and iodine intake

This is worrying: “Cold hands and feet, especially in morning. Feel very cold all over in morning, moreso in the last few years.”

check DHEA-S, rT3

Hematocrit 39.7, this is bad, testosterone is indicated to improve this, get a good CBC!

are you taking high dose vit-D3 and fish oil?

3

[quote]KSman wrote:
please report body temperatures and iodine intake

are you taking high dose vit-D3 and fish oil?
[/quote]

I’m not currently taking any supplemental iodine, vitD3, or fish oil. Are you suggesting that would help, or it may be partially causing my symptoms? I will measure body temp on waking in the morning and a few times throughout the day and report back.

[quote]KSman wrote:
check DHEA-S, rT3
[/quote]
I was about to order the DHEA-S and rT3 tests, but then wanted to check cortisol too, and I see two tests: “Cortisol” vs. “Cortisol, AM”. The first has no special instructions, the 2nd says “Blood MUST be drawn at 8am”. Should I get one or the other, or neither?

[quote]KSman wrote:
Hematocrit 39.7, this is bad, testosterone is indicated to improve this, get a good CBC!
[/quote]
I do have some other blood count numbers from my first test. Here’s everything I left out of my initial post:
Uric Acid, Serum 7.1 mg/dL 3.7-8.6
BUN 24 mg/dL 6-20
Creatinine, Serum 0.87 mg/dL 0.76-1.27
eGFR If NonAfricn Am 114 mL/min/1.73 >59
BUN/Creatinine Ratio 28 8-19
Sodium, Serum 141 mmol/L 134-144
Potassium, Serum 4.1 mmol/L 3.5-5.2
Chloride, Serum 104 mmol/L 97-108
Carbon Dioxide, Total 22 mmol/L 20-32
Calcium, Serum 9.2 mg/dL 8.7-10.2
Phosphorus, Serum 4.4 mg/dL 2.5-4.5
Protein, Total, Serum 6.6 g/dL 6.0-8.5
Globulin, Total 2.2 g/dL 1.5-4.5
A/G Ratio 2 1.1-2.5
Bilirubin, Total 0.6 mg/dL 0.0-1.2
Alkaline Phosphatase, S 67 IU/L 25-150
LDH 201 IU/L 0-225
AST (SGOT) 21 IU/L 0-40
ALT (SGPT) 14 IU/L 0-55
GGT 10 IU/L 0-65
Iron, Serum 101 ug/dL 40-155
WBC 6.4 x10E3/uL 4.0-10.5
RBC 4.66 x10E6/uL 4.14-5.80
MCV 85 fL 79-97
MCH 29 pg 26.6-33.0
MCHC 34 g/dL 31.5-35.7
RDW 13.9 % 12.3-15.4
Platelets 239 x10E3/uL 140-415
Neutrophils 61 % 40-74
Lymphs 31 % 14-46
Monocytes 6 % 4-13
Eos 1 % 0-7
Basos 1 % 0-3
Immature Cells
Neutrophils (Absolute) 3.9 x10E3/uL 1.8-7.8
Lymphs (Absolute) 2 x10E3/uL 0.7-4.5
Monocytes(Absolute) 0.4 x10E3/uL 0.1-1.0
Eos (Absolute) 0.1 x10E3/uL 0.0-0.4
Baso (Absolute) 0 x10E3/uL 0.0-0.2
Immature Granulocytes 0 % 0-2
Immature Grans (Abs) 0 x10E3/uL 0.0-0.1

Apologies for not including them in my first post, didn’t realize they’d be relevant.

Thanks very much!

4

Get the 8AM cortisol, levels change through the day and the 8AM number is actionable.

There are some supplements that support proper metabolism, and they can be helpful.

Are you using iodized salt, sea salt does not count. Iodine in your multi vits?

Hematocrit is low for a male. I wanted to see if RBC was low, everything else seems good.

5

I’ve got two electronic thermometers, one for mouth, one for ear. Both seem flakey though, giving results with too much variation. If the mouth temp is to be believed, I’ve been getting around 96.5-97.5.

[quote]KSman wrote:
Get the 8AM cortisol, levels change through the day and the 8AM number is actionable.[/quote]
Folic Acid, Serum 12 ng/mL >3.0
DHEA-Sulfate 211.8 ug/dL 160.0-449.0
Reverse T3, Serum 15.7 ng/dL 13.5-34.2
Vitamin B12 653 pg/mL 211-946
Cortisol â?? AM 11.5 ug/dL 6.2-19.4

[quote]KSman wrote:
Are you using iodized salt, sea salt does not count. Iodine in your multi vits?[/quote]
Not using iodized salt, and not taking any vitamins.

Thanks. Doc appt on Friday, will report back with what doc says.

PS: Does my in-range LH and FSH but low testosterone and DHT indicate secondary hypogonadism, hence perhaps a pituitary problem? I didn’t mention in my original post, but at 6’4" with a 6’9" wingspan, I’m a lot taller/longer than the rest of my family. Also my nose, jaw, lips, brow, hands, are all a bit on the big side, makes me look like I may have slight acromegaly. Didn’t seem to be the case when I was very young, may have gradually happened while in my late teens. Not anything like Bigfoot Silva or Andre the Giant, but noticeable.

6

You could test IGF-1 to see if your GH is abnormal. If so, there would be a MRI followup.

I thing that we can assume that you are iodine deficient and you would use 12.5mg iodine tablets from iodoral for iodine replenishment. Search here for “ksman has a thyroid problem”.

Your AM cortisol would be better closer to 15. Do you have energy crashes during the day? How do you react to a major stress event?

7

[quote]KSman wrote:
I thing that we can assume that you are iodine deficient and you would use 12.5mg iodine tablets from iodoral for iodine replenishment. Search here for “ksman has a thyroid problem”.[/quote]
I searched and found a lot of references to that thread, but I don’t see the thread itself. Can you give me a link?

I don’t know if I’d call them energy crashes, but I do seem to have low energy levels pretty often, and often suffer from lack of motivation.

Re: emotional stress, I’ve got mild bipolarII/cyclothymia (never took drugs for it. got diagnosed by marriage counselor who was a licensed shrink), and tend to have dysphoric mania. In the last few years when I’m really frustrated, I seem to just switch off and lose all motivation (partially intentionally, to avoid ripping someone’s head off). Back in the day, I’d be much more confrontational verbally, and also feeling like I’m overflowing with physical energy (pace back and forth, feeling antsy). I had thought that meant I was getting better at managing mental issues, but it could be I’m just as crazy as I used to be, but now my physical issue of lack of energy is preventing me from getting manic like I used to. On the one hand it’s nice not having dysphoric mania, but on the other hand I miss the periods of high amounts of energy and productivity I used to have occasionally (used to work all night writing software even with no deadline looming. haven’t done that in a long time)

Thanks very much!

PS: I tend to introspect excessively. I wrote a few paragraphs, deleted them, rewrote, deleted again. Went in to a lot of detail on bipolar problems, old marriage problems, job problems, reactions to physical stress vs. emotional stress, etc., then deleted it all. I only mention it because a web search says that excessive introspection may be a symptom of adrenal fatigue, so I thought it might be relevant.

8

The search function is at the top of this page.

9

[quote]DFW wrote:

BUN 24 mg/dL 6-20
Creatinine, Serum 0.87 mg/dL 0.76-1.27
eGFR If NonAfricn Am 114 mL/min/1.73 >59
BUN/Creatinine Ratio 28 8-19
Sodium, Serum 141 mmol/L 134-144
[/quote]

The kidney function values in those labs seem to indicate something. Dehydrated? High protein diet? Catabolic due to working out? Did doctor mention elevated kidney function?

10

[quote]KSman wrote:
The search function is at the top of this page.
[/quote]
I tried that first, it only had a few results, all of which talked about the thread, but none of which were the thread. Then I tried google with site:T-Nation.com, and got a lot of results, but again none were the thread itself, they all only referred to it. I reread the sticky on bloodwork though, and found a link to “KSman has a thyroid problem” in there: http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/ksman_has_a_thryoid_problem

I had a doc appt. today and brought up the kidney numbers. She asked if I ate a lot of protein and when I said I’ve been aiming to reduce carbohydrate intake, she thought that explained the numbers, and she wasn’t concerned. Likewise she wasn’t concerned about the elevated LDL, because my total cholesterol and triglycerides were fine, and high LDL can apparently be explained by eating low carb.

The doc prescribed androgel 1.62%. I’m planning to take it as rx’d for 2 weeks, then get total testosterone, free testosterone, estradiol tested again. Should I get DHT tested again also?

Thanks!

PS: Will also start taking multivitamins, including iodine.

11

You can’t do anything for DHT, it simply follows FT levels. Some docs used to worry if it got high. Until you get your protocol settled and TT levels high normal, no point in checking.

12

[quote]DFW wrote:
The doc prescribed androgel 1.62%. I’m planning to take it as rx’d for 2 weeks, then get total testosterone, free testosterone, estradiol tested again.[/quote]
I didn’t get much of any effect from the androgel. Might’ve had a bit more energy for a few days, but could’ve been my imagination. Got a slight bit of bacne, but it cleared up after a few days too.

So, after 2 weeks on androgel, I got tested 11/15/2012, at 10am (with last application of androgel being the day before at around 9am). Here’s my numbers:
Testosterone, Serum 102 ng/dL 348-1197
Free Testosterone 2.9 pg/mL 8.7-25.1
Estradiol 5.9 pg/mL 7.6-42.6
LH 2.0 mIU/mL 1.7-8.6
FSH 2.8 mIU/mL 1.5-12.4

So, my testosterone is even lower now! LH and FSH are just below half of what they were in original blood test, but still inside the ‘normal’ range. Seems as if I am not absorbing the androgel very well (otherwise T would be high, and LH and FSH would have dropped to nothing).

I’m going to call my doc up and see what she recommends. If you have any advice on what to ask for, I’d appreciate it, otherwise I will base it on info already in TRT: Protocol for Injections - Testosterone Replacement - Forums - T Nation

Thanks

13

Just got a shot of 1mL of 100mg/mL testosterone cypionate. Right now the Rx is for 1 shot every two weeks, which I know is not what’s recommended here. It is, however, the same amount that is recommended to inject per week, so I should be feeling pretty good for the first week.

When should I get blood tests for TT, FT, and E2? Perhaps 1 blood test Friday (2 days after injection), and another 10 days after injection? Then if my E2 is high on the first test I’ll know if I need arimidex. And if my testosterone is good on the first test but low on the 2nd, it’ll be evidence for keeping the dose the same but increasing frequency (to match the recommended 100mg/week, rather than the 100mg/2weeks that I am prescribed right now).

Thanks.

PS: For anyone who’s worried about needles: I went in to the doc’s office and a nurse did the injection. High up on my glute, barely felt the needle go in, seemed to only take a few seconds to inject.

14

I think that 50mg/week will take you to 350-400, back to square one. With a single injection you will not do well and the lab numbers will be greatly controlled by when you do the lab work - sort of useless.

Test 1/2 week after the second injection. Do not bother testing LH/FSH!

You need to self inject at least twice a week.

15

[quote]KSman wrote:
I think that 50mg/week will take you to 350-400, back to square one. With a single injection you will not do well and the lab numbers will be greatly controlled by when you do the lab work - sort of useless.

Test 1/2 week after the second injection. Do not bother testing LH/FSH!

You need to self inject at least twice a week.[/quote]

I got a blood test 1 week after the first (and only, so far) 100mg shot of 100mg/mL testosterone cypionate. Results are:
total test 446 ng/dL 348-1197
free test 8.5pg/mL 8.7-25.1
e2 20.3 pg/mL 7.6-42.6

My symptoms seemed to only marginally improve on days 2-4 after the shot, and now I’m back to the same (or perhaps worse) than before treatment. I’m going to tell the doc I’d like to change the prescription to 100mg per week instead of 100mg every two weeks, and that I’d like to self inject (so I can do smaller more frequent doses if I need to). I’m not going to ask for Arimidex/anastrozole yet since my E2 is currently good, but will make sure to retest E2 since it’s likely to go up when my TT goes up.

Thanks.

PS: I’m surprised my TT is as high as it is, considering no front loading was done. If testosterone esters really do have exponential decay, then mathematically it’d take about 6 weeks of periodic redoses to approach a steady sawtooth (where the peaks all have same height). Perhaps that’s why KSMan recommended blood tests after the 2nd injection instead of the first injection. I wanted the blood test earlier though, because I’m hesitant to ask the doc for a change in the prescription without numbers in hand, and I would like to get to the recommended dose of 100mg/week sooner rather than later.

16

Your FT is below range and it was higher a few days earlier, the drop does not feel good. After two weeks it will be hell. Note that the medical criteria is to get you into normal range, ignoring how you feel or the effects of changes within the range.

17

The doc agreed to change my prescription to 100mg/week, and I’ve been taking that in 1 shot per week for the last 3 weeks. I got retested on 12/28/12, following an injection of 100mg testcyp on 12/22/12 (6 days prior), here’s the numbers:
Testosterone: 607 ng/dL (348-1197)
Free Testosterone: 16.5 pg/mL (8.7-25.1)
Estradiol: 34.7 pg/mL (7.6-42.6)

Since then, the 0.5" 0.5cc 29g insulin syringes I ordered online have arrived, so I did my first shot of 50mg last night, planning on 50mg twice a week. My libido has improved somewhat in the last few weeks, but no major change, although some days are better than others. Curiously, it’s not just the day after the shot that’s good, maybe because of too high E2? I’m not really feeling much improvement in energy like I had expected, especially considering that if I’m at 600ng/dL 6 days after a shot, I must’ve been around 1000ng/dL one day after a shot.

So, two questions:

  1. Should I ask for 1mg/week of anastrozole/arimidex as recommended in the stickies, or a different dosing based on the 34.7pg/mL of estradiol I tested at?
  2. Should I ask to increase my dosage of test cyp from the current 100mg/week? If so, should I go to 125, or maybe 150? I understand that testing 6 days after a shot of 100mg once a week will give a lower number than I’ll have 3 days after a shot of 50mg twice a week, so just by switching to more frequent injections I should be improving my lowest blood level.

Thanks. Sorry for not following the recommendations in the stickies sooner, I should’ve been more decisive with my doc from the beginning.

PS: I’ve also been taking iodine drops, I couldn’t find high-dosage iodine pills anywhere in town (went to GNC and a few health food stores). They are 1.8mg per drop, and I’ve been taking 20 drops every few days in a glass of water (whenever I remember).

18

T levels should be low after 6 days. You will test higher with two injections per week and should test half way between. Then the labs will be representative and you can adjust from there.

1mg anastrozole is as good a guess as any. With things done as above, your dose can be adjusted either way.

You will do a lot better.

Walmart has those syringes and in many States you do not need a script for those. Get alcohol prep pads there too.

19

[quote]KSman wrote:
T levels should be low after 6 days. You will test higher with two injections per week and should test half way between. Then the labs will be representative and you can adjust from there.

1mg anastrozole is as good a guess as any. With things done as above, your dose can be adjusted either way.

You will do a lot better.

Walmart has those syringes and in many States you do not need a script for those. Get alcohol prep pads there too.[/quote]

I bought 30mg of 1mg/mL anastrozole as a research chemical online, it arrived on 1/11/2012. Started on 1mg/week in two doses, at the same time as the 50mg injections of test cyp.

Had a doc appt on 1/17/2012. Based on continuing symptoms and bloodwork, the doc agreed to change my dose to 150mg/week. I didn’t bring up E2 control with the doc.

On 1/18/2012, I started doing 3 injections of 50mg of test cyp a week (150mg total per week), and 0.33mg of anastrozole at the same time as each injection (1mg of anastrozole per week). Didn’t notice a difference the first week, but the 2nd week, I started getting sore joints, night sweats, and had a bad time with congestion and catching my breath when running. I went on a group workout and couldn’t keep up during the warmup jog. I could do 30 second hill sprints, but it’d take a long time to recover (basically same performance as if I held my breath while sprinting). Not sure if this is “test flu”, or regular flu. Also not sure if the sore joints are part of the flu-like symptoms, or if it’s sore joints due to E2. From reading online, some people experience night sweats when E2 is too high, or too low.

I took another blood test on 1/27/2012, anxious to see if it says E2 is high or low. Seems most likely it’s too high, so I skipped today’s anastrozole dose, will see how I feel over the weekend. Should have blood results by monday or tuesday, and hopefully by then I’ll also see if the sore joints/night sweats are better or worse.

Thanks. It’s really frustrating how long this takes to get dialed in properly. If all I had was my doc and didn’t have this forum, I would’ve given up by now, so I really appreciate all the advice.

20

TT: 1135 ng/dL (348-1197)
FT: 34.2 pg/mL (8.7-25.1)
E2: 22.1 pg/mL (7.6-42.6)
I also had the following two tests, because they came in a package deal with the above 3 for a special price:
DHEA-Sulfate: 257.3 ug/dL (160-449)
Prostate specific ag serum: 2.7 ng/mL (0-4)

So, TT is high, FT is too high, E2 looks perfect, but I’m still tired, sore joints, low libido :(. I skipped the anastrozole dose yesterday morning (when I thought I had low E2, before receiving blood test results), haven’t noticed a change in symptoms. To be honest, I haven’t noticed a pronounced change in feeling regardless of what blood tests have indicated. From before I started TRT and had TT of 340, to when I was on androgel, to 100mg for two weeks, to 50mg three times a week. Everything’s been so subtle it’s been hard to tell if there are actual changes or if I’m imagining it, and any changes that do occur don’t seem to be well correlated to specific events. I’ve read on several forums that it can take weeks or months for noticeable changes to occur, but I’ve also read countless threads where someone notices dramatic changes after a single injection.

This test was almost 48 hours after a prior injection, not half-way between two injections. Given the relative half-lives of anastrozole and test cyp, it seems reasonable to conclude that my testosterone was on the way down and E2 on the way up. Based on that, I am considering lowering my anastrozole slightly (perhaps 0.25mg or 0.30mg 3x a week, instead of 0.33mg). However I don’t know if that’ll make any difference at all, since I’ve been dosing MWF and I’ve been having 2,2,3 days between injections, and not noticing differences in symptoms at any point during the week (when logic says that at various points in time my E2 has been both higher and lower than 22, and I still haven’t felt ‘right’).

Is my TT or FT high enough to warrant lowering test cyp dosage? I’m confused because I read stories of people taking 500mg+/week and feeling great (aka steroid users), and have also read of people on TRT purposefully reducing their dose after blood tests indicate supraphysioligical scores and that they felt better with lower doses.

Thanks.