Among Other Things, Low T

Pharma TRT
1

45 yrs old, 5-10, 188 lbs, 34 waist. I am very healthy and go to the gym lift a lot, cardio moderately, and have quite a bit of muscle. I have never used steroids etc. Don’t need to, don’t want to.

Recent labs are below.

Total Test (LC/MS) 360 (range 348-1197)
Free T (Direct) 8.9 (range 6.8 - 21.5)
LH 4.9 (range 1.7-8.6)
FSH 4.1 (range 1.5-12.4)
Estradiol 21.3 (range 7.6-42.6) ECLIA methodology
Prolactin 11.0 (range 4.0-15.2)
Aldosterone 14.5 (range 0.0 - 30.0)
Renin Activity, Plasma 11.6 (no range given)
Aldos/Renin Ration 1.3 (Range 0.0-30.0)
Dihydrotestosterone 32 (no range given)
DHEA-S 131.9 (range 44.3 - 331)
DHEA-S + Testosterone 439 (range 348-1197)
Hematocrit 44.6 (range 37.5-51.0)
Vitamin D (25-Hydroxy) 58.2 (range 30-100)
PSA 0.6 (range 0.0 - 4.0)
LDH 153 (range 0-225)

T3: 65 (range 55-170)
Free T3 2.9 (range 2.0 - 4.4)
Free T4 1.9 High (range 0.8-1.7)
Antithyroglobin AB <20 (range 0-40)
Thyroid Peroxidase TPO 14 (range 0-34)
Axillary Basal Temperature - 96.6 (3 day average)

Glucose Serum 105
Hemoglobin A1C 6.0 (range 4.8 - 5.6)
Albumin Serum 4.4 (3.5 - 5.5)

WBC 3.2 (low)
RBC 4.8 (low)
Hemoglobin 13.6 (low)
Hematocrit 39.8 (low)

total cholesterol 178
HDL 46
LDL 116
triglycerides 82
AST 45 (0-40) high due to statin
ALT 70 (0-40) high due to statin

I take many vitamins including ZMA, Vitamin C, D, B12, CoQ10 (100).

No digestive or gut issues. No food sensitivities.

I also usually have to take something to sleep (Zolpiem 5 or Alpazolam 0.5). zolpiem twice/week. Alprazolam twice/week (I alternate). Sometimes none for a week or more.

On cholesterol meds for 15 years (currently vytorin 10/10 (which is zetia 10 add zocor 10). It is controlled, but I already have two stents already (poor genetics). No heart damage. Also on Ramipril 10. No cough.

I eat a low glycemic, high protein, low processed carb diet with healthy fats (olive oil, nuts, avocado).

Went on full thyroid replacement 200mcg 15 years ago.

Blood sugar is also on the rise slowly over the years.

I had the dreaded DRE, all is fine. Not much problem with ‘the boys’ aching, no injury…

Complaints: Low sex drive, morning wood gone, low energy/motivation, etc.

Urologist prescribed Axiron. Not hopeful after reading through the forum…

What do you make of my case/labs?

2

Anemic?

3

Glucose is a concern. If T levels were restored, insulin sensitivity would improve. Would also improve endothelial cell function and could lower BP. But cannot replace scar tissue.

TSH, fT3, fT4 would be helpful, please post your body temps as per sticky referenced below.

Get tested for serum iron, ferritin and blood in stool.

Test AST, ALT, albumin, PSA, CRP, homocysteine and get urine tested.

Test DHEA-S.

Any digestive or gut issues? Food sensitivities?

Read the advice for new guys sticky. We need more data.

Not impressed with long term use of those sleep aids, can cause problems. Suggest:
Rx trazodone, start at 25mg, expect to need 50 soon after, scored 150mg tablets, cheap.
OTC 5mg TIME RELEASE melatonin. Sold on vitamin shelves. Must be time release.
-I use both.

Are you using a statin drug? Causes cough? Taking CoQ10/ubiquinol?

4

Okay, I posted more lab results/information to the opening post. I will have to work on getting a few more lab tests done.

From what I can tell it looks like secondary hypogonadism. Correct?

I want to avoid taking any more medications than I need, and I want to avoid TRT side effects. And I know everyone is different. Is it reasonable to shot for a mid T level of 700 and limit side effects or need for more meds?

It doesn’t sound like Axiron can get me that far. Is it worth a shot or should I go straight to compounding? It sounds like a daily cream will limit the spikes in T (even better than injection every 3 days), and will therefore limit side effects / need for other meds.

It seems like if you can get good absorption, then that is the healthiest way to go. If you can’t then do injections. Is that about right?

5

T side effects are from:
1- Elevated E2, problems avoided with AI and getting near E2=22pg/ml can optimize quality of life.
2- Enlarged prostate, mostly from elevated E2, see above
2- Hair loss, that is your genetic response to a youthful level of T, it that a side effect

The side effects of not dealing with your current hormone level are severe and will shorten your life and make you miserable.

Might be combination of primary, secondary. You could determine with hCG challenge/trial.

Right now, you are estrogen dominant.

Transdermal T creates the highest levels of E2 [bad] and highest levels of DHT [great for libido, accelerates hair loss for those with vulnerable genetics]. I am not a fan of transdermals, high concentration creams are better, and cheaper than the gels that are spread over large skin areas.

Meds, you probably need T, anastrozole and injected hCG. That is three drugs. E2 management is mission critical.

6

My T levels have been consistently in the mid to upper 300s the past several years.

I was getting ready to start TRT, but for the past three weeks I started getting some light morning wood and ‘the boys’ have a slight dull ache most nights now.

So I used privatemdlabs/labcorp and had the following tests run. These are four weeks past my opening post T numbers.

Test 461 (range 348-1197) was 360 – +101 in four weeks with no TRT
LH 4.1 (range 1.7 - 8.6) was 4.9
FSH 3.9 (range 1.5 - 12.4) was 4.1
Estradoil 20.4 (range 7.6 - 42.6) was 21.3

These are what I can identify changing over the last three weeks.

  1. Haven’t worked out (lifted) in three weeks. I generally lift 4 days per week. Heavy, not very heavy for 70 minutes/session.

  2. Stopped taking a dieuretic 12.5 (BP was lower, so I was able to get off it. Only on this for about a year and T in the 300s has been several years).

  3. Been sleeping better, and not taking any sleep meds

  4. Stopped creatine monohydrate (since not lifting)

  5. I made more of a conscious effort to eat nuts, avacado, olive oil, or fish every day to ensure healthy fats are up.

  6. Started Plavix and asprin.

I am shocked at the sudden jump and wondering what caused it.

I am going to head back to the gym next week, but am going to avoid lifting two days in a row.

Questions:

  1. I guess the boys have a dull ache as they are kicking it up a little? Do I need to go back to urologist or is this normal?
  2. At 461, should I start TRT or see what happens over the next month?

I would like to have a better T to E ratio.

I am searching for a non T adverse endo who can look at my thyroid treatment, rising blood sugar, and low T together. It is probably a dream, but I would like to find one person to treat it all since they are all probably related.

Still working on getting more labs done.

7

What are your waking and mid afternoon body temperatures?

Have you tested DHEA-S?

At your age, DHEA-S levels can be expected to have dropped. If low, that can reduce T production.

Take fish oil every day.

Stopping those sleeping meds may have a big effect and your brain may take a while to recover/improve.

8

Had additional labs ran… No sleep meds for over 6 weeks. Taking 2400 Fish Oil daily.

T3: 65 (range 55-170)
Free T3 2.9 (range 2.0 - 4.4)
Free T4 1.9 High (range 0.8-1.7)
Antithyroglobin AB <20 (range 0-40)
Thyroid Peroxidase TPO 14 (range 0-34)
Aldosterone 14.5 (range 0.0 - 30.0)
Renin Activity, Plasma 11.6 (no range given)
Aldos/Renin Ration 1.3 (Range 0.0-30.0)
Dihydrotestosterone 32 (no range given)
DHEA-S 131.9 (range 44.3 - 331)
DHEA-S + Testosterone 439 (range 348-1197)
Hematocrit 44.6 (range 37.5-51.0)
Vitamin D (25-Hydroxy) 58.2 (range 30-100)
PSA 0.6 (range 0.0 - 4.0)

Hemoglobin A1C 6.0 (range 4.8 - 5.6)
Axillary Basal Temperature - 96.6 (3 day average)
Mid Afternoon Oral Temperature - 98.4 (3 day average)

I have been thinking about first tackling thyroid and switching to Armour or adding Cytomel. Axillary Basal Temperature is low and Free T4 to Free T3 ratio is not good.

Any thoughts on thyroid and how my DHEA-S and other labs look?

9

DHEA is a bit low. You can try 25mg/day. Take with a meal that has more fats/oils.

Thyroid numbers are odd. T3 is low.

No TSH?

Can you get waking oral temperatures?

Do you use iodized salt?