Another Low T Guy

Pharma / TRT Testosterone Replacement
21

Would it matter if I didn’t have sufficient Selenium until halfway into IR? Since I have not had iodine for 20 years, I have still hope that things will naturally be restored if I give it time. I was wondering if a lower dose (5-10mg/day) + Selenium over 1-2 weeks might allow things to settle in? Or is that just wishful thinking since if I were to respond I would have already (18 days since start of IR).

Would it be fair to assume that thyroid levels have not changed if temps did not rise during IR? If so, then more lab work would just more waiting and more money. If I do the thyroid trial, do you think the dose is sufficient to see the effects (30mg/day = half grain/day = not much)? And what happens when the feedback mechanism kicks in and I am back to same levels? I don’t get that part.

22

I decided to start the thyroid trial the other day. KSman, can you comment on the following:

  • Is 30mg/day a sufficient amount for a trial? It seems pretty low.

  • How do I deal with the possibility that I naturally stop producing some thyroid? In other words, how do I know that actually I have a net increase in thyroid hormone?

23

How much, that is hard to say. Your body temperatures would be a good guide as well as how you feel.

Yes, small amounts of thyroid meds will simply repress before levels go up. I have never had to use thyroid meds myself, so I can guide you very much.

IR is building up your reserves. Selenium is not; only instantaneous levels matter.

I would continue IR and thyroid meds together.

You should not need labs to know if how you feel is better and temps are improved. Labs do not tell you when to feel good.

24

I agree with your comment about how I feel and body temps, but I am not sure this trial holds water.

Say for example I were to do TRT, but just at a small dose. My body would respond by making less testosterone and I would continually testosterone need more until I have gone to total replacement. Only at that point, would I be able to assess if the effects are positive.

Wouldn’t the same thing happen with thryoid? Would a trial really “work” if I don’t acheive levels sufficient for replacement? In that sense, I don’t know that a small dose trial holds water.

I concerned that a geninue trial would require a slow increase of thyroid until I achieved total replacement. Otherwise, if I get no improvement, I don’t know that I have learned anything. It could easily be attributed to my body just producing less thyroid to compensate for the ingested amounts.

25

Well, the second figure indicates that a trial of thyroid meds may increase temps. So perhaps the feedback loop isn’t quick enough and there can be a net increase in thyroid hormone before full replacement occurs. I just don’t know though.

http://www.drrind.com/therapies/metabolic-temperature-graph

26

Cortisol and DHEAS Saliva Tests. Very high DHEA and normalish cortisol:

Cortisol - Morning (Saliva), 7.6 ng/mL, (3.7-9.5)
Cortisol - Noon (Saliva), 1.5 ng/mL, (1.2-3.0)
Cortisol - Evening (Saliva), 2.3 ng/mL, (0.6-1.9), HIGH
Cortisol - Night (Saliva), 0.5 ng/mL, (0.4-1.0)
DHEAS (Saliva), 36.5 ng/mL, (6.0-18.0), HIGH

27

Also, here is the blood test for DHEA.

Dehydroepiandrosterone (DHEA), 221 ng/dL, (31-701)

28

Based on serum DHEA-S, things look good and many age management docs would want higher DHEA levels.

Yes, cortisol looks good. But I don’t know what optimal morning would be. You feel that you have decent energy in the morning?

29

Is there any concern that the blood DHEA test is low in the range, but the saliva DHEAS is 200% of maximum? That is strange to me. I have read that the saliva test is more accurate, but that the blood test is the gold standard. So I just don’t know. Some indicate that high DHEA and normal Cortisol could indicate a that a crash is about to occur. Who knows.

No idea about cortisol optimal levels either. The range is pretty broad and varies by time of day. This is a challenge since my schedule is shifted compared to most and I am up late into the evening. Long story short, this is probably a pretty good result considering my odd schedule. I sent in for a total testosterone test and that will give me a 3rd data point. I am beginning to think that is the root cause here. Thyroid and adrenal may not be optimal, but I don’t see anything alarming either.

30

Forgot to answer your question. Energy levels are not great in the morning. Not terrible, but not good/great.

31

Serum DHEA is pulsatile so we should test serum DHEA-S which is not. I don’t know how pulsatile salival DHEA is; perhaps not a good choice.

32

Had another testosterone test from ZRT labs. It came back as 206 ng/dL. With the other two tests (190 and 293), that is an average of 230 ng/dL.

Do you think it is time to go on TRT? I seem to be consistently low and don’t think that I can do anything that will naturally get it into levels that are good. My only concern is whether low T is the root cause or a symptom. If it is root cause, I have no problem going for it. Clearly, my levels are very poor.

33

Your LH was low, FSH was not, sort of ambiguous for primary hypogonadism. You did the iodine replenishment?

Root cause: You are a bit young for age related decline. I agree that you need to do something to get back your quality of life. Do you have a doc who knows what to do or listen?

34

I don’t know how to interpret LH and FSH as they relate to primary or secondary. I looked around and didn’t see much on this site regarding that. Iodine replenishment is complete.

For reference, 2.5 years ago total testosterone was 480 ng/dL. I felt I had symptoms of low T at that point, but was not clinically low.

My doc seems to be very willing to listen. But at this point, I don’t have anything to offer. I have done IR, all hormone lab work including cortisol. What else can/should I do?

35

I saw my doc and he doesn’t know what else to check for regarding root cause. I also checked for HIV just in case, but no problem there. He said I could see and endo for another opinion as well. I don’t have any other thoughts.

In the meantime, he put me on testosterone since that should hopefully at least try the symptom as I continue to search for something deeper. He started me off at 60mg/week instead of 100mg/week to see how my body reacts. But he has no problem increasing it. He gave me a script for anastrozole as well (he will be out of town for a while), but said he didn’t want me to use it and give things some time to adjust. He did not give me hCG but understands that it might be beneficial. He wanted me to wait on that and see how I respond. All of this seems pretty fair, at least for symptom treating.

I don’t have any other ideas other than to talk to other docs. In the meantime, does the TRT plan pretty good, at least for starters. He did say if the testosterone was too low (via how I feel) then to up to 100mg/week and check back later.

Thanks for any help. I took the first injection several hours ago, but so far nothing. I guess it will take some time?

36

Did IR do anything for body temperatures or energy?

Sounds like your doc will get around to doing what is needed. 60mg T is probably not going to float your boat. It might avoid problem E2 levels, but that is not really the point.

Followup labs:
TT
FT
E2
hematocrit
PSA if older and DRE at 6 months if older

37

No increase in temp or energy from IR. This was disappointing since long term iodine has been near zero. I would have thought something would happen. Oh well.

I have the testosterone cyp vial and the doc said I can go to 100mg/week if I feel that is what is needed. He just suggested to start at 60mg/week, but it was a soft suggestion. His was hoping that it would add enough to get to 600-700ng/dL, but I suspect my body will shut down natural production and keep me more like 400ng/dL?

I guess the main question is can/should I be on TRT? I hate to just mask a problem if there is something deeper going on here. But the problem is what else can be done or tested for? Am I basically at the point where I just need to treat the symptom?

Are the any last ditch efforts? For example, I am cutting caffeine and soda, adding ZMA at night, and no wanking it. Everything else is pretty much optimal (workouts OK, bodyfat low, good sleep, low stress). I held off any any further injections and want to do one more total testosterone test. After the first injection, it got real that this would be for life and I want to try harder to get it back naturally. Basically, I am just nervous about treating the symptom versus ignoring a deeper problem.

38

You got FSH, not FSH and LH, but FSH is the better indicator of LH status than LH itself. So you appear to have primary hypogonadism and that is simpler to deal with than secondary. With primary, if the testes simply don’t work, there is nothing to fix unless the problem is vascular and that can sometimes be fixed with surgery. But often guys feel that. A doc can tell with a physical exam but I see that some are now doing an ultrasound exam. If testes do not have a surgically correctable vascular problem, I can’t see that there is any recourse to TRT. However, I do not know how thyroid replacement might affect how your tests work. So I have some uncertainty.

Are you feeling better with Armour thyroid? Body temperatures good now? Any hormone tests while on Armour?

39

Thanks for the help. I have this data. Isn’t this both FSH and LH?

FSH, 7.04, mI U/mL, 1.27-19.26
LH, 3.52 ml U/mL, 1.24-8.62

I haven’t noticed pain, lumps, or any physical difference in the testes/scrotum. Should I ask the doc about vascular? Did you mean you can’t see any recourse but to TRT (i.e. that TRT is the “solution”)? There may be a slight terminology issue on my end and I wasn’t sure what you were saying there.

I forgot to mention, I decided to hold off on the thyroid treatment for a couple reasons (did it for 5 days with no noticeable effect to temp or otherwise). I asked around in a thyroid specific forum and the response was that my labs were probably OK enough and if I did want to treat, it would be with just T4 in this case and not with Armour. But based on the first set of thyroid data, it looked pretty good:

Triiodothyronine, Free, Serum, 3.02 pg/mL, (1.9-3.5)
Free T4, 0.94 ng/dL, (.58-1.64)

It seemed they focused more on FT3 (just about 3/4 range) than FT4 and I didn’t want to get into a spiral where I had no idea what was going on. And since all of my symptoms are testosterone related (I have nearly every one), I figured it would be best to go at that angle first.

Any concern that testosterone went from 480 to an average of 220 in just 2.5 years? That is quite a decline. I guess 480 isnt that great either so even if I was to get to 400 or so, I still may not feel that great. So maybe that is a moot point and TRT was always going to be necessary to have a normal qualify of life? I may just start the TRT at 100mg/week and see how it goes. At least I would get a data point for how I feel.

40

In addition to the last post, some other lab data I did not previously state. Not sure if this helps and only BUN was out of range:

Red Blood Cells, 5.16 M/uL, (4.2-5.8)
Hemoglobin, 15.3 g/dL, (13.5-18)
Mematocrit, 45.7 %, (40-54)
MCV, 88.6 fL, (80-102)
MCH, 29.7 pg, (27-34)
MCHC, 33.5 g/dL, (32-36)
RDW, 12.9 %, (10-15.0)
Platelets, 191 K/uL, (150-450)
MPV, 11 fL, (7.5-11.5)
Segs, 62 %, (38-80)
BANDS, 1 %, (0-12)
Lymphs, 23 %, (15-49)
Atyp Lym, 0 %, (0-0)
Monos, 10 %, (0-13)
Eosinophils, 4 %, (0-8)
BASOS, 0 %, (0-2)
Promyelos, 0 %, (0-0)
Myelos, 0 %, (0-1)
Blasts, 0 %, (0-2)
NRBCM, 0 , (0-3)
RBC Morph, Normal , (Negative)
PLT Est, Adequate , (Normal)
Glucose, 87 mg/dl, (65-99)
BUN, 29 mg/dl, (7-25.0) <--------------------HIGH
Creatine, 1.1 mg/dL, (.6-1.5)
Glom Fit Rate, Est, 73 mL/min/1.73 m2, (>59)
If African-American, 88 mL/min/1.73 m3, (>59)
Sodium, 139 mmol/L, (135-152)
Potassium, 4.3 mmol/L, (3.5-5.5)
Chlorine, 103 mmol/L, (95-109)
Carbon Dioxide, 27 mmol/L, (20-32)
Calcium, 10 mg/dl, (8.3-10.7)
Total Protein, 7.1 g/dl, (6-8.5)
Albumin, 4.8 g/dl, (3.5-5.5)
Total Bilirubin, 0.4 mg/dl, (0-1.5)
Alkaline Phosphatase, S, 71 U/L, (10-130)
AST/SGOT, 24 U/L, (5-34)
ALT/SGPT, 32 U/L, (5-31)
C-Reative Protein, Quant, <4 mg/L, (0-5)
Prolactin, 4.5 ng/dL, (2.1-17.7)
Sedimentation Rate, 5 mm/hr, (0-15)
Vitamin B12, 822 pg/mL, (180-914)