I am a 50 y/o male 5’10, 215 BF% ~15% (exercise 4-5 x/ wk mix of cardio and weights) experiencing classic ADAM test sx over the last 2 years. Trialed on Clomid tried 25 mg daily or 50 mg EOD for several weeks,(brought up my test to low 400’s, but felt horrible on it, no libido, moody), also trialed HCG 500 iu 3x a week for several months with similar results.
Recently had lab work done which I will post. The DO I am seeing is big proponent of keto diet. Was told that once I fix my insulin resistance T could go up 250 points…seems a stretch to me. Also told my pregnenelone was low.
Rx’d compounded Pregnenelone 25 mg daily (I went up to 50 mg, but had insomnia and some irritability), taking 25 mg of DHEA on my own as well as well as turmeric, liver sup, krill oil, berberine, ALA, some agmatine, and the occasional Cialis, OTT I am on no other rx’d meds at this time. I do have moderate central and obstructive sleep apnea and failed trials on several different masks.
Am going to ask to start on TRT at next visit as I am still having zero morning wood, and no libido, low energy and motivation. Asking to start at 50 mg test cypionate 2x a week with no AI or HCG, at least initially.
Any thoughts, lab analysis, and/or suggestions are appreciated. Thank you very much!
When I see someone has sleep apnea, I always suspect that person has a problem with its thyroid, especially when the person also has low testosterone.
Your TSH value is too high (even though it is within the range). I had the same TSH value and a very clear case of hypothyroidism once I saw my free T3 values.
Your free T4 values are too low but you are missing the most important blood work which is your free T3. You should make sure to test that as soon as you can.
Your Reverse T3 is good.
Here you can see how treating hypothyroidism (which I believe you have) can help your sleep apnea and other symptoms you have right now.
" “To determine the incidence and frequency of sleep apnea in persons with hypothyroidism, 11 consecutive patients with newly diagnosed disease were studied before and during thyroid hormone replacement therapy. Nine patients had episodes of apnea, with the number of episodes per hour of sleep ranging from 17 to 176 (mean, 71.8). Six of the nine patients were obese and had 99.5 episodes per hour compared with 16.3 episodes per hour in the 3 nonobese patients ( p < 0.02). After 3 to 12 months of thyroxine replacement therapy, mean apnea frequency decreased from 71.8 ± 18.0 (SE) to 12.7 ± 6.1 episodes per hour, without reduction in body weight"
TRT will improve insulin resistance and changes to glucose management in 6-9 months. I’ve never seen estrogen dominance on this scale before, if you were to double your testosterone, your E2 would likely skyrocket.
You are one of those guys who will likely need a low dose AI with your TRT protocol, otherwise estrogen is going to be a problem. You aromatase like crazy and need to lose body weight.
Clomid and HCG was the wrong move with your estrogen dominance. DHEA will increase estrogen, you need TRT and a low dosage AI to block some of that T–>E2 conversion.
Losing weight with low testosterone, that will be a challenge because you’re also your insulin resistant. Exercising with low testosterone can cause more harm by burning out the adrenals and you are running on mostly adrenaline.
This is the bad move, cypionate causes spikes in T and E2 unlike your natural production, you need daily injections to minimize T–>E2 conversion, then if E2 is a problem you may need a low dose AI. You can use 27-29 gauge insulin syringes and inject in shoulders and quads.
Your thyroid doctor is old school, fT3 is the active hormone and I find it strange he tested rT3 without testing fT3 to compare the two. T4 should be midrange and is towards the lower end, you now have a reason for elevated TSH. I bet fT3 is on the lower end as well.
Optimal fT3 levels are needed for testosterone to be metabolized in the liver and therefore for TRT to show optimal results.
Thank you for the prompt reply. I guess I have done too much reading! Thought I should try TRT w/out an AI first. Would you recommend a low dose of exemestane? or anastrozole. Ditch the DHEA and preg also?
you are so correct, this is me: “Losing weight with low testosterone, that will be a challenge because you’re also your insulin resistant. Exercising with low testosterone can cause more harm by burning out the adrenals and you are running on mostly adrenaline”. Very hard for me to loose, on top of that, I am doing mostly low carb so I feel drained most of the time.
I am constantly tired and not motivated to w/o even though I have worked out at least 3 days a week for the last 30+ years. I have to have some hit of PWO or something to get going.
I will get the free t3 tested, start on trt and ask for a low dose of exemestane…Not real sure if this doc is up on all of this, I may have to seek out another…good thing is, he takes tricare
From what people tell me and my own experience, the aromasin is better tolerated than anastrozole if dosed 1:1, anastrozole is faster acting than aromasin and the anastrozole has the terrible rebound effect in some men when stopping it completely. In the end I over-responded to both and can’t touch the stuff ever again even at 1/8th of an anastrozole 0.050.
I over-respond to all medications needing only a fraction of a normal dose. My advice is start out low as you can to see how you respond to AI’s, because crushed estrogen levels is no fun, ten times worse than low testosterone!
If I get 100mg/week I will prob try ED or EOD dosing, if I can avoid the AI I will, I also want to get the rT3 and the estradiol LC-MS to see what my estradiol level really is, suspect the value is excessively elevated d/t the outdated test being performed.
Appreciate the input.
Your E2 likely won’t be that much different on the sensitive test. Mine is almost 80 on the sensitive test and I don’t have any issues. Using 100mg likely won’t do much unless you are super low SHBG.
Had some labs pulled including the free t# as you recommended, been on 50 mg t-cyp, x 2 weeks, then I upped in 2 75 mg, starting 25mg eod. DO originally put me on 50 mg 1 x a week, (switching Docs after this).
ALL BELOW FROM SONORA QUEST LABS----------------
TSH 2.38 RR: 0.45-4.50
T4 1.2 RR: 0.8-1.7
T3 FREE 3.5 RR: 2.0-4.8
T3 REVERSE 16 RR: 8-25
ESTRADIOL MALE SENSITIVE 24.00 RR< 44.00
SHBG 21 RR: 10-50
@sccoam
There’s a ton of restaurants out there and you are at the only one that serves a 5oz ribeye. Go next door to the place serving 1.5lb ribeyes and get what you need. Find a different doc. Why are you putting yourself through this? 75mg is feel like shit level. Seriously.
