Hi Everyone,
I started TRT roughly 6 weeks ago: 200 mg/mL cream - 2 clicks (.5 mLs or 100 mg) applied to the scrotum OPD in the morning. I’m 45, 5’7 sitting at around 150lbs and about 12-14% BF. Protocols: IF 16:8 daily (4 years now), heavy resistance training 6 days a week, clean diet grassfed/ organic meats (bastardized carnivore/ Paleo). I was also taking Finasteride for close to 15 years and got hit with this elusive Post Finasteride Syndrome (PFS). Symptoms are predominantly neurological - 24/7 “brain fog” and chronic fatigue. I’ve been working with a TRT Dr. in hopes of mitigating some of these symptoms. So far I’ve had incremental improvements but nothing earth-shattering. Prior to starting T I’ve also had joint pains, prone to injury, DOMS/ very long muscle recovery. Here are my labs prior to starting T:
Testosterone Free and Total: 8.7pg/mL // 461 ng/dL
DHEA-Sulfate: 113.6
Luteinizing Hormone(LH): 5.9
Prolactin: 3.8
Sex Horm Binding Glob: 52.0
Estradiol, Sensitive: 13.8
Dihydrotestosterone: 37
Here are my 3-month labs:
Testosterone Free and Total: 19.2pg/mL // 914 ng/dL
DHEA-Sulfate: 109.4
Luteinizing Hormone(LH): Did not repeat
Prolactin: Did not repeat
Sex Horm Binding Glob: 58.6
Estradiol, Sensitive: 32.1
Dihydrotestosterone: 397 (is this a mistake!?)
Symptoms: Still chronic fatigue, joint pains (I feel like I’m a flea-hair away from an injury), 24/7 brain fog (slight improvements after high intensity lifting). I don’t have any shedding (hair) given that high DHT number, occasional acne in weird spots (arm pit, thigh).
Any help would be appreciated on reading these tea leaves before my next appointment with my doc! I have other labs not listed like a complete thyroid panel and other standard labs like CBC/ lipid, etc. If anyone would like to see them let me know.
Thanks all!
If thyroid or mineral deficiency can’t explain continuing symptoms than you may have lost the ability to process androgens, typical PFS.
DHEA looks to be on the low side and is needed for joints.
Thanks systemlord.
I know some of the studies on PFS have talked about the AR conundrum. If I fell in that camp, wouldn’t there be a disruption in how T is being metabolized in my system, and show up on some of these labs? My T almost doubled and Free T looks to be where it should be. T conversion seems to be taking place (estradiol is up, etc.). Maybe I’m not understanding the science of it all. Either way this is a big mystery.
You mentioned thyroid here’s where I stand:
TSH: 2.34
T4 (Free): 1.47
T3 (Free): 3.1
Reverse, T3: 22.2
Do you suggest checking for any mineral deficiencies? Latest Vitamin D was a 60.8. What else would make sense to check?
I was reading about other PFS sufferers getting relief at higher T levels in the 1500s. I’m on the fence about getting that high. Any suggestions on that approach? One last thing you picked up on was DHEA was low. Do you also suggest including DHEA supplementation? What would be the best delivery method?
Thanks again for your help!
There wouldn’t be in the same way we have no way of testing for T3 resistance at the receptor.
You really don’t need a test, if your hormones are optimal and you still feel like hormones are low, this is a sign androgens are not being used do to gene expression damage.
Some of your Free T3 is not able to get into the cells, this is not optimal because Free T3 isn’t even mid-range and Reverse T3 is high normal. It is by now means terrible, but is not optimal either.
For what it’s worth (and it may not be a lot) I got on TRT for the sole reason I had major fatigue. Never took finasteride but I had 10 years of heavy drug use. I feel best with a total T at 2000 with no AI. It took a while before my fatigue got better. It wasn’t like “oh I’m at 2000 now so I’m good to go”. It took 6 months for noticeable improvement and a year for total improvement.
Go to discountlabs dot com and search for their fatigue panel. I did that and found out I was anemic and supplemented iron & B12 and that helped a lot as well. Thyroid plays a major role in fatigue so check out their full thyroid panel as well. You can take the list of labs to your doc and try to get insurance to cover it. I’ll post my results so you have something to look at.
Thanks for all the advice. And thanks for sharing your labs Dex. I’ll bring up thyroid treatment with at my next consult with my Dr. I’ll update this thread when I know more.
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