Late 40s, Libido Gone. Bloodwork Inside, Thoughts Appreciated

Pharma TRT
1

Hey Gents, I would appreciate any thoughts on my situation.

About me:
-Male 47 years old
-height: 5’7"
-waist: ~35"
-weight: 190lb
-17% – 20% body fat

-body and facial hair: I’m a pretty hairy Italian. I have a full head of hair and haven’t experienced any hair loss. I have moderate hair on my chest, but hairy arms, legs, face and some back hair.

-describe where you carry fat and how changed
I’ve always had a layer of fat around my stomach and lower back but I did see my abs on my last cut. I think I have decent muscle tone. No real changes here.

-health conditions, symptoms [history]
I’m possibly anemic (see low MCV and MCH below). Apparently this runs in my family. It also looks like I have high LDL but ratio is ok. Also at times lately it has become a little difficult to piss. It’s like my prostate is enlarged or something but it is somewhat random and taking L-arginine helps a lot (see below). Over the past 2 years or so, I’ve had times of really low energy, brain fog, and my libido has drastically dropped off. No morning wood ever. Very moody. Sleep is horrible. I wake up 4 or 5 times a night. High anxiety from time to time, especially at night and when cutting. Overall I generally kind of feel like crap unless I’m at the gym. Although lately, I’ve been super sore with significant DOMS. It has been very tough to recover from my workouts. However, after I started the 500mgs of Tribulus (see below), the soreness went away which was awesome. I started struggling to focusing at work and just remembering the names of things and people, which is pretty damn scary. I’d be looking at a mechanical pencil for instance, and I would not know the name of the thing for a good 10 to 15 seconds sometimes. I work on a computer at a desk all day long. I’ve seen major changes in my symptoms over the past 12 months. I feel like I’m deteriorating too rapidly.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Never have taken any hair loss or prostate drugs.

-describe diet [some create substantial damage with starvation diets]
I’m on intermittent fasting protocol whereby I eat from 1:30 to 10PM only (most days I eat just 2 meals, first meal is small and the second one very significant). I’ve been on a bulk for the last year consuming about 2800 calories (1 gram of protein per pound of weight, 25 to 30% of total calories from fat and the rest carbs) and went from 175 to 200. Not sure if I gained much muscle to be honest but I felt really strong. The year before that I was on a cut and went from 195 to 175 on about 1800 calories down to about 1400 at the end. I did not eat much fat on this cut. I would guess less than 15% of my calories were from fat. In any event, I think I retained very little muscle on that cut which was a real bummer. I did feel like shit at the end of this cut.

Overall, my diet is pretty clean and I stick to my macros. I cheat about once per week on my cuts and roughly 2 times per week on bulk. I have a good BM every day. Recently started using iodized salt but not before.

-describe training [some ruin their hormones by over training]
I’ve been training with weights for 25 years. I dont do any cardio. During the last 3 years I’ve done a 5 day split (Wednesday - Sunday) hitting one muscle per day. Sessions last 45 mins to an hour. De-load every 4 to 6 weeks. Reverse pyramid protocol doing sets of 15/4/6/8 reps for a total of 10 to 12 sets per workout.

-testes ache, ever, with a fever?
Nope

-how have morning wood and nocturnal erections changed
No morning wood no nocturnal erections for at least a year now. I’ve also experienced some mild ED. Boners are not as strong as they were just a year ago which really sux.

Supplements currently taking:
5 to 10 grams of creatine Every workout day
8 to 10 grams L-Arginine ED mostly for circulation since my arms fall asleep a lot at night
500 mg of Tribulus ED

My body temps were as follows:

Monday:
6:15 97.3 (waking)
Noon 97.5
2:00 98
4:15 97.7

Tuesday:
6:15 98 (waking)
Noon 98.6

Wednesday
6:15 97.3 (waking)
Noon 97.5
8:00 97.3

Most recent labs below taken on March 15, 2017 while fasting:

Glucose, Serum 97 mg/dL 65-99
Uric Acid, Serum 5.2 mg/dL 3.7-8.6
BUN 23 mg/dL 6-24
Creatinine, Serum 1.10 mg/dL 0.76-1.27
eGFR If NonAfricn Am 80 mL/min/1.73 >59
eGFR If Africn Am 92 mL/min/1.73 >59
BUN/Creatinine Ratio 21 High 9-20
Sodium, Serum 139 mmol/L 134-144
Potassium, Serum 4.7 mmol/L 3.5-5.2
Chloride, Serum 99 mmol/L 96-106
Carbon Dioxide, Total 24 mmol/L 18-29
Calcium, Serum 9.6 mg/dL 8.7-10.2
Phosphorus, Serum 3.7 mg/dL 2.5-4.5
Protein, Total, Serum 7.1 g/dL 6.0-8.5
Albumin, Serum 4.8 g/dL 3.5-5.5
Globulin, Total 2.3 g/dL 1.5-4.5
A/G Ratio 2.1 1.2-2.2
Bilirubin, Total 0.2 mg/dL 0.0-1.2
Alkaline Phosphatase, S 61 IU/L 39-117 LDH 148 IU/L 121-224
AST (SGOT) 20 IU/L 0-40
ALT (SGPT) 30 IU/L 0-44
Iron, Serum 67 ug/dL 38-169
Cholesterol, Total 222 High mg/dL 100-199
Triglycerides 103 mg/dL 0-149
HDL Cholesterol 45 mg/dL >39
VLDL Cholesterol Cal 21 mg/dL 5-40
LDL Cholesterol Calc 156 High mg/dL 0-99

T. Chol/HDL Ratio 4.9 ratio units 0.0-5.0

T. Chol/HDL Ratio
Men Women
1/2 Avg. Risk 3.4 3.3
Avg. Risk 5.0 4.4
2X Avg. Risk 9.6 7.1
3X Avg. Risk 23.4 11.0

Estimated CHD Risk 1.0 times avg. 0.0-1.0

T. Chol/HDL Ratio
Men Women

1/2 Avg. Risk 3.4 3.3
Avg. Risk 5.0 4.4
2X Avg. Risk 9.6 7.1
3X Avg. Risk 23.4 11.0

The CHD Risk is based on the T. Chol/HDL ratio. Other
factors affect CHD Risk such as hypertension, smoking,
diabetes, severe obesity, and family history of pre-
mature CHD.

WBC 6.7 x10E3/uL 3.4-10.8
RBC 5.47 x10E6/uL 4.14-5.80
Hemoglobin 14.0 g/dL 12.6-17.7
Hematocrit 42.4 % 37.5-51.0
MCV 78 Low fL 79-97
MCH 25.6 Low pg 26.6-33.0
MCHC 33.0 g/dL 31.5-35.7
RDW 13.7 % 12.3-15.4
Platelets 237 x10E3/uL 150-379
Neutrophils 60%
Lymphs 29%
Monocytes 7%
Eos 3%
Basos 1%
Immature Cells
Neutrophils (Absolute) 4.0 x10E3/uL 1.4-7.0
Lymphs (Absolute) 1.9 x10E3/uL 0.7-3.1
Monocytes(Absolute) 0.5 x10E3/uL 0.1-0.9
Eos (Absolute) 0.2 x10E3/uL 0.0-0.4
Baso (Absolute) 0.0 x10E3/uL 0.0-0.2

CMP14+LP+4AC+CBC/D/Plt
Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 x10E3/uL 0.0-0.1
NRBC

Testosterone,Free and Total
Testosterone, Serum 414 ng/dL 348-1197

Adult male reference interval is based on a population of lean males up to 40 years old.
Free Testosterone(Direct) 8.9 pg/mL 6.8-21.5

Pregnenolone, MS 25 ng/dL ES

Reference Range:
Adults: <151

Dihydrotestosterone 37 ng/dL ES

Reference Range:
Adult Male: 30 - 85

T4,Free(Direct) 1.03 ng/dL 0.82-1.77

DHEA-Sulfate 232.6 ug/dL 71.6-375.4

Cortisol 6.6 ug/dL

Cortisol AM 6.2 - 19.4
Cortisol PM 2.3 - 11.9

TSH 1.460 uIU/mL 0.450-4.500

Estradiol 15.9 pg/mL 7.6-42.6

Prostate Specific Ag, Serum 0.9 ng/mL 0.0-4.0

Triiodothyronine,Free,Serum 2.9 pg/mL 2.0-4.4

Sex Horm Binding Glob, Serum 44.9 nmol/L 16.5-55.9

Any insight, commentary, or questions are welcome and appreciated. I’m happy to provide more information as well. Thanks in advance for your thoughts on what I can do to start feeling better.

John Boy

2

fT3 is the active hormone. fT3 and fT4 should be near mid-range or a bit better.
TSH should be closer to 1.0

You will need more than iodized salt. See the thyroid basics sticky and get selenium too.

SHBG is high, creating a lot of T+SHBG which inflates TT and TT is thus overstating your T status. FT is pulsatile and we can’t know if you caught a high or low etc.

Some blood abnormalities can be from GI blood loss. A simple occult blood [stool] test will rule that in/out. Had your lower intestine scoped, colonoscopy?
E2 does not explain SHBG. TRT with high T and E2 near E2=22pg/ml would be helpful.

Get KAL brand progesterone cream at USA amazon and apply to inner arms. This is one step away from cortisol and will help. No Rx needed in USA for this.

Muscle cramps indicate magnesium deficiency.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc
  • thyroid basics

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

3

Thanks for your time and valuable information @KSman I really appreciate it.

I’ve done a lot more reading given what you wrote and would like to do the following based on your information:

Early morning, with food I will take:

50mg of iodine ED
400 mcg of selenium ED
400 mg magnesium ED
2000mg of vitamin C ED
K brand progesterone and apply that to my inner arms ED

I will get occult blood test. I have not had colonoscopy or lower intestine scoped. I do occasionally suffer from hemorrhoids tho.

I will continue to monitor body temps ED.

I’m unsure what to do about high SBGH, I need to research that more. DO I need to unbind SBHG from T to get it to go down? Or I am I missing the point?

Regardless, would you agree that after three months it would be a good idea to check bloods again and see the impacts of this protocol and decide if I need to do something else or are you suggesting TRT is the only thing that will fix my T and E?

Thanks again for your time and help!

4

Dhea and cortisol are both low dhea should be atleast 400-450 and not sure when cortisol was done but if that’s morning that is very very low. Sounds like you are having some adrenal issue my friend.

5

Thanks marcusarmani.

My blood work was done at 10:45 AM. I had fasted for about 12 hours at that point.

I understand cortisol is highest in the morning so I see your point being mine is a 6.6 in a range of 6.2 to 19.4. I did some reading about adrenal gland fatigue and I do have some of the symptoms. I don’t feel particularly drained during the day but after a simple moderate workout, I’m freaking dead. Regardless, I do get really tired at night but a lot of time, I cannot sleep. It’s looking like the 8 years of Obama caused me enough stress to shut me down…lol

Does the thyroid contribute to this condition (or the other way around) or are they independent issues?

6

You’re cortisol is still extremely low for a 10am draw. It should still be above 12 at that time if not higher you’re lower dhea also points to adrenal issues ass well as being whipped out after a workout. If thyroid is sluggish it will affect adrenals and vice versa. Let me tell you one thing, you do not want to ignore is adrenal issues I did and pretty much ended up with Addison’s disease and still am all sorts of messed up today. How’s blood pressure? Ever get light head when you stand after sitting for a while? Anxiety? Depression? Digestive issues?

7

Also I’d suggest getting a good nights rest and have blood done again at 8am. Could be a mistake with the labs it happens all the time. Retesting would be a good idea if still low you really need to address the issue

8

My blood pressure is high, and I do get lightheaded at times fairly regularly and have anxiety and occasional depression.

From what I can tell, fixing adrenals is not an easy thing.

Sorry to hear about your situation. I dont know anything about adrenals or Addison’s for that matter, so I have to read up on it. But if you dont mind, why cant you correct your adrenals?

9

Sounds like a good idea. I assume you;re suggesting I do that straight away rather than waiting three months to see if I can get my thyroid to fire up.

Thanks for your help, marcusarmani.

10

You describe exactly how I was in beginning stages. You’re morning cortisol is low but not being able to sleep tells me you either have high cortisol or you’re body is pumping out adrenaline for the lack of cortisol to keep the body going. I used to be exhausted but could not sleep for the life of me. My blood pressure also used to be high and then a few months later it was 80/44 and would drop further when I’d stand and led to fainting.

Healing adrenals is very complex, it involves diet, sleep, exercise, hormone balancing. If the adrenals get out of whack the entire body does. You need to find a doctor that is educated on adrenal fatigue and see one endos know nothing about it all they know is a little about thyroid and diabetes.

11

I have tried everything to help me sleep ZMA, melatonin, etc. they help a little. Mostly though, I can be dead tired and I simply can’t fall asleep.

Thing is, when I take 500mg of Tribulus ED, the fatigue, sleep issues, moodiness, recovery time between workouts, etc go away. It takes a month or so before it kicks in but it seems to have a really positive effect on me. The problem is I think Trib kills libido and seems to cause my prostate to enlarge b/c it becomes harder to piss but regardless, after a month or so, the results drop off…I dunno, it’s all very confusing.

I’m going to read more about adrenals and thyroid and focus there for now. If I can get a positive results from addressing those issues, maybe I wont have to do TRT.

That said, are you on TRT, did it help your situation?

Your last sentence is the biggest issues I see: finding a DR who gets it.

12

You’re total T isn’t that low I feel it may come up if you get you’re adrenals in line. The trib might be causing libido issue because it might be causing a spike in e2. I had to travel all the way to Florida just to see a doc that understood my condition and he understood it very well.

TRT did help my situation as far as libido and what not but still have horrible digestive issues, sleep issues, and blood pressure issues after 2 years I’m still trying to get my body functioning properly again. You may want to add some pantethine to you’re supplements take 900mg a day. It will take a lot of stress if you’re adrenals and also throw in some ubiquinol

13

Sorry to hear that man.

Thanks for the advice I’ll look into those 2 supplements.

14

So the company I bought the blood work from offers free evaluation of the results. I talked with a medical technician the other day. We went through line by line and she explained her opinion of the test results and while she made the disclaimer she could not provide medical advice, she actually gave me a lot of advice. I was impressed with her knowledge and straight forward approach.

In summary unsurprisingly, she thinks my issues are due to a poorly functioning thyroid and adrenal glands, low T, low cortisol, and low E. She recommended at least 10 different pills to take, but was honest about saying while I should feel a little better overall, the pill protocol most likely would not result in getting me to optimal levels in those areas. Basically said, TRT is the best shot and referred me to several area doctors.

I decided to try the pill protocol listed below based on what I’ve read, advice here and her suggestions for three months ending around June 25. It seems like a ton of pills to take everyday so I’m not that excited about it but will to try and see what happens. After that I will get blood work done to see the impacts, assess how I feel, and make a decision about TRT.

In the meantime, I will continue to eat right, workout on a 4 day split routine using 5/3/1 and will post up here to document my journey. Please jump in and post with any comments or questions.

I appreciate the support I’ve received here.

Thanks T-Nation!

John Boy

Protocol (all daily each morning, except as noted)

5,000 IU D3
50 MG iodine (25 AM and 25 mid day)
50 MG Zinc
400 MG Magnesium
400 MCG Selenium ( follow iodine supplement)
8G’s L-Arginine (half AM and half PM)
50 MG DHEA
1,000 MG Niacin
50 MG pregnenolone
Use progesterone lotion each night

15

Hey gents, little update as it has been a few days on my new protocol described above.

Workouts: My workouts have been pretty good. I feel a bit stronger, a little more enthusiastic and seem to have a bit more energy.

Sleeping: I tend to sleep a bit better so that’s an improvement.

Muscle soreness: Overall, my muscle soreness has diminished. Admittedly, I have backed off my lifts a bit but I’m still hitting it hard enough to be sore but so far the pain is right where it should be after a hard workout: tender to the touch.

Energy: I’ve noticed a bit more energy but nothing significant.

Brain fog: Still have a problem here. I feel like I just dont remember details of anything and I have to read complex stuff several times to get it. My focus is really low.

Trmps: Morning temps still in the mid 97 range.

Libido: The first couple of days, my libido kicked up noticeably, however, now, it’s worse than before. I struggle to “perk up” even with direct contact. Very sad.

Appetite: No real changes with my appetite. I’m cutting and just pegged my calories to lose about 1 pound per week. Going well so far.

Moodiness: Seem to be a little more moody, it comes and goes really. I guess I would say I’m a bit more volatile but only moderately.

Overall, not much has change really. Little minor things here and there but nothing to jump up and down about. That said, I dont expect any significant changes at all really.

As always, comments, thoughts, advice welcome.

John Boy.

16

Hi folks, it has been a few months since my last post.

I have followed the above protocol (mostly) and got additional blood work that I would like to share with you all in hopes of getting some feedback. Any comments welcome. @KSman

Overall, I think I got my thyroid cranking but zero effect on my T levels, actually T dropped a bit…and skyrocketed my E.

Here are my recent blood test results:

Check out the super high DHEA-S and Estradiol!

CMP12+LP+6AC+CBC/D/Plt+PSA

AST (SGOT) 20 IU/L 0-40 SO
ALT (SGPT) 26 IU/L 0-44 SO
GGT 27 IU/L 0-65 SO
Iron, Serum 82 ug/dL 38-169 SO
Cholesterol, Total 173 mg/dL 100-199 SO
Triglycerides 103 mg/dL 0-149 SO
HDL Cholesterol 44 mg/dL >39 SO
LDL Cholesterol Calc 108 High mg/dL 0-99 SO
T. Chol/HDL Ratio 3.9 ratio units 0.0-5.0 SO
T. Chol/HDL Ratio
Men Women
1/2 Avg.Risk 3.4 3.3
Avg.Risk 5.0 4.4
2X Avg.Risk 9.6 7.1
3X Avg.Risk 23.4 11.0
Estimated CHD Risk 0.7 times avg. 0.0-1.0 SO
T. Chol/HDL Ratio
Men Women
1/2 Avg.Risk 3.4 3.3
Avg.Risk 5.0 4.4
2X Avg.Risk 9.6 7.1
3X Avg.Risk 23.4 11.0
.
Homocyst(e)ine, Plasma 8.9 umol/L 0.0-15.0 SO
Prostate Specific Ag, Serum 0.9 ng/mL 0.0-4.0 SO
.
Free Testosterone(Direct) 17.5 pg/mL 6.8-21.5 BN

DHEA-Sulfate >1000.0 Abnormal ug/dL 71.6-375.4 S* >1000.0
Estradiol 68.6 High pg/mL 7.6-42.6 SO

C-Reactive Protein, Cardiac 1.93 mg/L 0.00-3.00 SO
Relative Risk for Future Cardiovascular Event
Low <1.00
Average 1.00 - 3.00
High >3.00

WBC 5.7 x10E3/uL 3.4-10.8 SO
RBC 5.70 x10E6/uL 4.14-5.80 SO
Hemoglobin 14.7 g/dL 12.6-17.7 SO

Vitamin D, 25-Hydroxy 94.7 ng/mL 30.0-100.0 SO