Man Down

Pharma / TRT Testosterone Replacement
1

Hopefully this post will have some useful information to others such as were the posts I’ve been reading for the past four months. Short story, felt like I was 65 years old for the past three years. Finally doctor suggested it might be low T so he tested. November 2009, tests (results below) showed low T so went on 50mg of compounded T, twice daily. Was on it for six months with 50mg DHEA/day. Felt a little better at times but last few months went back to feeling like crap as usual. Got retested in June (results below). Looking for some of advice/wisdom on what may look wrong or what may be recommended. I appreciate your time.

Height 6’2"
Weight 225
Waist 36
Age 34

Symptoms:
Fatigue/Lethargic
Unable to focus/Clouded head
Loss of drive/ambition/motivation
Loss of libido/sex drive
visceral fat
Less socialablea
No problems falling asleep but wake up tired
Sleep Apnea tests (three total) are negative
Excessive sweating at gym

Additional Info:
gyno: none
Gaining fat: yes (stomach/sides)
Physique - pretty good except for stomach/waist fat. V-shaped build. Ex-water polo player. Still swim for fitness.
Dont feel depressed. Just weak and run down with no drive.
Changes in how you react to stress [adrenals]: always laid back
History of stimulant use [adrenals]: just coffee to help fatigue
History of steroid use: no
Deca?: no
Hairloss drugs?: no

November 2009, 9AM

UREA Nitrogen (BUN) 24 7-25 mg/dL
Sodium 137 135-146 nmol/L
Protien Total 7.8 6.2-8.3 g/dL
Potassium 4.1 3.5-5.3 nmol/L
Glucose 87 65-99 mg/dL
Globulin 2.7 calc g/dL
Creatinine .89 .79-1.33 mg/dL
Chloride 101 98-110 nmol/L
Carbon Dioxide 23 21-33 nmol/L
Calcium 9.5 8.6-10.2 mg/dL
Bilirubin Total .7 .2-1.2 mg/dL
AST 31 10-40 U/L
ALT 23 9-60 U/L
Alkaline Phosphate 55 40-115 U/L
Albumin Globulin Ration 1.9 1.0-2.1
Albumin 5.0 3.6-5.1 g/dL

Triglycerides 130 <150 mg/dL
LDL 153 <130 mg/dL
HDL 43 >=40 mg/dL
Total Cholestrerol 223 125-200 mg/dL
Chol/HDLC Ratio 5.0 <=5.0 calc

Testosterone Total 157 132-813 ng/dL
Testosterone Free 31.8 47-244 L
FT4 0.76 0.6-1.2 ng/dL
TSH 2.139 0.4-4.0 uIU/mL
.SHBG 29.4 13-71 nmol/L

WBC 6.8 3.8-10.8 thous/uL
RBC 4.84 4.2-5.8 million/uL
hgb 16.0 13.2-17.1 gm/dL
Hct 45.9 38.5-50 %
Plt 202 140-400 thous/uL
MCV 94.3 80-100 fL
MCH 32.0 27-33 pg
MCHC 35.0 32-36 gm/dL
RDW 12.4 11-15 %
ABS Neut 4768 1500-7800 cells/uL
ABS Lypmh 1249 850-3900 cells/uL
ABS Mono 573 200-950 cells/uL
ABS Eos 283 15-500 cells/uL
ABS Baso 28 0-200 cells/uL

June 2010, 1PM

BUN 13 8-12 mg/dL
Sodium 138 133-143 mMol/L
Protien Total 7.4 6.3-8.2 gm/dL
Potassium 3.8 3.4-5.0 mMol/L
Glucose Level 91 65-99 mg/dL
Globulin 2.7 g/dL
Creatinine 0.85 .6-1.3 mg/dL
Chloride 107 98-108 mMol/L
C02 26 21-32 mMol/L
Calcium 9.7 8.5-10 mg/dL
Bili Total 1 0.0-1.2 mg/dL
AST 27 15-40 U/L
ALT 26 10-60 U/L
Albumin 4.8 3.5-4.8 gm/dL
GFR Estimate >60 >=60 mL/min/1.73m2
Alkphos 53 30-100 U/L

Dihydrotestosterone LC-MS/MS 315 106.0-719.0 pg/mL
FT3 3.1 2.6-3.9 pg/mL
FT4 0.84 0.60-1.20 ng/mL
TSH 2.205 .400-4.000 uIU/mL
Estradiol 20 <=47 pg/mL
FSH 3.3 1.3-19.3 mIU/mL
LH 1.9 1.2-8.6 mIU/mL
Prolactin 5.3 3.0-14.7 ng/mL
DHEA Serum 2.18 1.330-7.780 ng/mL
.IGF-1 112 115-307 ng/mL
.SHBG 22.8 13-721 nmol/L
Testosterone Total 188 132-813 ng/mL
Testosterone Free 43.7 47.0-244.0
.TPO Ab 28.2 <35
Triiodothyronine Reverse 261 90-350 pg/mL

WBC 6.0 3.8-10.6 thous/uL
RBC 4.70 4.40-5.90 million/uL
hgb 16.5 13.0-18.0 gm/dL
Hct 45.5 40.0-52.0 %
Plt 220 150-450 thous/uL
MCV 95.9 80.0-100.0 fL
MCH 33.6 26.0-34.0 pg
MCHC 35.6 32.0-36.0 gm/dL
RDW 12.0 11.5-14.0 %
MPV 7.9 6.0-9.5 fL
Neut% 52.4 42.0-75.0 %
Lypmph % 30.7 20.0-55.0 %
Mono % 8.2 0.0-10.0 %
Eos % 8.3 0.0-5.0 %
Baso % .4 0.0-2.0 %

2

I went through the same thing with Androgel 1.5 years ago. Felt great the first couple of weeks, but after 3 months had lower T levels than when I started. I think it causes your natural production to shut down, and unless you are one of the lucky few who are good absorbers, it won’t get you in the range you need. I suspect compounded creams are similar in that aspect. Switched to injections a year ago and have never regretted it. Also, you should be tested for Estrodial - if that is high could be compounding your problems. Been there, done that.

3

Interesting. Thank you for the response. Though I’ll say I would like to avoid injections. Seems like such a nuisance, but then again the T-cream twice a day is getting to be a PITA also.

4

[quote]nbdyfcnsqnc wrote:
I would like to avoid injections. Seems like such a nuisance, but then again the T-cream twice a day is getting to be a PITA also. [/quote]

WHen I started TRT it was w/ Testim, 2 tubes a day… it took 5 minutes to rub it in, 5-10 minutes to dry (kind of dry) before I had to put shirt on (shirt still stuck to chest), and I stunk all day. Now that I’m doing injections (as of now almost at 10th week) it takes me less than 10 minutes every OTHER day, and I’m DONE no smell no rash and I’m at 1200 TT and was at 30 E2 last check (working dosage of adex to bring me closer to 22 E2)

Not to mention I feel way better … way better. Sex way better, gym performance is insane…I actually kinda look forward to it now…

5

Wow, injections EOD. I thought once/week was the norm. This is good info. Thank you.

6

If you do go the injection route, you should convince your doctor to let you self-inject. Then you can set the schedule yourself. At first, my doctor had me on every 2 weeks in his office, and the last week of the cycle was hell. When I switched to self-injection I started on every week, and settled on every 5 days. I honestly cannot say a feel any difference between day 1 and day 5 on this schedule. Like jhoward said, 10 minutes max and you’re done. It does get easier after time - almost routine.

7

Also, why were you on DHEA? Did your doctor prescribe this? To the best of my knowledge, there are no clinical studies that proves that this helps in any way other than converting to E, which is what you don’t need. If you want to increase your T, you must take more (or a better delivery method). Keep E in check with an AI if required once youe T levels are where they need to be.

8

June 2010, 1PM

BUN 13 8-12 mg/dL
Sodium 138 133-143 mMol/L
Protien Total 7.4 6.3-8.2 gm/dL
Potassium 3.8 3.4-5.0 mMol/L - Low potassium --how much working out are you doing?
Glucose Level 91 65-99 mg/dL
Globulin 2.7 g/dL
Creatinine 0.85 .6-1.3 mg/dL
Chloride 107 98-108 mMol/L
C02 26 21-32 mMol/L
Calcium 9.7 8.5-10 mg/dL
Bili Total 1 0.0-1.2 mg/dL
AST 27 15-40 U/L
ALT 26 10-60 U/L
Albumin 4.8 3.5-4.8 gm/dL
GFR Estimate >60 >=60 mL/min/1.73m2
Alkphos 53 30-100 U/L

Dihydrotestosterone LC-MS/MS 315 106.0-719.0 pg/mL - When was gel taken in reference to blood draw or is this with out anything?
FT3 3.1 2.6-3.9 pg/mL
FT4 0.84 0.60-1.20 ng/mL
TSH 2.205 .400-4.000 uIU/mL
Estradiol 20 <=47 pg/mL - Wrong test - need sensnitive could be giving you a false e2 level.
FSH 3.3 1.3-19.3 mIU/mL
LH 1.9 1.2-8.6 mIU/mL
Prolactin 5.3 3.0-14.7 ng/mL
DHEA Serum 2.18 1.330-7.780 ng/mL - low suspect adrenal issues…
.IGF-1 112 115-307 ng/mL - low suspect insulin imbalances or from low testosteorne or low dhea
.SHBG 22.8 13-71
Testosterone Total 188 132-813 ng/mL low
Testosterone Free 43.7 47.0-244.0
.TPO Ab 28.2 <35
Triiodothyronine Reverse 261 90-350 pg/mL

WBC 6.0 3.8-10.6 thous/uL
RBC 4.70 4.40-5.90 million/uL
hgb 16.5 13.0-18.0 gm/dL
Hct 45.5 40.0-52.0 %
Plt 220 150-450 thous/uL
MCV 95.9 80.0-100.0 fL
MCH 33.6 26.0-34.0 pg - low iron, b-6, b-12, folate
MCHC 35.6 32.0-36.0 gm/dL - low ron b-6, b-12, folate
RDW 12.0 11.5-14.0 %
MPV 7.9 6.0-9.5 fL
Neut% 52.4 42.0-75.0 %
Lypmph % 30.7 20.0-55.0 %
Mono % 8.2 0.0-10.0 %
Eos % 8.3 0.0-5.0 %
Baso % .4 0.0-2.0 %

Need more testing
ferritin
vitamin D 25 oh probably very low.
estrodial sensitive not ultrasensitve
24 hour cortisol salvia to rule out adrenal issues
Homocysteine
ha1c

NExt steps
Identify primary or secondary - 7 day clomid challege
suspect thyroid issue from antibodies run TGAB to see if that is normal
Examine sleep patterns
Examine lifestyle, nutrition, any hidden infections, heavy metals, mental or emotional , phyiscal trama
Potential zinc , magnesium deficeincy

9

More tests…and I thought I covered them all. I’ll research these and see about getting tested this week. Questions, whats ha1c? Thanks for response.

10

Pcdude, yes he recommended Dhea each day. I’ll research it more also.

11

Read the stickies, that will help a lot.

You must inject, transdermals are not working for you. With T levels corrected, many parts of your metabolism will change.

What caused your low T to begin with? Drugs, Rx or OTC, alcohol, xeno estrogens, blow to the head, other illnesses, damage to testes, testes ached during a fever…

Take 4000 - 6000iu of vit-D then later test vit-D25 to determine dose changes. Testing before you start taking vit-D is a waist. Find 2000 or 5000iu oil based caps.

Start the DHEA ASAP. DO NOT tests for DHEA as the levels are highly changing. Test DHEA-S, the sulphate.

Do you use iodized salt?
Do you get cold easily?

Start taking fish oil caps and other EFA rich foods. Get a good B vitamin complex product that also has a good spectrum of trace minerals. Note that most vitamin products are junk.

For your weight, you may need a bit more T than the typical 100mg test eth or cyp per week.

What is your diet?

Any loss of peripheral vision? Headaches?

Low GH suggests a pituitary problem, might be good to get that imaged.

What problems with skin, nails and hair?

12

are you using an endo or a GP? Your Test looks low low and the thyroid numbers are questionable. Some GP’s like to muck around with this stuff and they are really out of their depth. GP’s tend to say that if you are within the range, your golden. There is more evidence that this is not the case.

13

Thanks ksman.

What caused your low T to begin with? Not sure about this. Started feeling tired all the time back around mid-2006. I did get really sick that year. I think I got mono. Lasted about a month. I do have pretty bad allergies which result in my chronic sinusitus. Though I’ve never went on meds for the allergies. None of them have ever worked for me. So, i just use a sinus rinse twice/day. Never used drugs and hardly ever drink. Maybe drink twice/mo (3-4 drinks a time). But I actually drink less and less these days. It has been making me feel sick whereas it use to make me feel just relaxed/fun. Perhaps I’m just getting old. heh

I’ll grab some vid-D, b-complex and give them a try. I do currently take two fish oils caps/day along with my Kirkland multi-vitamin pack. I’ve also been taking 25mg DHEA twice daily for six months (50mg total). I’ll see about getting the DHEA sulfate test and not the serum test.

Do you use iodized salt? Do not add any salt to my meals. Perhaps I should begin using some iodized salt?
Do you get cold easily? Only the days I dont work out.
What is your diet? I eat a pretty clean die. Fast food once or twice a month at most. Nothing out of a box except raisin bran. Eat mostly chicken, frozen veggies, potatoes, whole grain bread, peanut butter, oatmeal, cheese and smoothies made out of plain yogurt and frozen fruit.

Any loss of peripheral vision? Headaches? Visions has worsened the past year but its more focusing then peripheral. No headaches. One a month maybe.

I’ll see if I can get a pituitary MRI done.

What problems with skin, nails and hair? Hair and skin have been noticeably more dry this past year or two. I needed to put on a lot more lotion and use hair conditioner than I use to. Nails have gotten better since I started multi-vitamin packs six months ago.

14

dogsoldier, correct its a GP. Not an endo. Thanks for the input.

15

You will feel better with T levels restored. Given your history of illnesses and allergies, adrenal fatigue could be a factor. TRT will fix the dry skin problem. Your thyroid levels seem good. So dry skin might not be from that. You need a source of iodine. If you do not care for salt, then find a supplement that also has that, or a dedicated supplement. Your thyroid tests are comfortably middle of range.

Were you taking 25mgX2 DHEA for that lab work or since? If before, you are not absorbing very well.

16

ksman, yes on taking the dhea since November. 25mgx2. I have schedule an appointment this week. Well see what the GP says about these results. Hopefully he will refer me to an endo or at least an order an MRI.

17

KSman, you mentioned in one of your posts:

Labs that are stupid after you start TRT
-LH/FSH

Could you explain what happens to LH/FSH after TRT? Up or down and why? Reason I asked is I started t-cream and didn’t test LF/FSH until five months on TRT because I saw this board and asked my GP to test them.

I really appreciate all your posts and help. They’ve helped a great deal.

18

If TRT works, your HPTA shuts down and LH goes near zero. The lab would show that you are on TRT that works, or that is does not work, which can be the case with transdermals. Testing LH/FSH before TRT can indicate whether one has problems with the pituitary release of LH [low] or the testes are not responding a functional level of LH.

19

Thanks as usual ksman.

Quick update. Another Dr. appointment and I’ve request Lyme and co infection tests. I also switched from compounded-T to Androgel (what a mess the stuff is!)

I’ll report back with how the angrogel works out for me along with Lyme results. Probably negative but have many of the symptoms…low free t, joint pains that move shoulder, knees, feet… headaches etc. Could just be getting old too. :slight_smile: