My Case: 43yr old Active Duty Military

Pharma TRT
1

-age: 43
-height: 5’11
-waist: 37 sucked in, 43 relaxed
-weight: 210 and rising
-describe body and facial hair: Thick, no issues
-describe where you carry fat and how changed: Large majority of all my fat is in my abdominal region. Thin arms and calves.

-health conditions, symptoms [history]
Surgeries from most recent: Back fusion L5/S1 2014, Rectal Fissure 2014, Appendectomy 2006, Kidney Stone removal 2005, Vasectomy 1999
Diagnosed with Sleep Apnea (use CPAP machine), high cholesterol, PTSD, Depression, Anxiety, Migraines

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
– real dangers! see this http://propeciahelp.com/overvi…
Never took hair loss or prostate drugs
Rx:
Simvastatin for cholesterol
Nexium for acid reflux
Wellbutrin & Lexapro for PTSD/Depression/Anxiety
Propranolol for Migraine prevention (beta blocker high blood pressure medicine but I don’t have high blood pressure. It does work pretty well at preventing most of my migraines and my blood pressure is in the lower normal range.

OTC: Vit D w/ Calcium supplements: 600 IUs taken 3 times a day for 1800 IUs daily

-lab results with ranges (have had a lot of labs in 6 weeks)

Prostate Specific Antigen Chemistry/Hematology 07 Jul 2015 @ 1301
Prostate Specific Ag, Serum or Plasma Quantitative 0.96 ng/mL (<0.05-2.5)

Ferritin/Iron/TIBC Chemistry/Hematology 07 Jul 2015 @ 1301
Iron Binding Capacity.Unsaturated, Serum or Plasma Quantitative 178 mcg/dL
Iron, Serum or Plasma Quantitative 107 mcg/dL (46-178)
Iron Binding Capacity, Serum or Plasma Quantitative 285 mcg/dL (260-430)
Iron Saturation, Serum or Plasma Quantitative 38 % (20-50)
Ferritin, Serum or Plasma Quantitative 365.0 ng/mL (30-400)
Hemolysis Index, Serum or Plasma Quantitative NORMAL
Lipemia Index, Other Specimen Quantitative TRACE
Icteric Index, Other Specimen Quantitative NORMAL

Transferrin Chemistry/Hematology 07 Jul 2015 @ 1301
Transferrin, Serum or Plasma Quantitative 240 mg/dL (200-400)

CBC Profile Chemistry/Hematology 07 Jul 2015 @ 1301
Hemoglobin, Blood Quantitative 14.7 g/dL (14.0-18.0)
Hematocrit, Blood Quantitative Automated Count 46.4 % (41-52)
Leukocytes, Blood Quantitative Automated Count 9.6 x10(3) (3.4-9.8)
Erythrocytes, Blood Quantitative Automated Count 5.28 x10(6) (4.5-5.9)
Mean Corpuscular Volume, RBC Quantitative Automated Count 87.7 fL (83-98)
Erythrocyte Mean Corpuscular Hemoglobin, RBC Quantitative Automated Count 27.9 Lower Than Normal pg (28-33)
Erythrocyte Mean Corpuscular Hemoglobin Concentration, RBC Quantitative Automated Count 31.8 g/dL (31-36)
Erythrocyte Distribution Width CV, RBC Quantitative Automated Count 13.6 % (10.0-14.0)
Platelets, Blood Quantitative Automated Count 311 x10(3) (142-362)
Platelet Mean Volume, Blood Quantitative Automated 7.8 fL (6.7-11.1)
Neutrophils/100 Leukocytes, Blood Quantitative Automated Count 63.0 % (41-73)
Lymphocytes/100 Leukocytes, Blood Quantitative Automated Count 25.9 % (18-46)
Monocytes/100 Leukocytes, Blood Quantitative Automated Count 7.7 % (0-10.0)
Eosinophils/100 Leukocytes, Blood Quantitative Automated Count 2.9 % (0-6.0)
Basophils/100 Leukocytes, Blood Quantitative Automated Count 0.5 % (0-2.0)
Neutrophils, Blood Quantitative Automated Count 6.1 x10(3) (1.4-6.5)
Lymphocytes, Blood Quantitative Automated Count 2.5 x10(3) (1.2-3.4)
Monocytes, Blood Quantitative Automated Count 0.70 x10(3) (0.0-0.8)
Eosinophils, Blood Quantitative Automated Count 0.30 x10(3) (0.11-0.59)
Basophils, Blood Quantitative Automated Count 0.00 x10(3) (0.0-0.2)

Testosterone with Indices Chemistry/Hematology 26 Jun 2015 @ 1251
Testosterone, Serum or Plasma Quantitative 91.06 Lower Than Normal ng/dL (280-800)
Hemolysis Index, Serum or Plasma Quantitative NORMAL
Lipemia Index, Other Specimen Quantitative NORMAL
Icteric Index, Other Specimen Quantitative NORMAL

Thyroid Panel Chemistry/Hematology 26 Jun 2015 @ 1251
Thyrotropin, Serum or Plasma Quantitative Detection limit <= 0.05 mIU/L 1.61 mcIU/mL (0.27-5.00)
Thyroxine.Free, Serum or Plasma Quantitative 0.90 ng/dL (0.6-1.8)

Follicle Stimulating Hormone/Luteinizing Hormone Chemistry/Hematology 26 Jun 2015 @ 1251
Follitropin, Serum or Plasma Quantitative 1.8 mIU/mL
Lutropin, Serum or Plasma Quantitative 3.6 mIU/mL

Testosterone with Indices Chemistry/Hematology 16 Jun 2015 @ 1325
Testosterone, Serum or Plasma Quantitative 192.4 Lower Than Normal ng/dL (280-800)
Hemolysis Index, Serum or Plasma Quantitative NORMAL
Lipemia Index, Other Specimen Quantitative NORMAL
Icteric Index, Other Specimen Quantitative NORMAL

Vitamin D 25-Hydroxy Chemistry/Hematology 16 Jun 2015 @ 1325
25-Hydroxyvitamin D2+25-Hydroxyvitamin D3, Serum or Plasma Quantitative 21 Lower Than Normal ng/mL (30-100)

Follicle Stimulating Hormone/Luteinizing Hormone Chemistry/Hematology 16 Jun 2015 @ 1325
Follitropin, Serum or Plasma Quantitative 1.7 mIU/mL
Lutropin, Serum or Plasma Quantitative 2.8 mIU/mL

Prolactin Chemistry/Hematology 16 Jun 2015 @ 1325
Prolactin, Serum or Plasma Quantitative 14.45 ng/mL (4.1-18.4)

Complete Testosterone Evaluation Chemistry/Hematology 03 Jun 2015 @ 1251
Sex Hormone Binding Globulin, Serum or Plasma Quantitative 13.6 Lower Than Normal nmol/L
Testosterone.Free/Testosterone.Total, Serum or Plasma Quantitative PL Cancelled %
Testosterone.Free, Serum or Plasma Quantitative PL Cancelled pg/mL
Testosterone.Bioavailable, Serum or Plasma Quantitative 187 ng/dL
Testosterone.Bioavailable/Testosterone.Total, Serum or Plasma Quantitative 67.0 %
Testosterone, Serum or Plasma Quantitative 279 Lower Than Normal ng/dL

Vitamin B12 and Folate with Indices Chemistry/Hematology 03 Jun 2015 @ 1251
Cobalamins, Serum or Plasma Quantitative 263 pg/mL (211-946)
Folate, Serum or Plasma Quantitative 7.1 ng/mL
Hemolysis Index, Serum or Plasma Quantitative NO HEMOLYSIS
Icteric Index, Other Specimen Quantitative 0 ABS Index (0-15)
Lipemia Index, Other Specimen Quantitative 21 ABS Index (0-50)

Thyroid Panel Chemistry/Hematology 03 Jun 2015 @ 1251
Thyrotropin, Serum or Plasma Quantitative Detection limit <= 0.05 mIU/L 1.410 mcIU/mL (0.27-5.00)
Thyroxine.Free, Serum or Plasma Quantitative 0.9 ng/dL (0.6-1.8)

Comprehensive Metabolic Panel Chemistry/Hematology 03 Jun 2015 @ 1251
Alkaline Phosphatase, Serum or Plasma Quantitative 126 mcg/mL (58-137)
Albumin, Serum or Plasma Quantitative 4.3 g/dL (3.5-5.2)
Bilirubin, Serum or Plasma Quantitative 0.2 mg/dL (0.2-1.1)
Calcium, Serum or Plasma Quantitative 9.7 mg/dL (8.0-10.4)
Chloride, Serum or Plasma Quantitative 105.1 mmol/L (96-108)
Creatinine, Serum or Plasma Quantitative 1.33 Higher Than Normal mg/dL (0.67-1.17)
Glucose, Serum or Plasma Quantitative 106 mg/dL (74-109)
Potassium, Serum or Plasma Quantitative 4.7 mmol/L (3.3-5.1)
Protein, Serum or Plasma Quantitative 7.1 g/dL (6.4-8.3)
Sodium, Serum or Plasma Quantitative 144 mmol/L (133-145)
Aspartate Aminotransferase, Serum or Plasma Quantitative 18 U/L (4-40)
Carbon Dioxide, Serum or Plasma Quantitative 27 mmol/L (22-32)
Urea Nitrogen, Serum or Plasma Quantitative 9 mg/dL (8-23)
Alanine Aminotransferase, Serum or Plasma Quantitative 31 U/L (4-41)
Anion Gap, Serum or Plasma Quantitative 12 mEq/L (5-16)
Glomerular Filtration Rate^Race.Non-Black, Serum or Plasma Quantitative 65.0 mL/min
Glomerular Filtration Rate^Race.Black, Serum or Plasma Quantitative 75.2 mL/min

CBC Profile Chemistry/Hematology 03 Jun 2015 @ 1251
Hemoglobin, Blood Quantitative 15.3 g/dL (14.0-18.0)
Hematocrit, Blood Quantitative Automated Count 46.9 % (41-52)
Leukocytes, Blood Quantitative Automated Count 10.8 Higher Than Normal x10(3) (3.4-9.8)
Erythrocytes, Blood Quantitative Automated Count 5.40 x10(6) (4.5-5.9)
Mean Corpuscular Volume, RBC Quantitative Automated Count 86.9 fL (83-98)
Erythrocyte Mean Corpuscular Hemoglobin, RBC Quantitative Automated Count 28.3 pg (28-33)
Erythrocyte Mean Corpuscular Hemoglobin Concentration, RBC Quantitative Automated Count 32.5 g/dL (31-36)
Erythrocyte Distribution Width CV, RBC Quantitative Automated Count 12.8 % (10.0-14.0)
Platelets, Blood Quantitative Automated Count 301 x10(3) (142-362)
Platelet Mean Volume, Blood Quantitative Automated 8.0 fL (6.7-11.1)
Neutrophils/100 Leukocytes, Blood Quantitative Automated Count 66.8 % (41-73)
Lymphocytes/100 Leukocytes, Blood Quantitative Automated Count 23.4 % (18-46)
Monocytes/100 Leukocytes, Blood Quantitative Automated Count 6.7 % (0-10.0)
Eosinophils/100 Leukocytes, Blood Quantitative Automated Count 2.5 % (0-6.0)
Basophils/100 Leukocytes, Blood Quantitative Automated Count 0.6 % (0-2.0)
Neutrophils, Blood Quantitative Automated Count 7.2 Higher Than Normal x10(3) (1.4-6.5)
Lymphocytes, Blood Quantitative Automated Count 2.5 x10(3) (1.2-3.4)
Monocytes, Blood Quantitative Automated Count 0.70 x10(3) (0.0-0.8)
Eosinophils, Blood Quantitative Automated Count 0.30 x10(3) (0.11-0.59)
Basophils, Blood Quantitative Automated Count 0.10 x10

-describe diet [some create substantial damage with starvation diets]
Diet is pretty steady, yogurt/tea/fruit for breakfast, salad/fruit/nuts for lunch, and the varying dinner with starch/veggie on the side. Avg about 1500 calories a day
-describe training [some ruin there hormones by over training]
No energy to train
-testes ache, ever, with a fever? No
-how have morning wood and nocturnal erections changed - Nonexistent, but I can obtain and maintain an erection

I am 43 yrs old and been in the active duty military for almost 18 years. About four years ago I hurt my back while deployed. Just last year they finally decided to perform the fusion. Surgery went well. Healing up nicely.

Since the surgery, no energy level has been zero. My PTSD has gotten worse, my depression is horrible. It takes pure energy to get out of bed every morning. I have no desire to leave the house. I go to work every day and I burn every atom of motivation to get through the day. Working out is actually painful. I have put on about 30 lbs since November 2014, and if feels like it all went to my gut. Mental health doctor had my testosterone and thyroid checked. Thyroid labs came back normal. T-levels were 192 with a range of 280-1000. Referred back to my PCM. He retested, with a 194. He tested again, this time a 97. He ordered a CBC with Prostate Antigen, Ferritin/Iron, and Transferin tests. All four came back with everything called “In Range” or “Normal” except one Red Blood Cell test that came in barely short of “Lower than normal”. All the labs posted above.

I still have an interest in sex, I can get an erection and ejaculate, but it all feels pretty “bleh”. I remember sex feeling better.

Now I want to say to you all for the record that I am not suicidal or homicidal, but I also admit that my “zest for life” is non-existent. I work because I have a family that depends on me. If I didn’t have a family depending on me, I could care less if I didn’t wake up the next morning or lived in a box in an ally. This isn’t who I am.

My doc is getting ready to do a prostate exam and he has ordered a brain MRI with contrast. The earliest I can get that MRI is early August (scheduling). My doc seems to be taking a very over-cautious route and ruling out as much as possible before referring me for TRT.

What I want to know is what you all think. You will be the first people I ask about this outside of my doctor or my family.

2

Look for posts by Ksman in this pharma section.

3

Thyroid:
These are labs to have: TSH, fT3, fT4 [please not T3m T4]

What is normal? Certainly not the lab ranges:
TSH should be near 1.0
T3, T4, fT3, fT4 should be near mid range or a bit higher.
Lab ranges are wrong and doctors do not know better.

Your FT4 suggests iodine deficiency, low overall thyroid function …

Check your overall thyroid function:
Check oral body temperature when you first wake up. 97.7-97.8 is OK, a bit higher is nice, 97.3 is too low.
Also see of you hit 98.6 mid-afternoon
Have you been using iodized salt long term or are you iodine deficient? time_line?

Your background has a lot of stress event, surgeries etc.
You could have adrenal fatigue.
In the thyroid basics sticky, use control-H and search for"

  • stress
  • adrenal fatigue
  • Wilson’s book
  • rT3 - this blocks fT3 at T3 receptors
  • 98.6
  • iodine

Your T levels are not normal and you need TRT.

Labs: - you have some now
TT
FT
E2
prolactin
CBC
AM cortisol
vit-D25
TSH
fT3
fT4 [we need free hormones, not bound]

Please list ?other? meds
What drugs introduced within last year with dates

What is your history with prednisolone type drugs?

4

How long have you been using a STATIN drug to lower cholesterol? Fits the time line?
Do not take Total Cholesterol below 180
Statin drugs can induce CoQ10 deficiency, weakening muscles, causing left ventricle to not work well, blood pools in lungs, fluid leaks, long term low level coughing as this is technically a drug induced congestive heart failure. Taking CoQ10 prevents this, Ubiquinol is the best form, note spelling and its more costly but much more bio-available.

5

Thanks for your reply. To answer your questions:

Diet is usually high in iodized salt. I have been told I use too much salt on my food, and it’s always been the iodized kind. Never told I was iodine deficient before.

Never used prednisolone based on what I looked up. If I did, it was for a very very short time. Most of my anti-inflammation drugs have been of the Motrin kind.

I have been using Statin for almost 10 years. Sadly, it doesn’t fit the timeline. My severe weight gain (all in the abdominal region) began after my back fusion in Nov 2014…as has my fatigue, lack of motivation, etc.

No other meds than what I listed. Honest! :slight_smile:

6

My wife switched our salt to non-iodized once, messed me up.
Many of the containers of non-iodized salt are labeled similar to iodized and located on the same shelf. Does not hurt to double check what is in your kitchen.

You could still have some CoQ10 issues from the statin drug. See if you do better on Ubiquinol or do CoQ10 lab work.

7

Three days, avg was 97.6 waking up, and 98.9 middays.

[quote]KSman wrote:

Check your overall thyroid function:
Check oral body temperature when you first wake up. 97.7-97.8 is OK, a bit higher is nice, 97.3 is too low.
Also see of you hit 98.6 mid-afternoon
Have you been using iodized salt long term or are you iodine deficient? time_line?

[/quote]

8

good that doc order MRI for you, how many teslas will have your MRI machinety ? 3T is optimal, but ask doc also for pituitary gland MRI, beacuse pituitary gland might be the reason.

9

[quote]Pappabear_USAF wrote:
Three days, avg was 97.6 waking up, and 98.9 middays.

[/quote]

Not so bad, but could be better in the AM.
98.9 seems odd. Can someone else get 98.6? If reading .3 high, then waking up might be 97.6 - .3 - 97.3

10

Update: Started Fortesta, 4 pumps a day. Today is day 2.

Don’t know if it is mental or honeymoon, but I do feel more alert. Not necessarily more energetic, but I feel the fog lifted. I hope that lasts…mental or not.

Now, should I be concerned with estrogen? My last panel above showed SHBG was a little lower than range. I don’t see anything referring to E2 above.