Need Advice 38 Y/O, Low T...

Pharma TRT
1

Looking for some adive. I’m an active duty military member who ahs been extremely overtired for the past year/year and a half. Practically no energy. I have an appointment with my primary care doc on Tuesday to talk about the different options for T replacement. After reading through the stickys I have gotten some great info to go into my doc with. I don’t see an issue with getting the doc to give me the TRT protocol that is recommended in the sticky. She pretty much does what the patient ask within reason of course.

The questions that I’m wondering base off the info below, should I go in an directly ask for the TRT protocol or can I just do the T itself and see results?

For the hCG can you get away with injecting less than EOD like every 3 or 4 days?

I do have quite a bit of fat in the chest area but not gyno. So would the Arimidex/anastrozole be require to prevent gyno.(will be asking to get E2 tested)

Also is this something that can change or reverse itself or will TRT be a life long process?

From what I see my insurance will cover all things in the TRT Protocol. Just wanna make sure I get the greatest benefit. I will continue to read all the stickys a few times over so I go in with the most knowledge I can. Thanks in advance for any advice and information anyone provides.

I’m 38 yrs old, 5’10, waist is about 39", weight fluxs 216-226, never have grown much body hair, facial hair is thin with some patches, gain most weight in mid section, inner thighs, and chest/lat area. Have gained weight even on a clean diet while lifting/cardio 5xwk.

In the past two year I have had a couple surgery’s to include gallbladder removal and discetamy to L4/L5 that had ruptured. Had a vasectomy in 2007 (4 kids we are done).

My recent symptoms are fatigue, weight gain, mood swings, have a hard time staying awake unless I’m actively busy, mood for sex has been low.

Currently taking Nexium for reflux, ibuprofen 800mg as need for back, Percocet 10/300 (may be cause of elevated liver enzymes)only take when back really bothers me, Compound pain crÃ???Ã???Ã??Ã?¨me, was on Ambien haven’t taken in about 6 wks, Soma/Flexural.

OTC supplements: WHey protein, Creatine, Magnesium, Fish Oil, Milk Thistle.
No hair loss or prostate drugs.

Recent Test Conducted

Testosterone Free Equilibrium Ultrafiltration + Testosterone Total

% Free Testosterone 2.55 % 1.50 - 4.20 Adult male reference interval is based on a population of lean males
Performed @ LabCorp Testosterone, Free/Tot Equilib Testosterone, Serum 263 Low ng/dL 348 - 1197 Testosterone,Free 6.71 ng/dL 5.00 - 21.00 up to 40 years old.

Vitamin B12 and Folate with Indices

Cobalamins, Serum or Plasma Quantitative 559 pg/mL 211-946 Final
Folate, Serum or Plasma Quantitative 10.6 ng/mL Final
DEFICIENT <2.1 ng/mL INTERMEDIATE 2.2 - 4.1 ng/mL INTERPRETATION(S): NORMAL RANGE 4.2 - 19.9 ng/mL
Hemolysis Index, Serum or Plasma Quantitative NO HEMOLYSIS Final
Icteric Index, Other Specimen Quantitative 1 ABS Index 0-15 Final
Lipemia Index, Other Specimen Quantitative 15 ABS Index 0-50 Final

Thyroxine, Serum or Plasma Quantitative 7.8 mcg/dL 4.5-12.0 Final

Thyrotropin, Serum or Plasma Quantitative Detection Limit <= 0.005 mIU/L 2.01 mcIU/mL (0.35-4.94) Final

Comprehensive Metabolic Panel with Glomerular Filtration Rate

Albumin, Serum or Plasma Quantitative 4.3 g/dL (3.5-5.2)
Bilirubin, Serum or Plasma Quantitative 0.4 mg/dL (0.0-1.0)
Calcium, Serum or Plasma Quantitative 9.7 mg/dL (8.4-11.0)
Carbon Dioxide, Serum or Plasma Quantitative 26 mmol/L (22-31)
Chloride, Serum or Plasma Quantitative 102 mmol/L (98-107)
Creatinine, Serum or Plasma Quantitative 1.0 mg/dL (0.67-1.2) Final 6th Medical Group

Glucose, Serum or Plasma Quantitative 100 Higher Than Normal mg/dL (70-99)
Interpretation: New ADA upper limit reference range effective 21 Oct 2011: 70-99 mg/dL

Alkaline Phosphatase, Serum or Plasma Quantitative 78 U/L (40-129)
Potassium, Serum or Plasma Quantitative 3.7 mmol/L (3.4-4.7)
Interpretation: NOTE: Effective immediately, the upper reference range for potassium has been adjusted to 4.7 mmol/L.
Protein, Serum or Plasma Quantitative 7.1 g/dL (6.4-8.3)
Sodium, Serum or Plasma Quantitative 135 Lower Than Normal mmol/L (136-145)
Alanine Aminotransferase, Serum or Plasma Quantitative 123 Higher Than Normal U/L (0-41)
Aspartate Aminotransferase, Serum or Plasma Quantitative 122 Higher Than Normal U/L (0-38)
Urea Nitrogen, Serum or Plasma Quantitative 15 mg/dL (6-20)
Glomerular Filtration Rate/1.73 Sq M.Predicted.Non Black, Serum or Plasma Quantitative Creatinine-based formula (MDRD) 98 See Below (SEE-BELOW)
Glomerular Filtration Rate/1.73 Sq M.Predicted.Black, Serum or Plasma Quantitative Creatinine-based formula (MDRD) 113 See Below (SEE-BELOW)

Interpretation: 15-29 mL/min/1.73m2 = Severely decreased GFR 30-59 mL/min/1.73m2 = Moderately decreased GFR <15 mL/min/1.73m2 = Kidney failure >= 60 mL/min/1.73m2 = Normal or mildly decreased GFR American patients, therefore two GFR results are reported: GFR-Non AA and Collaboration Equation. The calculation automatically takes patient sex into GFR-AA. As with all estimations, results may not be valid for certain New method effective 20 May 2013: Results will not be reported on patients under 18 years of age. Some pharmacological therapeutics are dosed based on older versions of the This is an estimated GFR (Glomerular Filtration Rate) only. The value has account, but CHCS cannot automatically adjust the formula for African been derived from the Chronic Kidney Disease - Epidemiology (CKD-Epi) eGFR. Where deemed necessary, refer to Pharmacy for assistance or more failure), dialysis patients, and patients with atypical body habitus. hypoalbuminemic patients, patients not in steady state (including acute renal information. sub-groups including: pediatric patients (0-17 years old), severely

Levels in 2011 For T.

Testosterone Free, Weak and Total Panel

Testosterone, Serum or Plasma Quantitative 601 ng/dL 250-1100
Testosterone.Free, Serum or Plasma Quantitative 66.2 pg/mL 46.0-224.0
Testosterone.Bioavailable, Serum or Plasma Quantitative 127.4 ng/dL 110.0-575.0
Sex Hormone Binding Globulin, Serum or Plasma Quantitative 44 nmol/L 10-50
Albumin, Serum or Plasma Quantitative 4.2 g/dL 3.6-5.1

Current diet consist of lots of chicken, some seafood/red meat, minimum pork. Cook everything in Coconut oil, olive oil, Organic butter. eat a good amount of veggies and fruits, and some fast food but try to stick to the grilled chicken on the menu.

Previously diet was mixed of fast food, with the above just not as often as now. Drink lots of water and rarely drink soda.

Currently I’m on the stronglifts program with compound movements 3days aweek and cardio 3 days aweek. Usually steady pace cardio or interval training.

Prior to my back surgery not much do to the pain but ran 2-5 miles per day when possible with some weight training.

I do have the occasional testes ache. Sometimes feel like somebody kicked me in the balls.

-how have morning wood and nocturnal erections changed

Not as frequent over the past year.

2

What does Nexium have to do with your back? Naproxen? I was taking 1200mg/day for osteoarthritis in my fingers. Was not working. Doc put me on Rx 15mg/day meloxicam and that works very well. 15mg is a very low level of drugs vs 1200 mg. My “kidney markers” were elevated from the naproxen and normalized with the change. Meloxicam is very cheap, $40 per year without insurance. I think that it works as well as Celebrex which is expensive.

With your weight, your heartburn [Nexium] my be a hiatal hernia. Best thing to resolve that is major weight loss.

Most of your symptoms are also consistent with hypothyroidism, including weigh gain and inability to loose weight. Many here have low-T and thyroid issues, oddly enough. So combining both problems simply make the problems worse. We sometimes see that thyroid problems have caused low T and fixing the thyroid problem can lead to useful T level recoveries; however this is not a common event.

Now you know that T is low, time to find out more about why:

T, FT
E2
DHEA-S
LH, FSH
TSH, fT3, fT4
IGF-1
AM cortisol [8 AM or one hour after you wake up] and perhaps rT3 - read on

Self screen for functional hypothyroidism by checking body temperature as per the thyroid basics sticky. If you are not using iodized salt, you are deficient. Same goes for the whole family. If low body temps, add rT3 to the above labs. rT3 blocks fT3. Stress, accidents, infections, surgeries can lead to adrenal fatigue [tired all of the time, stress has too high of a negative effect]. That leads to increased rT3. So perfect thyroid labs and elevated rT3 can leave you with lower body temperatures.

Are you getting a lot of sun exposure? If not, 5,000iu per day Vit-D3, in tiny inexpensive oil caps.

Low LH can make your balls ache. TRT will take LH–>zero, making that worse. hCG will fix that.
hCG must be refrigerated, so you can’t take that into combat or extended field exercises.

You have T tunnel vision. Yes, you probably do need TRT. But you and your doc need to consider that your T levels are symptom and not a disease. You need to find out what is wrong with your metabolism that is causing your low T and your fatigue. Do take action if you cannot sleep. Trazodone and time release 5-6mg melatonin works well for me.

And as per the advice for new guys sticky, you could have secondary hypogonadism from a blow to the head that has damaged your pituitary and if that happens, other pituitary functions can be damaged. Your problems started 18-24 months ago. Did you have blow to the head or other trauma before this started. If so, things can be imaged with a MRI. I suspect that such things apply to a lot of guys in the armed forces.

3

KSman

Thanks for the response. Luckily my position in the AF keeps me out of the field and in positions that I could carry any meds I have to. I know I need to drop weight and have been working on that with diet and the gym but as hard as I’m working nothing is coming off.

The Nexium is for reflux. Get plenty of iodine, big Himalayan Salt user.

Will push to have the extra testing done. Pretty sure I’m vD deficient so will start that.

Have no issue getting to sleep…just never feels like I have gotten enough.

Not trying to get the tunnel vision. Just tired of feeling like crap 24/7. As far as head injuries, haven’t had one of those since 1995. Could it be some way connected?

No other traumas since symptoms started.

Will start doing temp measurements per the sticky.

Should I start the TRT treatment if prescribed or should I push for the testing you recommended before starting?

Would anything change with a vasectomy, I had mine in 2007.

4

Himalayan Salt contains a lot of contaminates that they call trace elements. The amount of iodine in Himalayan Salt is detectable but very very low and a sure path to get iodine deficiency! My wife switch to similar and … search here for ‘ksman has a thyroid problem’ and read. Others here have been messed up by Himalayan Salt and “felt like crap”.

No TRT until you have:
T, FT
E2
DHEA-S
LH, FSH

Concern is traumas before things went bad, not since.

Please consider all points in my prior post.

5

Thanks. Will have doc preform those test prior to starting TRT. Started the Vit D today. Will order some Iodine supplement and follow the protocol in the Thyroid sticky. The only head trauma was back in 1995 when I was 20 and nothing since. Would any type of surgery (i.e. gallbladder or discectomy) have similar effects. I know it can put strain on the adrenal glands.

Will post back when I see the doc on Tuesday, I’m hoping with the information I bring her she will listen.

6

Doc is sending me to see a Urologist that treats for Low T. She said she didn’t understand TRT enough to treat me but said that KSman’s protocol seemed sufficient. Waiting on referral…