New Request for Help

Pharma / TRT Testosterone Replacement
1

Hi KsMan,

Been following this forum for years, finally decided to participate and seek your advice. my Pregnenolone is very low, and suspect a lot of issue.

I had labs run couple years ago after suspecting I had high E2, and probably either low T or high aromatase. I spent 9 months with a trainer and couldn’t build much muscle, and couldn’t cut fat. fast forward to a few years later, I started having really bad memory and focus issues, and really suspected I had low hormones.

Found a DOc who is part of ACAM and is very open to working with me(I have a pharmacology background). We drew labs, I had low T, and low Cortisol about a year ago. Started on T-cyp 1/wk, can’t recall dose, I shot it SQ.

He also put me on a different AI, I had never heard of. Letrozole, which is used for lowering E2 with breast cancer, benefit seems to be taken once everywhere two weeks, half life is very long and it’s real cheap. I also tried you suggestion for HCG, but with my travel schedule I couldnt keep the stuff cool, so stopped it.

I noticed my mid section lost fat, and overall after a while felt really good. Ended up getting labs and adjusted dosage as I was up at 1200(Quest). But overall felt much better.

I got sick of loading 29g needles and found a compounding pharmacist who said lets try a topical he compounds. He included T, DHEA, and Terrebelus.
I tried it and found I guess I was aromatizing T, and saw my mid section grow, don’t think I was absorbing well. So stopped on that after about 8 months, been clean since july. Now looking to address this again. Just pulled latest labs two weeks ago below and other pertinent info below that.

ALBUMIN i 4.3 3.6-5.1 g/dL
GLOBULIN 2.7 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO . 1.6 1.0-2.5 (calc)
BILIRUBIN, TOTAL . 0.6 0.2-1.2 mg/dL
BILIRUBIN, DIRECT 0.1 < OR = 0.2 mg/dL
BILIRUBIN, INDIRECT 0.5 0.2-1.2 mg/dL (calc)
ALKALINE PHÃ??SPHATASE 70 40-115 U/L
AST 25 10-40 U/L
ALT 25 9-46 U/L
GGT 41 3-95 U/L
TSH 1.73 0.40-4.50 mIU/L
T4, FREE 1.0 0.8-1.8 ng/dL
T3, FREE 2.9 2.3-4.2 pg/mL
T3 REVERSE, LC/MS/MS 22 8-25 ng/dL
TESTOSTERONE, FREE 34.7 46.0-224.0 pg/mL (MD denotes low, obviously)
PREGNENOLONE, LC/MS/MS <5 L 13-208 ng/dL
CBC (INCLUDES DIFF/PLT)
WHITE BLOOD CELL COUNT 6.6 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.22 4.20-5.80 Million/uL
HEMOGLOBIN 15.0 / 13.2-17.1 g/dL
HEMATOCRIT 45.5 - 38.5-50.0
McV 87.2 80.0-100.0
MCH 28.7 27.0-33.0 pg
MCHC �· 33.0 32.0-36.0 g/dL
RDW 13.5 11.0-15.0
PLATELET COUNT 315 140-400 Thousand/uL
MPV 8.7 7.5-11.5
ABSOLUTE NEUTROPHILS 4488 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 1558 850-3900 cells/uL
ABSOLUTE MONOCYTES 376 200-950 cells/uL
ABSOLUTE EOSINOPHILS 152 15-500 cells/uL
ABSOLUTE BASOPÃ??ILS 26 0-200 cells/uL
NEUTROPHILS 68.0 %
LYMPHOCYTES 23.6 %
MONOCYTES 5.7 %
EOSINOPHILS 2.3 %
BASOPHILS 0.4 %
DHEA Sulfate 350 0-495 mcg/dL
FSH 3.5 1.6-8.0 mIU/mL
LH 2.1 1.5-9.3 mIU/mL
PROLACTÃ??N 5.3 2.0-18.0 ng/mL
TESTOSTERONE, TOTAL, MALES (ADULT), IA 211 L 250-827 ng/dL (LOW)
ESTRADIOL 37 < or = 39 pq/mL
Vit D,25-OH 42 300-100ng/ml

Cortisol 8AM 0.58 mcg/dL 8-10am 0.04-0.56
Cortisol 12PM 0.09 mcg/dL 8-10am 0.04-0.56
Cortisol 4pM <0.03 mcg/dL 4-6pm < or =0.15
Cortisol 12AM 0.06 mcg/dL 10-11pm < or = 0.09

-age 47
-height 6’1
-waist 40
-weight 224
-describe body and facial hair
Estrogen dominance effects weight around hips, butt, handles, gynecomastia(Since about 14), no facial hair, shave twice a week.

Since starting T therapy, noticed waist go from 38 to 40, which really no change in diet, assume E2 is culprit

-describe where you carry fat and how changed
see above (mid section and chest)
-health conditions, symptoms [history]
Low thyroid, been on desiccated thyroid for years

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever

3grain thyroid compounded, no hair loss or prostate drugs ever

-describe diet [some create substantial damage with starvation diets]

I traditionally dont at in AM, no red meat, lots of vegs, avoid wheat at times, limit dairy.

-describe training [some ruin there hormones by over training]

No energy to work out, do an eliptical occasionally with a HIT program

-testes ache, ever, with a fever?

No

-how have morning wood and nocturnal erections changed

no morning wood, usually no problem with erections, loss of interest from when younger, but may be stress related with my wife :slight_smile:

Considering going back on T-Cyp and the letrozole and poss Hcg per your recommendation.

I like the idea of pre loading 29g syringes, but back loading seems to present opportunity for contamination, found in past I would skip due to lack of time to load. Any new ways to load small guage needle?

Anything you see in the labs besides T and Preg, concern?

I am thinking of maybe starting on preg only and seeing if it increases my T. Any thoughts?

Thanks a bunch…

2

Biological half-life is two days.

TSH 1.73 0.40-4.50 mIU/L
T4, FREE 1.0 0.8-1.8 ng/dL
T3, FREE 2.9 2.3-4.2 pg/mL
T3 REVERSE, LC/MS/MS 22 8-25 ng/dL

-TSH too high, should be closer to 1.0
-T4 should be near 1.3, 1.0 is too low
-fT3 should be near 3.25, 2.9 is low
-rT3 is elevated

I suspect that you have hypothyroid symptoms. A combination of lack of medication and rT3 blocking some of your already low fT3.

Things are complicated as taking more T4 may increase T4–>rT3. In that case, you need to take a lot more T3 than T4, some stop T4.

Your transdermal T failed because that is typical for and a symptom of low thyroid function.

Please read these stickies:

Your diet suggests protein deficiency.

Elevated rT3 can be from adrenal fatigue. DHEA is good, but cortisol profile suggests something wrong.

Your thyroid hormones, suspected low body temperatures, elevated rT3 and suspected Adrenal fatigue all fit into your lack of energy and inability to loose fat. So that is your focus.

You can directly load #29 1/2" 0.5ml [NOT 1.0ml] syringes. No need to back fill. Just takes time. I hang the syringe and vial by the vial and go do other things [hCG] and filled when I return.

You need high normal T and FT to loose weight.
You need lower E2 to loose weight.
Anastrozole is critical for you.
Letro is very harsh and dose-response is quite unpredictable compared to anastrozole.

Tell me about PSA, A1C, fasting glucose and cholesterol. I am concerned about insulin resistance / diabetes
Also check IGF-1, progesterone, CRP and homocysteine. Concerned about inflammation.

Watch hematocrit on TRT!

Are you taking a statin drug?
Statins can induce CoQ10 deficiencies. See the Hormones and Health thread. Mitochondria make CoQ10, a lot is made in the testes.

So there are a lot of things here for you to do. Its up to you. Read this post a few times so you don’t miss anything. You should be able to post the waking and mid-afternoon body temperatures quite soon, DO NOT OVERLOOK THAT.

Make your own list of action items.

WHAT ARE YOUR supplements, Rx meds, OTC meds?
Taking DHEA?
Blood pressure and PR?
Muscle cramps?
Using iodized salt?

3

Thank you for your response.

Here are answers to your additional questions

Tell me about PSA, A1C, fasting glucose and cholesterol. I am concerned about insulin resistance / diabetes
Also check IGF-1, progesterone, CRP and homocysteine. Concerned about inflammation.

PSA - 0.4 was normal last time I measure, my MD is not a fan of PSA test.
A1C - 4.9 <5.7% Quest notes Consisten with the absense of diabetes (This was back in March '15)
Fasting Glucose - 90 (65-99mg/dL) Current
Cholesterol - 207 (125-200mg/dL) (These were back in March '15)
HDL - 50 >= 40mg/dl “”
TRIG - 99 < 150mg/dl “”
LDL - 137 <130 mg/dL “”
CHOL/HDLC Ratio 4.1

CRP - 0.30 < 0.8 (Back in 10’13) had similar issues at time, maybe worse

No statins, never would, learned in School how it depletes CoQ10, been educating people on that for years. Statins are bad IMHO.

WHAT ARE YOUR supplements, Rx meds, OTC meds?

avoid meds, only thing I am on is compounded dessicated thyroid 210mg
(am considering based on your advice above to move to cytomel(t3))

Supps
Multi vitamin ()
Ubiqinol 100mg
Quercetin 3/d cant recall size of top of head
Curcumin BCM-95 i think it’s 200mg
DHA tuna oil from (Standard Process)
PQQ
Vit C - non corn derived as well as food based
Just started on L-Glutamine for intestinal support
Magnesium 400mg/d
Zinc Orotate 15mg
And I take a probiotic mixture based on coconut water

Sometimes I add ALA - 600mg, but it can only take with heavy meal or get back stomach aches. May move to 100mg r-lipoic. Need for liver

I am not religious about taking this everyday, go through phases

Taking DHEA? NO had it in the transdermal T, but felt it was causing E2 increase

Blood pressure and PR?

usually around 120-126/76-82 PR is usually around 74-80

Muscle cramps? Yes now more than ever in legs, especially after sleep or sitting

Using iodized salt? No, use celtic salt, but not all the time.

What are your thoughts on taking 5mg of Pregnenolone? I am curious if that might help address the low T, although DHEA is ok, so not sure.

As for Iodine, I have taken Iodoral off and on, my uncle was an MD and recommended everyone take(buddies with Brownstein), I took it for years, and then read some info on a toxicity that could be caused, and stopped. Recently even saw some comments from a few ND’s the same, so I was worried continued useage could cause me permanent thyroid issues.

I am going to go back on iodoral 12mg and take it with SElenium, as I haven’t done that in the past(other than what was in my vitamin), also going to increase ZN as I have had a test 2 years ago which said I was deficient.

I am really confused on the adrenal/cortisol assesment, had a PharmD run some tests and tell me I am low cortisol, but the tests we just ran indicate the opposite in the AM. This seems to be tough to address, licorice root seems to be what they have prescribed in the past.

Any suggestions there?

Will do temp measurements again, have in past, and was normal when waking.
I have not done one at noon, that is a good suggestion.

What is your thought on moving from dessicated thyroid to Cytomel(t3), might try this after going on iodine for a few weeks, and get some new labs. If rT3 still high, maybe go on cytomel.

Thank you again for your feedback on this…

4

comment on diet, I left out , I mainly consume chicken for my protein, usually have it at each meal (lunch/dinner)

Given that have had concern over Xenoestrogens in chicken as only consume free range chicken when at home, but eat out a lot due to travel.
Eat a lot of beans as well, but have IGG reaction to dairy and wheat, dairy is off the charts, so limited on protein sources. I enjoy Sun Warrior protein, which is cranberry and pea based.

Just learned about collagen protein as well, going to try that…

5

There is a role for iodine in the body, even when taking thyroid meds. So iodized salt would be a good idea, VS Iodoral binging :wink:

T3 may allow rT3 to come down. You also should address stress issues/events/causes.
In any case, you appear to be under-medicated. Need body temps to quantify.

You have enough DHEA to make T. More preg would not help in that regard.

Thyroid problems can reduce LH/FSH

Try more magnesium and see if that addresses tendency for muscle cramping.
Magnesium oxide might not be very bio-available for you.

No OTC meds or antacids?

6

Hi Ksman,

Sorry for delay in getting back to you. Crazy travel schedule with work.

So no I do not take OTC or Prescript Meds, try to avoid at all costs, and other than the T/E2 and thyroid issue, been very healthy.

I take a compounded Thyroid today, made a local pharmacy, I think it s 85% t4 15% t3, but have to check.

Will go back to T Cyp, have an upcoming appt to get new script for that and will change from letro to armidex.

When I was shooting Tcyp before, was doing it once a week, so suspect Armidex at same time? once a week?

I went and bought a thermometer and will start taking basal temps, and update this post.

Thanks again.