Requesting Personalized Advice

Pharma TRT
1

I&lsquom so tired I can&lsquot live a normal life, I can hardly take care of my hygiene much less run errands. The day after even moderate exercise I feel too exhausted to move.

Age: 24
Height: 6&lsquo2&ldquo
Waist: 55&ldquo
Weight: 380 lbs.

Describe Body and Facial Hair: Moderately hairy chest, very hairy legs and arms, normal facial hair

Describe where you carry fat and how changed: I carry my fat in my midsection, but I&lsquom very overweight so it&lsquos everywhere. I didn&lsquot used to be overweight so I guess that&lsquos how it changed

Health conditions, symptoms:
I used to be a very active guy, very into weight lifting and bodybuilding style working out. Then I started to notice some days I was becoming more and more tired. This started my 3rd year of college, and by the start of my fourth year I had gained 90 pounds and was sleeping 11 hours a day and still feeling too tired to go to college. I had to get a medical withdrawal. I initially went to a therapist thinking I was depressed, and he did put me on meds which helped with me being upset with not being able to complete school, but my fatigue and oversleeping remained.

I tried working out, even hiring a personal trainer for 3x a week sessions, but I didn&lsquot lose a pound. I then dislocated my shoulder and completely fractured the glenoid cavity (the saucer in the cup and saucer joint where your arm goes into your shoulder, it was basically in half). Stopped working out besides PT after my shoulder surgery. Since then I have been bouncing from doctor to doctor trying to figure out why I am so tired. It&lsquos been 2 years since then and have gained another 80 pounds.

All in all I went from 210 pounds to my current weight of 380 pounds. I think I finally found a Doc who knows somewhat what he is doing, and we have found my testosterone, vitamin D, and thyroid panels are not what they should be. I have been officially diagnosed so far with depression, sleep apnea, hypothyroidism, hypogonadism, vitamin d deficiency, idiopathic tinnitus, and idiopathic hypersomnia.

I also dribble when I pee and need to go suddenly, frequently, and then don&lsquot go for very long (<10 seconds on average). I feel tired as heck and just want to get on with my life, I am not depressed and am very excited about the inevitable fact that I will beat this some day.

Rx and OTC drugs, any hair loss drugs or prostate drugs ever : No hair loss or prostate drugs ever. Currently taking range of homeopathic supplements including a multi, selenium, zinc, olive leaf extract, cumanda, krill oil, vitamin C, B-Complex, and teasel root.

I am also taking 5000 IU of D3 daily, and have been for 2 years. Been taking AndroGel 1.62% 3 pumps daily for about 1 year, but recently switched to 5 pumps and will be applying to different locations at advice of doctor for better absorption. Been taking Synthroid 125mcg for 2 years, but recently switched to Armour Thyroid 60 mg twice daily. Taking Lexapro 10mg and Wellbutrin 300 mg.

Diet: When I first started having problems, I had been doing a very low carb diet, about 2200 calories daily of mostly lean protein. Since I started getting so tired, my diet went totally opposite way and consists of 1-2 large meals of junk food.

Describe training: I was working out 5-6 times a week for an hour of weight lifting and 30-40 minutes of cardio. Then I started getting the fatigue and eventually stopped completely. I am now entirely sedentary and have now stamina.

Testes ache, ever, with a fever? : No

How have morning wood and nocturnal erections changed: I used to almost always wake up with an erection, now I almost never do.

Lab results with ranges:

5/24/2010
Free Testosterone (Direct): 6.2 (9.3-26.5) Low
Total Testosterone: 195 (280-800) Low
Vitamin D,25-Hydroxy: 21.7 (32-100) Low
TSH: 5.930 (.450-4.50) High

10/8/2010
Folate: 10.7 (4.2-19.9)

12/9/2010
Vitamin D,25 Hydorxy: 29 (30-100) Low

1/26/2012
WBC: 7.2 (4-10.5)
RBC: 5.77 (3.8-5.10) High
HGB: 17.3 (11.5-15.0) High
HCT: 49.5 (34.0-44.0) High
MCV: 86 (80-98)
MCH: 30.0 (27.0-34.0)
MCHC: 34.9 (32.0-36.0)
RDW: 14.1 (11.7-15.0)
Platelets: 245 (140-415)
Neutrophils: 68 (40-74)
Lymphs: 22 (14-46)
Monocytes: 5 (4-13)
Eosinophils: 3 (0-7)
Basos 1 (0-3)

ACTH: 30.4 (7.2-63.3)
IGF-1: 237 (116-358)

2/10/2012
TSH: 3.79 (.450-4.500)
Free T3: 2.9 (2.0-4.4)
Reverse T3: 31.8 (90-350)
Free T4: 1.49 (.82-1.77)

ATA: <20 (0-40)
TPO: <6 (0-34)

5/5/2012
Testosterone, Serum Total 242 ng/dL (348-1197) Low
Free Testosterone (Direct): 12.5 pg/mL (9.3-26.5)
Luteinzing Hormone (LH), S: 2.7 mIU/mL (1.7-8.6)
Estradiol Roche ECLIA methodology: 18.6 pg/mL (7.6-42.6)
IGF-1: 220 ng/mL (116-358)
Estrogens, Total: 88 pg/mL (40-115)
Sex Hormone Binding Globulin, Serum: 10.8 nmol/L (16.5-55.9) Low

I have read all stickies. After doing so, I have several observations:

  1. Doing LH and FSH blood tests now that I&lsquom on TRT doesn&lsquot tell me anything, same probably with IGF-1 and the Total Estrogens.

  2. I am probably not absorbing the AndroGel (considering I&lsquove been on it a year) because I am hypothyroid. Perhaps injections will be necessary.

  3. I am not also doing AI or HCG. I will discuss this with my doctor at next appointment.

  4. I for the life of me can&lsquot figure out why after 2 years of 5000 IU daily D3 my levels are still not even in range, much less optimal.

  5. I believe I should do a pituitary gland MRI with contrast. The reason is I have both the hypothyroidism and low T going on, and I want to rule out damage to the pituitary. I once shook my head back and forth and gave myself whiplash right at the dinner table and had to go to the hospital. I had a similar episode doing barbell shrugs one time before I got so sick/debilitated.

  6. My T3 is not optimal, seems my body is not converting T4 to T3 properly. Hopefully my new dose of Armour Thyroid will address this (60 mg twice daily for 120 total).

  7. Probably need to add the following labs:
    -Cortisol four sample saliva testing
    -Pregnenolone
    -DHEA no see DHEA-S
    -DHEA-S

2

Yes on the cortisol test and if you can try and get the 2hr glucose test!

When you have those post them up.

3

Thank you for taking the time to review my situation.

I think I did a 2-hour glucose test about 10 months ago. Is this where they check your glucose levels from fasting and then you go eat something that spikes your insulin and come back 2 hours later and they re-test? I did this because we wanted to rule out diabetes. Is this also why you were interested in this test? I remember it being negative for diabetes obviously.

I will make sure to get the saliva cortisol test.

Since my LH and FSH were within range before I ever started any TRT, does that mean I have secondary hypogonadism and therefore I should try to do HCG only for 6 weeks and re-test?

4

[quote]xtitan1 wrote:
Thank you for taking the time to review my situation.

I think I did a 2-hour glucose test about 10 months ago. Is this where they check your glucose levels from fasting and then you go eat something that spikes your insulin and come back 2 hours later and they re-test? I did this because we wanted to rule out diabetes. Is this also why you were interested in this test? I remember it being negative for diabetes obviously.

I will make sure to get the saliva cortisol test.

Since my LH and FSH were within range before I ever started any TRT, does that mean I have secondary hypogonadism and therefore I should try to do HCG only for 6 weeks and re-test?[/quote]

Yeah that is one of the reasons I said the glucose test. Mainly because of your low shbg could lead to a sign of insulin resistance. They take your blood then you drink some glucose and then 1/2 hourly take blood samples to see your insulin response. So sounds like you have had that done.

With LH in range and low test would point to being primary. But LH could be low in range and raising it to top of range could show if your boys are able to produce. You could definitely be a candidate to trial this out. Since your LH is pretty low in the scale you could try clomid or hcg and see if your boys respond when asked. That will tell you if you are primary or secondary. If I had to bet at the moment I would be inclined to say you are secondary. Just because the fact low lh low test. If LH was high and test low I would bet on primary.

This is just a guess though, you have to trial it out and see the response.

Also reducing weight may play a significant role in your situation.

I would wait to see cortisol test. If you want to try a clomid test well worth it or hcg.

Considering your age you might not need to be on TRT.

Your hematocrit looks to be high. Have you ever had iron and ferritin levels checked? If high could also be playing a role in your fatigue. Did doctor say anything about that? You might have to go give blood to drop your levels. Definitely something you need to look at.

5

Hmmm, may be worth it to just do another glucose test again. Couldn’t hurt. I’m definitely worried about insulin resistance / diabetes developing due to my high weight.

9/7/11 Glucose Test:
5.05 nmol/L Fasting
6.1 nmol/L 2 hours later after having high sugar meal

I’m so debilitated that I can’t really exercise. If I even just walk a mile, the next day I will feel like sleeping the whole day. There’s something going on besides just a lack of willpower or something.

I know what HCG is, but how does an HCG trial go specifically? Like how much and how frequent for how long? What’s the difference between that and clomid?

I think I got checked for anemia a year ago, but I agree I should get both Ferritin and Iron checked again.