TRT for 19 Year Old

Pharma
61

Metal, Your T3 seems low, you are not converting T4–>T3. Taking only T4 can be very dangerous. Armour should be able to increase T4 and T3. If not, perhaps you need to add T3.

Your E2 is way too high. That will shut you down. Any signs of gyno or bloat? You can reduce E2 with Arimidex, also using a short course of a SERM if there is gyno. Probe your chest, feeling for graininess. Lower serum E2 to the lower 20’s [0-53pg/ml]. This E2 problem alone could shutdown your HPTA. Prolactin also can do that, killing libido along the way.

You should get E2 controlled, then taper off of hCG. The hCG should have your testes recovered, then see if you can resume your own LH production. If you are to recover your HPTA, then you need to understand the principles of PCT.

Hypothyroidism causes weight gain. Fat leads to more estrogen. It seems odd to have high estrogen when there is almost no T to be converted into T. You are estrogen dominant which is dangerous for your health. You need to turn that around. HRT may be needed, but try other things as well.

You need to supplement with DHEA. You will need a script for that in Canada, UK and Australia.

You did not post the lab range for prolactin. If it is high, then the low LH and high prolactin could suggest a problem with the pituitary glad, possibly a tumor.

You probably do not get much exposure to the sun and are likely to be vitamin-D deficient. You probably need to take 2000iu/day in that climate. Vitamin D is stored in the body and you may need to take a lot to get your store levels up. The body turns vitamin-D into vitamin-D hormone as required. Every cell in your body has receptors for this hormone. Minimum daily requirements are typically enough to prevent bone deformities in children… way off the mark for optimal levels.

Do you use iodized salt?

If you are to start TRT, you will need to inject. It is the norm that guys who are hypogonadic do not absorb transdermal T products. Probably the same for transdermal DHEA and Pregnenolone [do not confuse with progesterone].

Research syndrome-X aka metabolic disorder.

62

SERMs and AIs

SERMs to not lower E2 at all. SERMs block E2 from docking in selected/some E2 receptors. This can blind the hypothalamus to existing E2, which then can run open-loop producing LH and FSH. That can lead to more T and more E2!

SERMs are not good for long term use, as these also have estrogenic side effects. Avoid Clomid. Use SERMs to deal with gyno and as part of a PCT type treatment.

AIs are aromatase inhibitors that reduce T–>E aromatization. You will need an AI during your SERM use and long term aftewards, perhaps permanent.

Arimidex/anastrozole has the best dose-response properties. Letro can be unpredictable and small doses can make E2 undetectable for a few. You should not take E2 to very low levels, that is unhealthy.

Progesterone will also shutdown the HPTA. I suggest that this is counter productive at this point in time. With T so low, if you attempt to increase progesterone to normal levels, the ratio of T:progesterone will be very low, and the combined T:E2+progesterone will be horrible. Prolactin is also HPTA repressive. Please post the reading with lab range.

Anastrozole is competitive with T for the aromatase enzyme. With little T, one should expect to not need much. And as T is increased, one needs to more. So the dose may need to be changed.

Again your very high E with low T does not fit normal understandings of how things work. Anastrozole might not work as expected, only thing to do is to try it and hope for the best.

E2 should have created high SHBG levels. SHBG is used to remove E and T from the body. These get dumped into the gut by the liver. A few can have bacterial flora that unbind E which is then free to be absorbed back into the blood stream. This is one possible explanation for your E2 levels. No way to test for that. I suggest an aggressive course of probotics and yogurt. There may be other things that you can do to improve digestive health. You current hormone state and thyroid history may be affecting the gut as well.

Some drugs may be affecting the liver’s ability to dump E. Liver health is part of the situation.

You will find more posts concerning hormone issues in the ‘over 35 lifter’ forum.

63

TRT/HRT:

After starting hCG, after you feel that your testes are [hopefully] larger and firmer, retest TT, FT. If these do not increase, this speaks to a lack of LH responsiveness. If that is the case, even if you can resume your own LH production, the results will be poor and TRT is probably your only option.

Get your DHT levels tested. DHT is vital to the developlent AND maintenace of the genitailia. Supplementing with DHT may make help the testes get started. After your T levels are up, your body can then convert T–>DHT. DHT may be needed as a jump start. Proviron or Masteron might do the job. Both of these have various anti-estrogen mechanisms as well. DHT has a strong binding affinity for steroid receptors and can also directly block E. Proviron at 50mg/day to start and later reduced to 25mg might be of benefit.

E is dangerous to the prostate and causes enlargement. You need E reduced to optimal levels to protect and probably reverse things going wrong with the prostate. DHT is absolutely vital. Guys who take 5-alpha reductase drugs to keep their hair, can get into serious hormone troubles; and sometimes stopping that drug does not lead to recover.

E affects how the brain works. It disrupts the male patterns of thought that you developed in your teens when T was high. E has changed how your brain and mind are working. Often this creates many profound problems. Typically, lower E will produce profound improvements.

64

Yes bloating is their and day to day water retention is crazy puffy like a balloon all over one day losing a lot of water the next.

Nipples are hard and when i press on them their is a hard small lump underneath. I don’t have recent results for prolactin but will update when i do my full blood work.

Im positive i’m not converting T4–>T3 thats why im using armour which is comprised of both and i’m pretty sure i have very high reverse T3 levels also so the T4 is converted to RT3 further slowing my metabolism.

I can ask my doc for some DHEA this would help my adrenal glands i know its very effective for women though im not sure how effective it is for men as it gets converted to both T and E but if i use an AI with it to control E2 this wouldn’t be of any issue so it’d help. My sun exposure is almost nothing right now! i will supplement with high doses of Vit D as you suggested and try to get more sunlight. I use iodized sea salt because its recommended to be use in cases of thyroid/adrenal problems.

If i’m on TRT theirs no way in hell id touch transdermal i’ve learnt that from the beginning inj are the only way to go. In regards to metabolic syndrome i have all the signs and symptoms and have had a glucose tolerance test with extremely high insulin levels but normal glucose (Insulin-resistance, pre-diabetes)

I have hashimotos thyroiditis (auto-immunes diseases) and this is linked with coeliac disease and gluten intolerance and ill be checking those out as well through IgE antibodies test.

My Liver Enzymes are also high though this is 3 months ago roughly.

AST: 78 (15-41 U/L)
ALT: 82 (17-63 U/L)

HCG + E2 would be the first option to restart things but if this fails then TRT + E2 would be the next. If i do have high cortisol i could manage that with something like aminogluthemide, but until i get more recent comprehensive blood work i won’t really know.

These High E symptoms have only been very recent and rapid in the past three months, though i don’t know how bad my E has been because i’ve never tested it until now. I have ALWAYS had low T and low LH levels.

Do you know if a level of 41.5 of IGF-1 and 5.4 for GH is normal? i have seen that the average ranges are 100-400 or something like that for IGF-1, I don’t know the reference range for either though when i did my labs for this sorry

65

[quote]

HCG + E2 would be the first option to restart things but if this fails then TRT + E2 would be the next. If i do have high cortisol i could manage that with something like aminogluthemide, but until i get more recent comprehensive blood work i won’t really know.

These High E symptoms have only been very recent and rapid in the past three months, though i don’t know how bad my E has been because i’ve never tested it until now. I have ALWAYS had low T and low LH levels.

Do you know if a level of 41.5 of IGF-1 and 5.4 for GH is normal? i have seen that the average ranges are 100-400 or something like that for IGF-1, I don’t know the reference range for either though when i did my labs for this sorry[/quote]

By hCG + E2, you mean hCG + E2 control?

GH and IGF-1: GH levels are so dynamic that the results can often be of little use. IGF-1 levels are quite steady and a better indicator of GH status. This is way to low. You may need to inject GH. With the low LH, GH and high prolactin it would make sense to have your hypothalimus and pituitray glands scoped!

66

Yeah hCG + E2 control.

Really good information KSman thanks. I might have to get em scoped as you say. I thought my IGF-1 levels were way low when i was talking to my old endo but he didn’t even mention their was any problem.

The problems im encountering are all to do with:

Hypothyroidism (diagnosed)
Hypogonadism
hyperprolactinema
Addisons or Cushings disease (high or low cortisol)
Insulin Resistance (yep)
Estrogen Dominance
Liver Disease

I will have blood work in a week or two (I think i’ve said that about 10 times in this thread already :P) so until then nothing is for sure.

By the way T-Nation kicks ass best forum out their :wink: A lot of knowledge savvy members, most forums just rely on Brotelligence.

67

HERES THE BLOOD WORK EVERYONE!!!:

LIVER FUNCTION TESTS

Bilirubin: 10 umol/L ( 0-20 )
ALP: 107 U/L ( 30-115 )
GGT 12 U/L ( 0-45 )
Lactate Dehydrogenase 305 U/L * ( 100-225 )
AST 67 U/L * ( 0-40 )
ALT 96 U/L * ( 0-40 )
T.Protein 79 g/L ( 60-80 )
Albumin 50 g/L ( 38-55 )
Globulin 29 g/L ( 20-32 )

Elevated Transaminase(s). Follow-up may be indicated.

Plasma Glucose: 4.7 mmol/L (3.6-6.0)

LH: Under 0.5 ( 2.0 - 10.00)
FSH: Under 0.5 ( 1.5 - 13.00)

Suspected Hypopituitarism *

Total Testosterone: 6.7 nmol/L * ( 12.0-32.0 )
Free Testosterone: 17.8 pmol/L * ( 43 - 138 )
DHEAS: 8.2 umol/L ( 2.5 - 13.00)
Growth Hormone: 0.5 mIU/L * ( 0-15 )
Sex Hormone Binding Globulin: 29 nmol/L ( 15-50 )
Prolactin: 190 mIU/L ( 85-500 )
(Done 2 weeks earlier - Estradiol: 306 * ( 0-160 )

Free Androgen Index: 23% ( 15-100 )

Gliadin IgA (Gluten Intolerance) 4 U/ml ( 0-20 )

THYROID FUNCTION TESTS

Free T3: 3.0 pmol/L ( 2.5-6.0 )
Free T4: 9 pmol/L ( 8-22 )
TSH: 3.76 mIU/L ( 0.30 - 4.00 )

Still waiting for TBG (Thyroid Binding Globulin), Reverse T3 and DHT. Im going to be doing a 24 hour urinary cortisol test as a one off cortisol reading isn’t at all reliable the reason i didn’t check it.

68

Opinions?