Young Man, Low T, Weird Case

Pharma TRT
21

[quote]KSman wrote:
What about vision disturbances or reduction in width of peripheral vision?

When there are disturbances to the function of the pituitary, a MRI can be useful. When multiple pituitary managed hormones are bogus, pan hypopituitarism, all the more reason to …

How long have you used vitamins with iodine? Note that these amounts cannot replenish iodine when one is iodine deficient. [/quote]

No vision disturbances that I am aware of. Peripheral vision seems completely normal.

I’ve always used multivitamins, though I cannot be sure that all of them contained iodine, as this one does. I would like to get the hashi’s ruled out before I further supplement with iodine–doesn’t seem to be a consensus as to whether or not it can exacerbate the problem

22

Update: Met with TRT specialist yesterday. I start on HCG today. Doc wants to saturate my system with HCG in order to prepare it for the testosterone, which he fully intends to begin in about six weeks. I worry that I might be a “super-responder” and the HCG might juuuuuuust nudge me into the green zone. And though I’d rather start T right away, I’ve got to do it his way–I lack the necessary bro-nections to go about acquiring testostosterone on the sly. If nothing else, I’ve read that solo HCG can at least improve sleep and cognition.

Interesting fact from the doc: Apparently androgel is ONLY effective if administered via ONE route: It must be applied to the thin veinous skin of your inner forarms. Rubbing it on your shoulders or abdomen, as the packet instructs, is a dosing avenue that allows for massive aromatisation as it must make its way through your fat.
Doctor was dismissive of other possible factors behind my low-T state, especially my concerns about my thyroid. Likewiese with my pituitary gland and orchiectomy. He seems all too willing to call the low T idiopathic. Given that my fT3 and fT4 remain high, he anticipates my TSH settling down, once the T is flowing through me. Does this sound legit?

In any case, I have six weeks before TRT truly begins. In this six weeks I will continue to monitor my temperature and will have every conceivable adrenal, thyroidal, and intestianal root cause explored and ruled out. I go to my GP tomnorrow morning with a battery of the tests you guys and the stickies have suggested–hashimoto’s antibodies, celiac antibodies, and reverse T3, to name just a few.

I’ll report the results when I have them. I want to get the go-ahead from you guys before my first injection. I’ve already wasted a few precious months of my life in a Robert Paulson Fight Club nightmare and I really don’t want to do it again.

23

New Labs: 01/11

TSH: 1.72 (.35 - 5)
fT4: 34 (12 - 22)
fT3: 4.5 (2.6 - 5.7)
TT: 337 ng/dL

Conclusions: TSH has stabilized by almost a whole point. fT4 continues to stockpile while fT3 remains perfect.
Total T has dived by more than a hundred points and sleep has worsened as a result.

Still to come: Thyroid antibodies tested today, as well as reverse T3. Celiacs antibodies as well. Physician would not do the 24 hour cortisol test (too fancy for socialized medicine) but, reporting subjectively, I’d say that adrenals seem most active in the evening, giving me a poorly timed brain and body boost that complicates my already patchy sleep.

HCG begins tomorrow. Hopefully it will stop the pain in my testicle as well as the cooling and reduction in size it undergoes at nighttime.

24

WTF: “Doc wants to saturate my system with HCG in order to prepare it for the testosterone”

What is the hCG dosing? [Not high I hope.]

25

[quote]KSman wrote:
WTF: “Doc wants to saturate my system with HCG in order to prepare it for the testosterone”

What is the hCG dosing? [Not high I hope.][/quote]

.4 ml drawn from a 10000 USP (IU?) vial of HCG taken 3X weekly. I don’t know how to convert it to daily IU’s. We’re chest-deep in metric values now.

This is my regimen for six weeks. After six weeks he’ll test my TT, GGT, AST, E2, and DHEA and determine how much (if any) testosterone he’ll need to prescribe. HCG seems to be a miracle remedy for some low t guys (30%, he says) and he wants to see if I’m one of those lucky few. I doubt it though, seeing as my LH has always been top notch.

And his reliance on Total T strikes me as odd. In fact, my diagnosis and HCG dosage were determined solely based on my Total T. This is troubling to me. My Total T has always been crappy, fluctuating between 337 ng/dl and 440 ng/dl, but my Free T has remained clinically low throughout. Additionally–and I could be wrong here–aren’t Free/ Bio-available T the more relevant figures?

26

Probably 400iu 3 times per week. That is OK.

For hypo guys, TT is a better measure of function than FT because FT changes minute to minute. No, not a lab number that correlates to how one feels.

I agree that you may be a bit primary. Your response to hCG will help define the possible treatment options.

When on a TRT delivery that has smooth T levels, then FT lab work can be very representative of whats going on.

27

The high FT4, TSH, and temperatures strike me as odd. I’m no expert, but I know cysts and nodules on the thyroid can secrete hormones as well as adenomas of the pituitary. The other cause could be hashimoto, which you said you were tested for and hopefully don’t have.

Some research:

“The major thyroid hormone secreted by the thyroid
gland is thyroxine, also called T4 because it contains
four iodine atoms. To exert its effects, T4 is
converted to triiodothyronine (T3) by the removal
of an iodine atom. This occurs mainly in the liver
and in certain tissues where T3 acts, such as in the
brain. The amount of T4 produced by the thyroid
gland is controlled by another hormone, which is
made in the pituitary gland located at the base of
the brain, called thyroid stimulating hormone (abbreviated
TSH). The amount of TSH that the pituitary
sends into the blood stream depends on the
amount of T4 that the pituitary sees. If the pituitary
sees very little T4, then it produces more TSH to
tell the thyroid gland to produce more T4. Once the
T4 in the blood stream goes above a certain level,
the pituitary?s production of TSH is shut off. In fact,
the thyroid and pituitary act in many ways like a
heater and a thermostat. When the heater is off and
it becomes cold, the thermostat reads the temperature
and turns on the heater. When the heat rises
to an appropriate level, the thermostat senses this
and turns off the heater. Thus, the thyroid and the
pituitary, like a heater and thermostat, turn on and
off. This is illustrated in the figure below:
T4 and T3 circulate almost entirely bound to specific
transport proteins, and there are some situations
which these proteins could change their level
in the blood, producing also changes in the T4 and
T3 levels (it happens frequently during pregnancy,
women who take control birth pills, etc)
Another measurement done to assess the thyroid status
of patients is the Free T4 measurement. The Free
T4 avoids any change the proteins could have, giving
us a more accurate value for the T4 level”

28

T4 and T3 in combination are the feedback signal and only fT4 and fT3, not bound thyroid hormones.

The pituitary does not sense thyroid levels in the blood. That is the role of the hypothalamus which controls the pituitary’s generation of TSH with TRH.

When it is stated that thyroxine-binding globulin (TBG), transthyretin, and albumin bind to the T3 and T4 and transport these, there is an implication that this transports these to cells that will use them. FALSE!

we are faced with:
“In the blood, T4 and T3 are partially bound to thyroxine-binding globulin (TBG), transthyretin, and albumin. Only a very small fraction of the circulating hormone is free (unbound) - T4 0.03% and T3 0.3%. Only the free fraction has hormonal activity.”

So the transport of these bound hormones must be to for metabolization somewhere. I assume that is gets cleaned up in the liver and the iodine is recycled. I have not seen an explanation of were the bound complex goes.

We have the same confusion as with SHBG+T which has no bio-availability, yet the literature is full of statements that SHBG+T transports T to cells for use. FALSE! SHBG+T transport is to the liver for garbage collection. Albumin+T is weakly bound and that is bio-available.

29

Hey guys. I appreciate all of the informative responses. I didn’t want to waste your time by replying until I had something of substance to report. Frustratingly, the results for the hashimoto’s, celiac, and rT3 blood tests have been held up somewhere along the process. My doctor couldn’t even give me an ETA. Here’s what WAS completed and available:

DHEAS: 16.1 umol/L (5.73 - 13.4)* Slightly high
SHBG: 42 nmol/L (16 - 56)
Progesterone: 4 nmol/L (.7 - 4.3)* Borderline high

The high(ish) SHBG is to be expected, I suppose, given my consistently depressed free testosterone and long history of estrogen dominance. The high DHEAS and progesterone would seem (based on my research) to indicate adrenal dysfunction. That’s not a surprise either: My androgen withdrawal coincided with a period of great stress in my life, forming a perfect storm of anxiety and sleeplessness; of course my adrenals took some abuse. Does this make sense to you guys?

I have another question for you. This one’s kind of intimate, but I have no competent medical professional to put it to. Here it is: Although I don’t wake up with morning erections, my genital region IS markedly healthier in the mornings. My flaccid state is fuller and warmer, as is my testicle, which hangs lower. As the day progresses, however, the entire region gradually whithers and retreats into my pelvis. By the evening, my tool is pale and atrophied and my testicle is cold and wrinkled against my groin. I attribute this daily transformation to the cyclical rise and fall a man’s free testosterone from its peak in the morning to its valley at night. In my case, I wake up with T values that are juuuust “in-range” but that decrease and dip into “sub-range” values at night. That’s my theory anyways. What do you guys think? Is it as simple as that or is something else going on?

***Two weeks on the HCG and no improvement. Slight estrogenization, if anything. I will invest in an AI as a precaution.

30

Any idea what your blood pressure is?

31

[quote]KSman wrote:
Any idea what your blood pressure is?[/quote]

I have had it tested many times, even recently. They told me it was “perfect”. While I can’t give quote you the exact figures, I do remember it being on the low end of “perfect”. What are you thinking?

32

Just fishing for complicating factors or influences that might be over looked. Seems like a good question to ask when you indicate strong changes in blood circulation.

33

I thought the same thing. I even went in to the hospital the first time I noticed serious blood deficit in my genitals. They ran all sorts of circulation tests, including an EKG, and then dismissed me, admitting that they could find no problem. Actually I’ve found that my circulatory problems most closely resemble those of sufferers of post-finasteride syndrome, even though they appeared after the androgel, not the finasteride. Here is a comprehensive list of the symptoms, for those who are interested:

http://propeciahelp.com/symptoms

The symptomology fits me like a glove.

34

“”"
The reason(s) for this adverse post-drug reaction, and why treatments designed to restore androgenic action in these men often meet with little to variable success, remains unknown.
“”"

My thinking on this is that this drug, which is a steroid hormone, gets into the cell nuclei as typical for steroid hormones, then there are epigenetic changes. Only some are affected. We see some young healthy guys getting these effects from prohormones or misadventures like a deca only cycle. And those who get whacked by hair loss drugs might have had the same result from other man made hormones. And we see failure to respond to HPTA restart, but should be attempted anyways. I have referred to this in the past as brittle HPTA, easily broken.

I have been ranting about the dangers of these things for years. There is a term for this now: Xenohormone - Wikipedia

35

Five years ago, before receiving hormonal intervention of any kind, if you’d placed me in a police lineup and instructed random people to guess which of the men before them had a brittle HPTA, I’d have been fingered 90% of the time. Either the androgel or the the fin would have been enough to break me, I guess, but I took both in a one-two punch.

I guess the weird bloodlfow problems are seen only in a minority of cases. It’s widely considered a paranoid urban legend. Try typing “shrinking penis” into a search engine and see what I saw: pseudoscience from one mouth and adamant denials of even the possibility from another. The only forums where such a thing is even acknowledged to exist are the post-finasteride website and resources concerning chemical castration (for prostate cancer and sexual reassignment).

I guess all I can do is wait and see if I respond to the testosterone.

I think the danger of finasteride and its ilk cannot be emphasized enough in the stickes. Many TRT resources even recommend mixing finasteride into the TRT regimen, as a precaution against steroid-induced baldness.

36

The steroid forums are full of information that lacks warnings as well. But you can’t fight bro-science!

37

Update: Very unsure of how to proceed; would appreciate a bit of input.

First and foremost, the Hashimoto’s/rT3/Celiac results are finally in. Hashi’s and Celiacs are definitive 'no’s (My Hashi antibodies amounted to less than 1 percent of the threshold; gluten antibodies did not even register). Reverse T3, however, is a problem.

rT3(serum): 31 ng/dl (9.2 - 24.1)

Certifiable adrenal fatigue. No surprises there, given my flipped circadian rhythm and increased wakefulness post-six pm. Not much of a concern, though; I think the low-T and T-withdrawal caused the adrenal fatigue, and not vice-versa. In any case, I’ve got Dr. Wilson’s book and have adopted his methods. With my caffeine-abstinence and vitamin regimen, rT3 ought to normalize, bit by bit, day by day, barring any further testosterone malpractice.

MORE IMPORTANTLY

**EDIT: I misheard the clinician and thought she said “decaonate” when she actually said “Delatestryl”. My actual dose is 200mg/ 2 weeks of testosterone enthanate.

Lab results for my six-week trial of HCG 400iu 3x weekly are in. Now, doc won’t let me see the lab workup (he’s one of those) but he DID prescribe me 1cc testosterone enthanate, 200mg every 14 days. Just getting a script is good news (I had worried that the HCG might have juuuust nudged me out of hypo-range), but this regimen strikes me as a bit dubious, based on my readings and the popular opinions of this site. If you guys could take a glance at some of these concerns, it would be a great comfort to me.

A two week interval between injections is a newbie’s mistake, or so my readings lead me to believe. While the dosage is correct (200mg/ 2 weeks = 100mg/week) it would be better to split it up and do it AT LEAST once a week, correct? Is there any reason why my doctor might opt for a bi-weekly injection? Or is he just making a common mistake? I’ve got needles to spare so I suppose I could split the dose myself and leave him none-the-wiser. What do you guys think?

I don’t have the result of the test, but I can report that it doesn’t feel like the HCG has really noticeably raised my T. As this stuff is bloody expensive can I reduce my dose of HCG to the amount recommended by the sticky? It’s over 90$ every 1 1/2 months, and OHIP (Canadian socialized health-care) won’t touch it.

Thanks guys. I know that’s a lot to throw at you all at once but, as I can’t impress upon you enough, I don’t have anyone else to ask these questions. My specialist will only deal with me over the phone, and even then often only via his clinic assistant.

38

Hey Guys. I understand your reluctance to comment on my previous post. I will be more brief and use more discretion going forward. My numbers have changed, as you will see, but I don’t feel any different, for better or for worse.

CURRENT REGIMEN (a little over a month):

50mg test enanthate 2x per week, injected subcutaneously.
400iu HCG 3x weekly, injected subcutaneously.

PRE-TRT BLOODS

Testosterone : 337 ng/dl (317 - 905)
Free Test : 29.1 pmol/L (31 - 94)
Estradiol : 30ng/dl (<110)
SHBG : 42nmol/L (16 56)

CURRENT BLOODS (about a month on above regimen):

Testosterone : 600ng/dl (242 - 827)------Meh
BioavailableT: 9.4nmol/L (2.10 - 8.50)----High
SHBG: : 19nmol/L (13 - 71)
Estradiol : 30 ng/dl (<205)
AM Cortisol : 190nmol/L (120 - 620)

CURRENT THYROID

TSH : 1.64 (.34 - 5.5)
fT4 : 17.6 (10 - 19)
rT3(serum) : 31 ng/dl (9.2 - 24.1)
*Negative screening for Hashimoto’s Disease

Thyroid remains unchanged, still showing non-optimal TSH. Temperature is steady and no Hashimoto’s, so the culprit, as my lousy AM cortisol (and very high PM cortisol, I have reason to suspect) plus very high rt3 will corroborate, is adrenal fatigue. I’ve got Wilson’s book and I’m working away at it.

My androgens are concerning. Why do I have such a “meh” total T but such a high Bioavailable T? And, though my bio available T has just about doubled, I feel unchanged. Sleep still sucks, rare morning erections, no energy, low libido, etc. Is it just a matter of time? Should I add more T to push my Total T up to where my Bio T is? What am I doing wrong and why don’t I feel as virile as my high bio-available T would indicate I ought to?

Thanks a lot, guys.

39

I am 24y/o and havr hashimoto and low
This is a very because no dr. Can help or endo
I havd to go to a anti aging clinic and pay out off my pocket
Close to $600 for mostly all test needed
I was prescribed
Hcg 500iu 3×WK
COLMID 1×DAY
ANASTROZOL 2×WK
ARMOUR THYROID 60MG

I DONT FEEL ANYTHING DIFFERENT
I HAVE TO GO BACK in a few weeks…

Wish every body the best with this problems…

40

I am 24y/o and havr hashimoto and low
This is a very because no dr. Can help or endo
I havd to go to a anti aging clinic and pay out off my pocket
Close to $600 for mostly all test needed
I was prescribed
Hcg 500iu 3×WK
COLMID 1×DAY
ANASTROZOL 2×WK
ARMOUR THYROID 60MG

I DONT FEEL ANYTHING DIFFERENT
I HAVE TO GO BACK in a few weeks…

Wish every body the best with this problems…