T-Nation | T Replacement

Thyroid Basics

Sat, 18 May 2013 05:29:00 GMT

This is a sticky. DO NOT POST YOUR PERSONAL DETAILS HERE, CREATE YOUR OWN THREAD.

Thyroid basics:

We have many guys here with thyroid issues. Somehow I want to think that these are uncommon. But here, we see these problems all of the time. Perhaps the guys who come here via Google or other search engines are as a group more likely to have these issues.

You cannot live without thyroid hormones. Thyroid hormones control metabolic rates and body temperature. The time frame for this is hours. You body temperature drops at night and warms up in the morning. As you will see later, thyroid problems can lead to lower body temperatures. We take advantage of this as a simple diagnostic tool. That method cuts through the complexities or ambiguous results of lab results, other symptoms and the blocking effects of rT3.

If one's thyroid hormones are low, or body temperature is low, one has hypothyroidism. If the problems are slight, it is called subclinical. Subclinical basically means that your doctor will not do anything. You have to remember that doctors are trained to deal with disease management, not health management. If you want to optimize your state of health, a doctor does not have any interest because you do not have a disease and associated diagnostic code that can be used for insurance billing.

So how does one interpret thyroid lab results? The range for Thyroid Stimulating Hormone [TSH] is 0.5 - 5. The range varies slightly from lab to lab. Fall in that range and many docs will say that you are normal and dismiss your concerns. So for those docs, a 10:1 range in this hormone is OK. In reality, you want to be somewhere close to 1.0. An endocrinologist professional group recommended that the range be changed to 0.5 - 3.0. However, labs have not change the ranges and effectively, hardly any doctors are aware of this change. You need to know that the normal range is from data fitting to a "normal" statistical variation which captures 95% of the sample group. So one normally finds 95% of the sample group falls within that "normal range". But that range captures a lot of people who are not well and the reason that their thyroid hormones not right.

We talk about optimal levels for hormones. But if you are in range, your doctor will probably tell you that you are normal. Those doctors have confused lab normal ranges with normal health function. This is the big problem. With thyroid hormones, optimal T3/T4 seems to be at the middle of the lab ranges.

TSH is released by the pituitary gland, the master gland. By varying TSH levels, the pituitary is able to control the output from the thyroid gland. The thyroid produces two thyroid hormones, T3 and T4. These hormones are a protein complex that includes 3 or 4 iodine atoms. Iodine is a trace element in nature, but it is so important for survival, that 1.0 to 1.5 grams can be stored in the human body. Evolution selected for that. Most iodine is stored in the thyroid gland. Women store more as iodine is also stored in breast tissue; with implications for increased breast cancer if one is iodine deficient and the obvious implication that breast milk can deliver iodine.

Hormones T3 and T4 are mostly carried in blood [serum is the medical term] bound to proteins and is not readily bio-available. T3 and T4 that are not bound are termed free and referred to as fT3 and fT4.

T4 is really a reservoir and it not so much bioactive. It is T3 that directs the metabolic rate of cells, and specifically fT3. T4 is converted to T3 [T4-->T3] inside the thyroid gland and also in other tissues [referred to as peripheral conversion. As we will see later, some people seem to have less ability for peripheral T4-->T3. If you give a T4 thyroid medication to those people, they will be T3 starved and they are still symptomatic. And surprise, most doctors are also clueless about that.

Your body has a feedback loop that compares T3/T4 in circulation with a "set point". If the serum levels are below the set point, more TSH is released to promote more action from the thyroid gland. If serum levels are above the set point, less TSH is produced and thyroid output falls. You can make an analogy with your home thermostat. Do you have a set-back furnace/heater thermostat that allows the temperature to drop at night during the heating season? Guess what, the same thing happens to your body temperature. The body temperature set point drops at night and your body cools down when you are sleeping.

Your pituitary gland is not fully in control. The hypothalamus monitors serum thyroid levels and it controls the pituitary gland by signaling with TRH.

You can read more here: http://en.wikipedia.org/wiki/T...

So that is the quick and dirty introduction. Now we need the practical information.

We will focus on hypothyroidism: http://en.wikipedia.org/...#Hypothyroidism

Hypothyroidism is a state of low thyroid hormone levels and in this sticky we will extend that broadly to include sub-optimal levels. We need to be more concerned with functional hypothyroidism as you will see later.

So what causes hypothyroidism? Things can go wrong, auto immune disease etc. But often there is not a disease state. We see that low testosterone levels, hypogonadism, often can create a degree of hypothyroidism and visa versa. So we often see guys who come here with hypogonadism issues having thyroid problems. And sometimes hypothyroidism causes hypogonadism.

It is also important to note that most of the symptoms of hypogonadism are also common to hypothyroidism. So you do not want either one, let alone the compound effects of both!

But back to basics - iodine.

Iodine is needed to make thyroid hormones and you would die without it. Low iodine can cause goiter http://en.wikipedia.org/wiki/G... When there is an iodine deficiency, the pituitary gland releases more TSH, to make the thyroid gland more active. High TSH levels have the effect of making the thyroid gland grow larger and that can lead to nodules inside the gland that might become cancerous. These nodules can also start to make T4 and T3 without the control of the TSH hormone. When that starts to happen, the serum hormone levels will rise, but TSH levels are reduced in compensation. If the nodules produce all of the hormones that your body needs, TSH is shut off [TSH-->0] and one is on the edge of hypothyroidism. If the nodules produce more than that, TSH cannot go negative and serum thyroid hormones can go to high and now one has hypothyroidism, which is a serious problem.

So back to iodine. Many places in the world, perhaps most places, do not have enough iodine in the soil to work its way up through the food change to provide the levels that we need [iodine deficiency ID]. For this reason, iodine has been added to salt and that is iodized salt. That eliminated goiter in most cases. And there also used to be iodine in bread, but that is no longer the case.

The iodized salt method of delivering iodine has two weak points. One is that sea salt has become popular. There is iodine in sea water. During the crystallization of salt from sea water, iodine is lost, not captured in the crystals. Sea salt is the big reason why iodine intake has dropped in many societies. Note that restaurants mostly do not used iodized salt. And prepared foods do not use iodized salt. So even if one has iodized salt at home, if one is not cooking most of their own meals, they have a limited opportunity to get iodine. The fancy "rock salts" that claim to have many trace elements are also very low in iodine and are not a source.

The second problem is that doctors tell people with high blood pressure to stop using salt. Sooner or later those people will suffer from the effects of iodine deficiency. This is a pathology directly caused by ignorant doctors.

I know someone well who used to cook for her grandmother who was told to get off of salt. So she learned to cook without salt and got used to that. Her grandmother was long gone, but she still did not use any salt. She ended up with goiter and nodules and is now border line hypo with TSH=0. She has been hospitalized twice as a result of high thyroid hormone levels, otherwise, she gets along fine is this state. She has nodules producing thyroid hormones without needing TSH. Her thyroid gland was visibly "thick" looking and asymmetrical. And there were lumps. Her doctor should have been picking that up by feeling [palpating] around her larynx. FAIL!

We now ask guys to have TSH, fT3 and fT4 lab work. Often this is not conclusive. But if their body temperatures are low, whatever the labs say, we can conclude that there is a state of functional hypothyroidism.

Testing your body temperature: Get an oral "fever" thermometer. Do not test in your arm pit. Do not test soon after you have been talking, panting, drinking, eating, screwing, training etc. Check your temperature when you wake up, before you get out of bed. 97.3 F or lower is definitely a problem indicator. Ideal would be near 97.7 F and could be higher. We have guys who are below 97! I have added to this a check during the mid afternoon to see if you are getting to 98.6; if you can't get there, that is a problem indication.

How many times to I need to ask a guy here before he checks his temperatures? Very often three times. Maybe there is a learning disability as a symptom of hypothyroidism.

Some people say that they have always had low body temperatures. I think that many times we are been told that they have low iodine intake!

If your thyroid hormones are suspect and body temperatures are low, one can take iodine supplements [iodine replenishment IR] to treat the presumed ID. If IR normalizes one's body temperatures, then that is diagnostic. If that does not work, you have more serious problems to consider.

I went trough ID, my wife started to buy the "dirty" rock salt about one year earlier with all of the nice trace minerals. My body temperature was low in the AM and I was close to 98 in the afternoon. IR fixed that. I had started to feel run done, depressed, no energy. That was resolved with iodine. All of my thyroid labs would have been "normal".

The amount of iodine in iodized salt, is really only enough to tread water. And the 150 mcg RDA in some vitamins is no better. Those amounts are useful if one has a good existing level of iodine. RDA is recommended daily allowance and mcg actually means micro-grams. .

So lets say one needed to take in 0.75 grams if iodine for IR. How many days would it take to intake 0.75 grams with the RDA of 150mcg. Simple, 0.75 grams /0.00015 grams per day = 5000 days. But over 5000 days you would loose most of that and for all intents and purposes, the RDA will never fix ID.

For IR you can take up to 50 mg iodine per day and get .75 grams in two weeks. I did that and started to feel better in 2-3 days. Some health food stores will have high potency iodine supplements. Many get a product called Iodoral from internet stores which is 12.5 mg iodine. Iodine was a common disinfectant in every home years ago. Rarely seen now. It was applied to cuts etc. But that stung and fell out of favour. So in large doses such as 50mg, it starts to kill of some of the bacteria in your gut. That can cause some disturbances for some, farting and loose stools etc. After a while I had that problem and skipped the iodine for a day then went on with a lower dose. So you can do something similar as needed.

More IR: Element bromine is related to iodine and in the body it can get stored where iodine would otherwise be stored. You can slowly build up bromine in your system and it is not good for you. Bromine is introduce in foods and medicines: http://en.wikipedia.org/...ne#Applications When you do IR, it will displace bromine in your body that is then excreted. However, serum levels of bromine can make one feel sick during the phase and people will feel that the iodine is making them sick. Those who have such levels of bromine should not abandon IR but should understand what is happening and why. They can also reduce their IR dose to see if things are more tolerable. Bromine stinks. Someone shedding bromine may smell bad or fishy and may have a metallic taste sensation. If this is happening, there would be some comfort in knowing that they removing toxins. If one feels that the bromine displacement is over, they could increase IR dose if that makes sense.

I have read a few comprehensive medical guides to thyroid lab interpretation for cases where the labs do not make any sense, describing various problems like cancer, medicine interference, various genetic abnormalities, T4 higher and T3 lower, vice versa etc. Not a single word about iodine, iodine deficiency, iodized salt or the fact that the GP may have taken the patient to a salt free diet. So you have these very high end endocrinologists who are thyroid specialized and publish about thyroid problems and lab interpretation who are blind to the central role of iodine. Unforgivable.

The cynical side of me wants to point out that if iodine was patented drug, then drug reps would 'detail' this to doctors and they would be aware and alert for iodine deficiencies.

So the complicator: rT3. Reverse T3 is almost the same as T3, except that the molecule is twisted the wrong/reverse way. It fits into T3 receptors and just parks there and does nothing, while not allowing T3 to activate the effected receptors. One could have perfect TSH, T4, T3, fT3, fT3 labs and not have any markers for autoimmune diseased of the thyroid, thyroid would be normal size, symmetric and smooth. But if rT3 is elevated, one can have hypothyroid symptoms. In this case, one can do rT3 lab work, or take your temperature. If temperatures [AM and PM] are low, then you can assume that you have a functional hypothyroid state then test rT3 to see if that is the reason.

So what can cause rT3 levels to be elevated? We do see this with adrenal fatigue, where high stress levels and/or events have exhausted the adrenal glands. The causes can be job stress, relationship stress, job loss, death of a loved one, accidents, injuries, infections acute or chronic, parasites etc. Dealing with adrenal fatigue is difficult and takes time. You can't fix that with a pill. We do see guys with this problem; some have hypogonadism, hypothyroidism and adrenal fatigue. If you want to know more, Google Wilson's book on "adrenal fatigue". It does require a book, not a sticky.

Note that starvation can increase rT3, so I will add starvation diets to that. You can get the same result from over-training, you need recovery days. We see guys here who have totally messed up their hormone systems with starvation diet or diets that are extreme low fat.

But why do we worry about these things in a TRT context? Both hypothyroidism and adrenal fatigue undermine your metabolic capacity. TRT often restores one's metabolism to a youthful state. However, if your adrenals and thyroid levels cannot support that restored metabolic state, you hit the wall, crash or whatever you want to call it. In these cases, guys go on TRT and do not do as well as they should, or simply feel unwell or worse than before they started TRT. So TRT finds these weak links, and surprise! Doctors do not get understand this. So again, you need to be the expert and find a doctor who is not an idiot.

Doctors: There are few who are great and really understand these issues, I have trained a few ;). Unfortunately, most doctors are a deep disappointment. You guys can understand these issues and all of the details that we discuss about TRT. But the doctors typically are clueless. So you are on your own. You have to manage your own health care and be proactive. It is really very rare that a guy will be in any way like that. Most people are totally ignorant about any level of health care issues, and they want to stay that way [passive]. That may sound surprising, but you have to understand that the process of guys using Google and hitting the page content here selects for guys who are trying to learn and find something better than their current state of health or standard of medical care. So these forums select for guys who are already proactive.

I am an old engineer and not a medical professional in any capacity. These issues simply make sense to me as just another system.

12/29/2012 - also see http://www.stopthethyroidmadne...
-- and http://personal.lig.bellsouth....

02/21/2013 - deep info on rT3
http://www.stopthethyroidmadne...

Update: You should not do thyroid labs soon after your thyroid gland is palpated. That can be from a doc or your own exam. This can increase serum thyroid hormone levels and make the lab results inaccurate. See: http://onlinelibrary.wiley.com/....20959/abstract

Parallel to the above, you should not do lab work that includes PSA soon after a DRE prostate exam.

Estradiol: Why You Should Care

Mon, 22 Apr 2013 14:00:00 GMT

Since this is a subject that comes up time and time again, I decided to start this thread so we can easily refer people to this information.

From the beginning...

Estradiol is an estrogen. It is known on blood tests as E2. Many people (even doctors) simply call it estrogen.

Why it Matters

There are basically two reasons we care about estradiol.

The first is that E2 is a powerful testosterone receptor antagonist. What this means is that estradiol binds to androgen receptors and renders them useless. When testosterone binds to an androgen receptor, it activates the receptor and you get the effect you're looking for. When estradiol binds to that receptor, it blocks testosterone from binding, yet it does not active the receptor, so nothing happens.

This means that if your estradiol is high, no matter how much testosterone you have, it isn't helping you as it should because too many of your androgen receptors are blocked by estradiol and your free testosterone has no where to go. Testosterone can't do you any good if it doesn't have receptors available to activate.

It can even get worse... because high levels of estradiol can cause the downregulation of androgen receptors. This means that your body may respond to higher levels of estradiol by creating fewer androgen receptors as cells are replaced in normal regeneration. In other words, not only does estradiol block the available androgen receptors, it causes your body to produce fewer of them in the future! This is one reason why raising testosterone levels may not have any immediate effect. It may be that your receptors have downregulated and so you'll need to lower estradiol and increase testosterone in order to get your body to upregulate again and this takes time.

The second reason we care about estradiol is that you also have estrogen receptors and estradiol binds to them and causes them to activate. This is fine if you want to grow man boobs, store fat on your belly, and have an enlarged prostate, but not so good if you want to look and feel like a man.

Where It Comes From

Brushing aside the highly controversial subject of environmental estrogens, the primary pathway for estradiol production is via the conversion of testosterone by aromatase. This means that the aromatase enzyme binds to testosterone and chemically converts it to estradiol. Think about that for a minute. Realize that this conversion is a double whammy. In one process you're losing T and gaining E. Obviously this is not good.

This is where aromatase inhibitors (AI) like anastrozole (brand name Arimidex - aka "adex" etc.) come into the picture. They bind to the aromatase enzyme and prevent it from converting your testosterone to estradiol. They do not work directly on estradiol nor on estrogen receptors. It is SERM's like Clomid and Nolvadex that bind to estrogen receptors. SERM's and AI's are different animals, so don't get them confused.

So an AI gives you the double whammy in reverse. It prevents the loss of testosterone to conversion and consequently lowers your estradiol which helps keep your androgen receptors available for testosterone.

E Follows T

Here's where doctors fuck up. They forget that E follows T. As your T levels go up, so will your E levels. If you're not doing something to control your E (like taking an AI) then you aren't really going to get anywhere with higher T levels because your higher E levels are just going to cancel out any beneficial effect from the T. Like I said, your T can't do you any good if all your androgen receptors are bound with estradiol.

For those of us with "age related" low T, this is a serious issue because our bodies are naturally trying to keep T low and E high by pumping out aromatase.

If you're younger and have low T for some other reason, aromatase may not be as much of an issue, but it still matters.

Fat

Fat produces estrogen and aromatase; even in men. If you're carrying extra fat, one of the best things you can do to help your hormone balance is to lose the fat.

In Range does not equal Normal

One of the problems you're likely to face is the problem of doctors believing that any blood test value that is "in range" is "normal" and therefor fine. I wish it was that simple.

Let's look at testosterone values. The range for Quest is 241-847 ng/dL. But those values are derived simply by looking at the values of everyone who has a blood test for testosterone. What's normal for a younger man is to be in the higher end of the range. What's normal for an older man is to be in the lower end of the range. Well low T might be "normal" but that doesn't mean it's good! I may be an older guy, but why should I be happy with low T simply because it's normal? ALL men of all ages should be in the higher end of the range if they want to feel good and perform athletically and sexually as men.

The same holds true for estradiol. The range is 13-54 pg/mL but "normal" young men are at the low end of the range and that's where you want to be as well.

Trust me, if your T is 250 and your E is 50, you may be "in range" for both values, but you aren't going to feel good or have anywhere near the athletic and sexual performance that would have if your T was 800 and your E was 15.

Natural Variation

All populations exhibit variation. The average height for men might be 5' 10" but we all know guys who are much taller and much shorter. This same variation applies to T levels, E levels, and reactions to various therapies. In other words, while the principals I've outlined hold true in general, how they specifically apply to you will vary. Be smart and deal with it.

Ok, that's enough from me for now. This is just a basic primer; there's a lot more to this subject so use this as a springboard to do more research on your own.

I'm sure others here will have significant things to say as well.

Good luck!

Advice for New Guys

Thu, 18 Apr 2013 23:55:00 GMT

NOTICE: [11/09/12] We are seeing that a many guys who find there way to this forum have thyroid problems and/or iodine deficiency. Please pay attention to the content below that addresses such issues. See: http://tnation.T-Nation.com/...thryroid_basics

----------------------------

This site has a lot of valuable information that you need to study. And there are a lot of dedicated guys here who provide extensive input and recommendations. While we want to be helpful, explaining the following issues over and over again gets old and frustrating. These recommendations will help us help you and will maintain the value of this forum.

There is a huge learning curve. Most seem to be able to absorb this material easily, but it takes time.

You may have found your way because you have low levels of testosterone [hypogonadism]. However, you can have other conditions that make you feel unwell. The can make the condition of low testosterone worse, or can be why your testosterone levels have dropped. We try to help sort that out so you can identify and treat root causes and not be simply covering up symptoms.

Recommendations:

1) When you open a thread [post] for your situation, you need to be using that same thread forever to maintain your "case". So choose the title with some care, you need to live with it.

2) Put all of your updates and questions into that one thread which is your case. We can then have complete context to best interpret and respond. If your case is all over the place, we can't do a very good job and we really are not interested in searching for your mess of different threads.

3) Read the stickies. There are basics in the 'protocol for injections' sticky http://tnation.T-Nation.com/..._for_injections that apply to all forms of TRT [testosterone therapy]. The Estradiol [E2] thread http://tnation.T-Nation.com/...you_should_care is a must study for any form of TRT.

Some do ask: Stickies are threads that are stuck to the top of the forum because they are important and should not be overlooked. Threads are the collection of posts that are collected under one topic.

4) Read the posts of others. You can find guys with similar issues and you can see how the threads progress and you can learn a lot from that.

5) Please do not inject your "case" into other threads. If the thread is a sticky, you are off topic and you reduce the value of the sticky. If the thread is someone else's case, that would be hijacking. You will not want others taking your case on a tangent either.

6) Your doctor is probably an idiot. If he/she is an endocrinologist or urologist you will probably have one of the worst idiots. This means that finding a good TRT doc is somewhere between difficult and impossible. There is a sticky for that: http://tnation.T-Nation.com/...nding_a_trt_doc

6a) Also see http://tnation.T-Nation.com/...docs_do_and_say
and add your own stories

7) We need you lab work in your case WITH LAB RANGES. If you doc tells you that something is normal, we still need the numbers because we see docs missing problems all of the time. There is also a sticky for lab work: http://tnation.T-Nation.com/...d_blood_testing

8) Do not accept "normal" from your doctor concerning any one lab reading or the whole report. You need to understand things deeper. Most of the time "normal" means that a particular result fits into a statistical measure derived from test subjects. "Normal" typically does not mean healthy or optimal. In a few cases, the ranges have been changed to recommendations such as fasting cholesterol and fasting glucose [blood sugar]. Doctors are really bad for thinking that lab normal means normal state of health.

9) If you are here trying to find sources for gear or someone to prescribe large doses of testosterone, go someplace else, we cannot help you in this forum. Do not post sources of drugs. Do not request that others post sources. What you do in PM's is your business. Bro-speak, bro-knowledge and bro-science will get you far on this forum.

10) You need to actively manage your own health care. Do not be a passive patient, which rarely has a good outcome when TRT is involved. Review your health conditions, symptoms and drugs your self. Many here will assist you. You also have to be proactive about your diet and supplements. You need to review drugs, Rx and OTC. Some make you feel worse, some make your hormone worse or cause the hormone problems. We can also review your meds.

11) Do not present what you know unless you are very certain of the facts. If you post crap, we will crap on you and we have to refute what you state so it will not mislead others. If you are not authoritative, don't be. Link to outside sources if needed. Be prepared to support things that you state. Otherwise, contribute!

In your case/thread opening post:
-age
-height
-waist
-weight
-describe body and facial hair
-describe where you carry fat and how changed
-health conditions, symptoms [history]
-Rx and OTC drugs, any hair loss drugs or prostate drugs *ever*
-- real dangers! see this http://propeciahelp.com/overvi...
-lab results with ranges
-describe diet [some create substantial damage with starvation diets]
-describe training [some ruin there hormones by over training]
-testes ache, ever, with a fever?
-how have morning wood and nocturnal erections changed

Note that you can edit all of your posts. In the lower RH corner, click 'edit' make changes and submit.

The language:

idiot -see doctor
T - testosterone
E - estrogens in general
E1 -estrONE
E2 -estraDIol - our main interest, you can basically ignore E1, E3
E3 - esTRIol
aromatase - enzyme that converts T-->E2
aromatization - action of aromatase
AI - aromatase inhibitor, reduces/modulates T-->E2 aromatization
anastrozole - AI
Arimidex - Brand/marketing name for anastrozole
DHT - dihydrotestosterone, a metabolite of T, mission critical for libido
5-alpha reductase - an enzyme that does T-->DHT
5-alpha reductase inhibitor - as implied, in hair loss drugs, very dangerous for a few
libido - sexual desire
T4 - thyroid hormone containing 4 iodine atoms
T3 - what you get when you remove one iodine atom from T3, the active form
rT3 - a non functional form of T3, creates serous problems if elevated
fT4 - amount of T4 that is not bound to thyroid binding protein
fT3 - guess
cholesterol - the starting point for all steroid hormones
mitochondria - ancient bacteria within cells that is symbiotic in most life forms
pregnenolone - made from cholesterol by mitochondrial bodies in your cells
CoQ10 - made in liver, reduced by statin drugs, essential for mitochondrial function
progesterone - made from pregnenolone [adrenals]
cortisol - made from progesterone [adrenals] - dead without it
ATCH - signals adrenals to make corticosteroids http://en.wikipedia.org/wiki/A...
DHEA - made from pregnenolone [adrenals]
T, testosterone - made from DHEA, mostly in the testes
Estradiol [E2] - made from testosterone in the testes and in the body
injected T: vegetable oil with dissolved testosterone esters and BA [~1%]
testosterone esters - chemicals that can be dissolved in oil
bio-identical testosterone - same molecule that occurs in the body
esterase - enzyme that removes esters, in this context, from testosterone esters
BA - benzyl alcohol to prevent bacterial growth
iu - international unit, definition varies with the drug/vitamin involved
vitamin D3 [vit-D3] - an essential vitamin
Vit-D25 - vit-D3 converted into the active steroid hormone
hematocrit - part of a CBC, fraction of blood cells that centrifuges separate from liquid.
CBC - complete blood work
FSH - a gonadotropin that is needed to make sperm
LH - a gonadotropin that is needed to make T in the testes
hCG - a gonadotropin that has one part that is identical to LH, weakly acts like FSH
peptide hormone - FSH, LH, hCG and growth hormone [HGH], amino acid based
prolactin - a peptide released by orgasms or in high amounts from a pituitary andinoma
adinoma - another word for a behign tumor
steroid hormone - based on cholesterol
doctor - see idiot
EFA - essential fatty acid, fish oil, nuts, flax seed etc, good for endothelium & more
endothelium - lining of blood vessels http://en.wikipedia.org/...iki/Endothelium
endothelial dysfunction - a mechanism of arterial/heart disease
Clinical research - yields info that can guide diagnosis, treatment and dosing
medical research - yields info about processes, very often misleads, may not be human
in-vivo - research based in living organisms, sometimes useful
in-vitro - research in "glass" as in test tubes etc, rarely of practical use
SERM - selective estrogen receptor modifier, leads to more LH. FSH, T, and E2
clomid - a SERM that is old with many functional research studies
nolvadex - a newer SERM that is better than clomid, but old research distorts the truth
transdermal - drug delivered through the skin, typically very inefficient and costly
QOL - Quality of Life
endothelium - lining of blood vessels http://en.wikipedia.org/...iki/Endothelium
endothelial dysfunction - a mechanism of arterial/heart disease

T+AI+hCG - a protocol that includes those three items

EOD or E2D - drug dosed every other day
E3D - guess

half life - how long a drug takes to fall to half of its peak level
clearance time - how long it take for a drug to be basically gone from your system

serum - pertains to blood levels
saliva - pertains to levels in saliva
tissue levels - can't do that on humans, saliva levels are thought to be similar to tissues

Rx - prescribed meds
OTC - over the counter meds

HPTA - Hypothalamic Pituitary Testicular Axis, regulates levels of steroid hormones. T and E inhibit the HPTA leading to less LH and FSH peptide release from the pituitary. E is much more repressive than T. Prolactin and progesterone are also repressive.

Hypogonadism: Your HPTA is broken or weak.
Primary hypogonadism: Your testes [testicles] are weak or failed.
Secondary hypothyroidism: Your pituitary+hypothalamus are producing little or no FSH & LH

Adrenal fatigue: AKA hypoadrenia or adrenal dysfunction. You will see this and other adrenal issues been discussed. Your adrenals can be weakened by long term stress, loosing your job, a death in the family, auto accidents or other trauma, chronic infections, chronic inflammation [like gum disease], parasitic diseases and more. This book is a really good reference: http://www.amazon.com/...TF8&s=books One of the signs of this is general weakness and feeling that stressful events wear you down or make you feel physically weak. Many docs do not believe that this condition exists, partly because there is no billing code for it.

Injections: Testosterone injections can be IM [intramuscular] or SC [subcutaneous] sometimes written as SQ. Injectable testosterone is most always 200mg of T ester per ml. To inject 100mg/week, you would inject 0.5ml/week. But report your dose in mg's, not ml's. The two most common T esters are testosterone cypionate and testosterone ethanate, also known as cyp and eth. As the dose also includes the weight of the ester group, once the ester group is removed in your body, the mg's of testosterone is less than the mg's of T ester injected. The result is around 70% bio-identical testosterone. There is more T in a T eth dose than a T cyp dose as eth ester groups weigh less, leaving more T per unit dose. T ester injections are time release delivery systems. Heavier esters release more slowly and lighter esters faster.

To read more, Google [term wiki] to easily find Wikipedia articles. While there explore the many links in the articles. IE http://en.wikipedia.org/...Steroid_hormone

If in doubt, Google and read.

A good first read: But predates use of hCG, anastrozole and has antiquated understanding of how T should be injected: http://www.amazon.com/...e/dp/087131858X

Lab Work, Blood Testing and Symptoms

Thu, 11 Apr 2013 17:15:00 GMT

This sticky is maintained by KSman. This lead post is the sticky. DO NOT ATTEMPT TO DISCUSS YOUR PROBLEMS HERE! This is for technical reference use. KSman will compile information here and it will be a conservative approach. The next post will be for a broader approach that will be more expensive than most will tolerate and beyond what most insurance will pay for. Keep suggestions and contributions on topic. Some things might be better as PM's to KSman to keep down the clutter.

To understand what the lab work means, what needs to be done, when it needs to be done and what is a waste of time, you need to become an amateur endocrinologist. Or in my case "Endocrinology is my hobby!" This however does give way too much credit to Endocrinologists as most of them really are the amateurs and make some of the worse blunders and have pathological ego problems that keep them from learning what they need to know. I hold most Urologists in the same high esteem. Some of the best TRT docs are not formally medical specialists, but are self taught enthusiasts. But we will save all of that for a [controlled] "Finding a TRT Doc" sticky.

This will be a mix of simple recommendations, explanations and the occasional rant.

-------------------------------
Added 01/26/2011

FT is T that is not bound to SHBG or other proteins.

SHBG: http://en.wikipedia.org/...inding_globulin
Note that SHBG does not transport and release T, SHBG bound [SHBG-T] is not bioavailable. You will find many incorrect references to the contrary.

SHBG-T is tightly bound. Estrogens bind weakly to SHBG and SHBG can transport estrogens and release the estrogens throughout the body. Note that SHBG occurs in blood, but does not exist in tissues. So all T in tissues is considered FT. Secretions, such as saliva, can be used for hormone lab work and the results are considered FT, thus there is no TT in saliva testing. Many feel that saliva testing is quite useless.

Weakly bound T: T can be bound to other proteins [not SHBG] such as albumin in the blood. Those are weakly bound and the albumin bound T can be release T to tissues and this is considered hormone transport. There are other proteins to which T can be weakly bound. Note that some males loose serum albumin levels as they age. This is thought to also reduce bio-T:TT to some extent. In reality, these guys have low T, and lower albumin is one of the catabolic effects of low T. TRT would be expected to improve albumin levels.

With age, we see E2 and SHBG increase. This tends to increase TT, as FT/bio-T are falling and that can be misleading.

Bio-T is FT plus weakly bound T. Both measures are technically useful. Bio-T and FT are roughly proportional. So you typically do not have any need to do both of these types of labs.

TT is FT + weakly bound + SHBG-T. Note that for a given production rate of T, or a given TRT dose of T, the more SHBG you have, the more TT you will have. In this regard, TT can be the wrong therapeutic target and can be a simplistic and inappropriate concern if one does not understand the larger picture.

From a practical point of view, lab results should be useful. So the results need to be something that others are sufficiently familiar with to interpret. Most here are familiar with FT and not with bio-T. So FT will be better from that point of view.

To put the whole picture together, you also need estradiol numbers. With FT, TT and E2, there is very little need for SHBG lab numbers.

Note that some labs produce high FT ranges and results compared to other labs. FT lab numbers always need the lab ranges for interpretation. In this regard, I expect that bio-T has the same problem and bio-T results will always needs the lab's ranges for interpretation.

In HPTA intact males, LH is released in pulses and diurnal patterns. This leads to changing FT levels. FT has a short half life. When you test FT in these males, the absolute number is not very important as the result is partly a factor of when the lab work was done. With TRT using transdermals, the swings in FT are more extreme and lab timing greatly determines the lab values. With frequently injected T, TT, FT and E2 levels can be very steady and FT lab results thus are more valuable in that case.

--------------

Labs to be done before you start TRT
-LH and FSH [LH/FSH]
-TT
-FT or bio-T
-E2
-Prolactin [optional in most cases]
-DHT [sort of a waist of time and blood if your testosterone levels are low]
-PSA
-DRE: the dreaded digital rectal exam, doc gives you the finger.

Labs to be done when on TRT
-TT
-FT or bio-T
-Implications of injections VS transdermals [and injection frequency]
-E2
-Prolactin [optional and almost never on-going]
-DHT [should be checked, but perhaps not on-going]
-LH/FSH [optional and one last time -do I have cancer?]
-PSA
-DRE: the dreaded digital rectal exam [Your doc does not enjoy this either!]

Labs to never do and timing issues:
-DO NOT test E2 ultra sensitive
-DO NOT do saliva testing for T or E2 and expect any help here
-DO NOT test for free E2
-DO NOT test total estrogens
-DO NOT test PSA within 48 hours after a DRE [digital rectal (prostate) exam] or ejaculation
-DO NOT test prolactin with 48 hours of orgasm, avoid hugging puppies and babies
-DO NOT do lab work when muscles are sore from training or injury as your "liver markers" will show high levels. Those "liver tests" are really not liver specific.
-DO NOT waist time and money on tests that you cannot take any action on. Example, testing IGF-1 for growth hormone status if there is no way you could every pay for GH or actually legally qualify for GH.
-DO NOT routinely test for LH/FSH when on TRT, perhaps once to rule out certain testicular cancers and never again
-DO NOT test for serum DHEA, must test DHEA-S
-DO NOT do saliva testing for T, DHT, DHEA, pregnenolone if taking sublingual/buccal T, pregnenolone OR DHEA OR other steroid. The tests will be wrong and you do not want cross reactivity unknowns
-Testing E2&TT&FT makes also testing SHBG sort of useless.

Labs that are stupid after you start TRT
-LH/FSH

Thyroid labs [basic first line]
-TSH
-T3 no see fT3
-T4 no see fT4
-are you getting enough iodine? probably not! http://tnation.T-Nation.com/...thryoid_problem
-? stuff that Hardasnails will suggest to me via PM

Adrenal labs
-Cortisol four sample saliva testing [the gold standard]
-Pregnenolone [the foundation of the adrenal hormones and all steroid hormones *]
-DHEA [can't make T without it] no see DHEA-S
-DHEA-S [DHEA Sulphate]

* Vit-D is multi-step derived from cholesterol directly, not via pregnenolone. Pregnenolone is also direct from cholesterol. Cholesterol is really the root of all steroid hormones. [Because cholesterol can be considered a precursor of testosterone, and testosterone a metabolite of cholesterol under Federal Statute [http://www.justice.gov/dea/pubs/csa/802.htm], cholesterol is technically a schedule III controlled substance and is subject to criminal penalties as an illegal anabolic steroid. Attempts by John McCain and others to explicitly classify DHEA as a schedule III anabolic steroid have nonetheless failed. See http://frwebgate.access.gpo.go... ]

General health labs
-CBC: Complete Blood Counts
-Hematocrit: Part of CBC but needs its own discussion
-Lipids: Fasting Cholesterol and related
-Vit_D25 hormone -yes vitamin D becomes an essential steroid hormone
-Glucose: Fasting levels indicate insulin function
-Liver markers -are they really liver specific? [Hint: not]

Things that you can determine without lab work

Symptoms: Why are you here
-Brain fog, no one knows what that means but everyone knows if they have it!
-Social withdrawal - "I would rather not go out"
-Why do I have boobs? This really is depressing if prolactin is the cause!
-Why do I carry fat like a woman?
-Why am I a moody bitch?
-Can't get it up?
-It is up, now it's gone.
-My penis is numb -your nerves love T too. Things to do with testosterone cream.
-My testes are softer and smaller
-My testes ache 24x7
-My scrotum is up-tight, gives "how are they hanging" a whole new meaning.
-Nocturnal erections -necessary but not sufficient
-"morning wood" -things are working
-Why do really hot looking women and girls now look like art instead of lust?
-I felt great when I started TRT, where did that go? Neural transmitters rule your life.
-My TRT seems ineffective or never was. Things that crash in the night.
-On TRT and still do not feel right, something else is wrong.
-Loss of hair on lower legs, skin below the knees is smooth and shiny.
-Why do I feel cold easily or all of the time?
-Why do really stressful situations leave me feeling physically beat up. Adrenal fatigue.
-Dry skin, brittle hair and nails
-Skin on the back of hand is thin, crinkly. Pinched skin does not recover
-Gum disease, the ugly killer
-Why do I have a chronic cough [when taking a statin drug]
-I have visual field disturbances such as reduced peripheral vision
-My joints have started to ache
-TRT and now leg cramps
-TRT and wife says I am snoring more
-I am not depressed, I just don't care about anything, no joy, no motivation, no reward
-I want sex twice a day and my wife/GF is freaking out. What do do about her.
-We fixed my wife's hormones and I can't keep up with her needs. [Give me her phone number!]
-I want sex twice a day and my wife/GF loves it. Why are you still here?

Related:
-pituitary MRI for younger cases of hypothyroidism "what is in there"
-testicular ultrasound exam, detects cancer [please help with other uses]

---------------------------------------

Serum E2 testing:

E2 is estradiol - in case you were wondering [E1=estrONE, E2=estraDIol, E3=esTRIol]. There are different lab tests to choose from and docs often get this wrong. Some testes have limited reporting ranges and will not report actual values below a certain level and might report <17 pg/ml instead of the actual value. The reason for this is that these tests were developed for work on women's hormones. Women who are fertile have very high levels of estrogen and some tests are appropriate for those levels. Women who are post menopausal have low levels of estrogens and the need tests that are sensitive for those low levels. For post menopausal women with breast cancer, SERM drugs are used to push there already low estrogen levels even lower. Ultra sensitive tests are used to detect these very low levels to determine the effectiveness of the treatment.

For TRT, use the basic LabCorp serum E2 test or Quest Sensitive 4021x. DO NOT USE Quest ULTRASENTIVE! There are some similar issues with other testing labs as well.

DO NOT test for free estradiol
DO NOT test for total estrogens
DO NOT do Saliva testing, simply because very few people know what to do with that data.

https://www.labcorp.com/.../?testId=408010

Note that many older men, getting fat with low testosterone, can have more estrogen than their post menopausal wives! And old men and women can end up having similar body shapes.

E2 levels are modulated with low doses of aromatase inhibitors such as Arimidex/anastrozole. Optimal level is near serum E2=22pg/ml. Some doctors will prescribe 1mg/day which is a TOTAL disaster unless you are female and have estrogen positive breast cancer. Another idiot doctor mistake.

------------------------------

See this thread concerning problems with Labquest FT testing:
http://tnation.T-Nation.com/...t_labs?pageNo=0
Note that Labquest can also report FT ranges that are about 5 times higher than reality. So you cannot compare Labquest results to Labcorp and others. FT lab results must be reported with lab ranges.

TRT: Protocol for Injections

Fri, 05 Apr 2013 17:07:00 GMT

Many guys ask for these details. Here is enough info to get started. You probably will not get your doctor aligned with this without a struggle [or a new doctor]. This is really a small part of what most guys need to know.

TRT: Protocol for Injections

* 100mg test cypionate or ethanate injected per week with two or more injections per week.
* 250iu hCG SC EOD [every other day]
* 1.0mg Arimidex/anastrozole per week in divided doses.

Injecting testosterone once a week induces spikes in testosterone levels followed by lows. This can make many feel bad or worse at the end of the week than their pre-TRT state. As time goes on the dead zone gets wider and they feel no relief with injections. These feel much better injecting twice a week or even EOD [every other day].

Injecting every 2, 3 or 4 weeks is horrible. You need to self inject and inject frequently. With frequent injections the volumes are very small and one can inject in the quads [vastus lateralis] with #29 0.5ml 0.5" [50iu] insulin syringes.

These are slow to load but injection times are reasonable as the small plunger diameters create very high pressures. Do not use 1.0ml syringes. This same size syringe can be used for hCG injections, which are also SC.

EDIT: Injecting EOD [sometimes written as E2D] or E3D [every third day] can be a difficult schedule. You can set up reminders or appointments in calendar software, such as MS Outlook, for E2D or E3D etc.

Small needles will reduce muscle damage. Some use #25 1" needles, but this may not be any "faster" than the above 50iu insulin needles.

You do not need to inject into your gluts with 1.5" needles!

Canadian clinical research has demonstrated that TRT by SC [under the skin injections into body fat] produce steadier testosterone levels and improves sense of well-being. Feel free to find out what is more comfortable for you.

For those who train and sweat/shower a lot, transdermal T creams and gels are not appropriate.

Transdermal T creams [and patches] are expensive. At best, only about 10% of applied testosterone is absorbed. Transdermal delivered dose is a crap shoot. Guys who have low thyroid levels are typically non-absorbers. Some absorb transdermals at the start, but skin changes can shut off absorption after a while. With injections, there are no unknowns about drug delivery.

hCG is a water based peptide hormone can be injected to replace the lost LH hormone that TRT shuts down. Without hCG, the LH receptors in the testes are no longer getting activated. The results are:

* The testes shrink. Over time for some the testes can eventually become small undifferentiated lumps of collagen. This is drug induced organ failure. The degree of shrinking varies from guy to guy and may be more of a problem for the older guys.

* Fertility can be greatly reduced or eliminated. If making babies is important, you need to inject hCG. If hCG is not used, its use after a long time may or may not recover fertility.

* When the testes get smaller, some feel an ache in their testes 24x7. hCG injections can eliminate that pain or avoid the whole episode.

* When there is no LH or hCG, the scrotum pulls up tight to the body. This has the appearance of a pre-pubescent boy. This is not good for ones sexual self image and this also affects how women perceive you sexually. Some women get very upset when they see this maleness disappear, thus affecting their sexuality and interest in you.

* The testes are the single largest producer of the hormone pregnenolone. Pregnenolone is important for proper mental functioning, and is the precursor to all of the steroid hormones such as DHEA, testosterone, DHT, estrogen, cortisol... Injecting hCG prevents a drug induced pregnenolone deficiency and helps support the other hormones. When guys are on T without hCG and then start hCG, they report a significant improvement in mood that many attribute to restored pregnenolone levels. [If that is not the case, hCG must have some direct effects in the brain.]

When injecting hCG, you inject into the fat under the skin just the same as diabetics inject insulin. The product literature is all about use a fertility drug for women with large IM [injected into muscle] doses. There is no need for men to inject hCG IM.

Research using SC injections in men has demonstrated the effectiveness of the 250iu EOD dosing. You can seek diabetic patient educational material for insulin injection techniques to use for hCG and/or testosterone injections.

Elevated normal [30pg/ml and up] serum E2/estradiol can block many of the benefits of testosterone replacement. Serum E2=22pg/ml is near optimal and one should dose anastrozole to get close to this level. Many who start TRT have some good results that soon vanish as E2 levels increase. My recommendation is to start anastrozole at 1.0mg per week [in divided doses] starting the day of the first injection. The let the first follow up E2 lab drive any needed anastrozole dose adjustments. It is not a good idea to wait and see how high E2 levels go before taking action. Dose anastrozole EOD if possible.

A few guys are anastrozole over responders. This is not known in the drug literature. These guys will get E2 in the single digits and will feel like crap physically and mentally. They may feel a spike of short lived libido as they fall through the E2 levels sweet spot. These guys need to take 1/4th or 1/8th of the expected anastrozole dose -something to watch for. If this is suspected, stop anastrozole for 6-7 days then resume at 1/4th the dose.

The 100mg dose of injected T should get guys into the 800-900 total testosterone [TT] range. That is nice to see, but one should be looking at free testosterone [FT] or bio-available testosterone [bio-T]. Some docs, who know what they are doing, will not bother checking TT numbers at all. SHBG levels increase with age and FT ratios drop.

A TT=1000 in a young man is not the same as TT=1000 in an older man with higher SHBG levels as the FT numbers will be well below that of the young man with the same TT. This may very well create TT levels that are above the youthful lab ranges and should not be a concern. Lab ranges shown on lab reports will be age adjusted. You need to be using the ranges for youthful men.

You need to know about PSA, prostate issues and DREs [digital rectal exam]. E2 is a large cause or aggravator of BPH [enlarged prostate]. Many find that lowering E2 to near E2=22pg/ml improves their BPH and urine flow is improved.

You need to monitor hematocrit levels as part of your routine lab work.

Finding a TRT Doc

Wed, 27 Mar 2013 19:28:00 GMT

Do not discuss your own issues in this sticky. Create your own post.

The biggest problem for guys with hormone problems is finding a doctor who knows what he is doing. Most doctors are ignorant and unwilling and many who are willing are dangerous and stupid. Do not think that a specialist like an endocrinologist or a urologist is going to be able to help you. As a rule, these specialists are some of the worst offenders. An enthusiastic GP is your best bet.

Factors:
-do you have insurance for docs and labs?
-do you have prescription drug coverage?
-does a doctor take your insurance?
-does your insurance cover compounded drugs?
-do you have any strong preference for injections vs transdermals?
-what country are you in? Any English speaking ex British colonies other than the USA are a problem

How to get a referral:

Talk to your doc first, if he is not willing or able, he may know who is. If he sends you to a endo or uro, he may simply be getting you out of his face.

-Google Earth: http://earth.google.com/...load-earth.html
--zoom into your region
--enter "compounding pharmacy" in the "fly to" box
--explore links to web sites, look for patient info concerning male hormones and referrals, start phoning and ask to talk to a pharmacist and explain your needs [factors above] and explain what you are looking for, health insurance issues, and preferences for injected vs transdermal and your needs for Anastrozole and hCG
--compounding pharmacies know regional doctors, the pharmacy need not be close to you.

-Local Pharmacies:
-- start phoning
-- local pharmacies will know local doctors
-- see above

-Anti Aging clinics:
--They can be good and bad. Many will do the labs and mail all of the drugs and syringes to you. The prices can be very extreme.

If you are paying out of pocket, injections are cost effective. Compounded T creams can be affordable. T gels are $250 - $300 per month, depends on dose. Do not consider pellets or patches.

Study: http://tnation.tmuscle.com/...e_your_hormones

And write down your history symptoms. Print two copies, one for you and one for your doc. Doc can mark that up and retain and spend less time taking notes and asking random questions. This puts your concerns up front and provides talking points.

age
height
weight
waist
describe body and facial hair
did to grow fast or slow and steady as a teen
testes ache or hurt? ever?
mood
depression
libido
get cold easily? a change?
dry skin, brittle nails?
use iodized salt?
eat much sea food?
exposure to chemicals?
ever used hair loss drugs?
Rx and OTC drugs

Related:
http://tnation.tmuscle.com/...27&pageNo=0

And just when you thought things could not get any worse: http://tnation.T-Nation.com/...nd_say?pageNo=0

Things that Damage your Hormones

Sat, 02 Feb 2013 21:02:00 GMT

This thread discusses things that cause hormone problems. This should be a "read the stickies" resource so we do not need to state the same things over and over in individual posts.

I will maintain this leading post by editing it. Additional material will be added to this leading post, not in posts that discuss these issues. This will keep chatter out of the sticky and this lead post is the sticky. Changes and corrections will be made as needed.

Please keep posts/comments/suggestions/contributions on topic. DO NOT ATTEMPT TO DISCUSS YOUR OWN PROBLEMS HERE! This post is meant to be a technical resource. Some things might be better sentas PM's to KSman.

--------------------
Things that damage your hormones -list of topics:

Pituitary damage: ref http://en.wikipedia.org/...Pituitary_gland
-blows to the head or whiplash http://en.wikipedia.org/..._%28medicine%29
-adinomas http://en.wikipedia.org/...tuitary_adenoma

Drugs and chemicals:
-Rx drugs
-OTC drugs
-hair loss drugs
-alcohol
-other chemicals, toxins, pollution
-heavy metals
-fire retardants in furniture or fire fighter's fire retardant clothes
-smoking

Effects of other reproductive and related hormones:
-Estradiol http://en.wikipedia.org/.../wiki/Estradiol
-Prolactin http://en.wikipedia.org/.../wiki/Prolactin
-Xeno estrogens http://en.wikipedia.org/...ki/Xenoestrogen
--lavender
-Xeno testosterone: http://tnation.T-Nation.com/...tase_inhibitors
--hair loss drugs 5-alpha reductase inhibitors -extremely dangerous for a few - see above
-Prohormones [PH] http://en.wikipedia.org/...wiki/Prohormone -extremely dangerous for a few
-Deca http://en.wikipedia.org/...wiki/Nandrolone - see xeno-testosterone above

Damage to the testicles [testes] ref http://en.wikipedia.org/.../wiki/Testicles
-cancer http://en.wikipedia.org/...sticular_cancer
-Varicocele [blood supply] http://en.wikipedia.org/...wiki/Varicocele
-Torsion [Physical damage] http://en.wikipedia.org/...ticular_torsion
-Trauma http://en.wikipedia.org/...sticular_trauma
-Fever: If you have a fever and your testes hurt, they may be damaged

Damage to the pituitary gland:
-head trauma, blow to the head or whip lash can scar the pituitary gland
-a pituitary adenoma http://en.wikipedia.org/...tuitary_adenoma
--can decrease LH and/or increase prolactin
--may press in optic nerves, reducing peripheral vision in one or both eyes
---could create other visual field disturbances [not vision correction issue]
--can results in other hormone problems
-watch for multiple pituitary hormone problems

Comorbidies: http://en.wikipedia.org/...iki/Comorbidity
-hypothyroidism http://en.wikipedia.org/.../Hypothyroidism
-adrenal fatigue http://en.wikipedia.org/...Adrenal_fatigue
--watch DHEA-S levels
-syndrome X aka metabolic disorder http://en.wikipedia.org/...abolic_syndrome
-insulin resistance [and diabetes] http://en.wikipedia.org/...ulin_resistance
-influences of the digestive system
-arterial disease and high blood pressure [BP]
-poor cell wall permeability

Deficiencies:
-low cholesterol, natural, diet induced, result of statin drugs
-low CoQ10, age related, induced by statin drugs
-low dietary EFA's [essential fatty acids]
-low iodine http://tnation.T-Nation.com/...thryoid_problem
-other low trace minerals
-sub optimal vitamin D
-anti oxidants

Supplements, when more might be better:

---------------
01/04/2010, created a post on dangers of 5-alpha reductase drugs, linked above under zeno-testosterone

Help with TRT

Mon, 20 May 2013 02:22:00 GMT

Yes I made a new thread to make it easier to look at things and try and give more info.. I included previous info. Currently i am taking test cyp 100mg/ml and 1.5 ml per week i have just this week started to split the injections and if i can get insulin needles will be starting SUB C injections..

-age:34

-height:6 foot

-waist:32 but more like 35 at navel (bloating)

-weight:185 ilbs

-describe body and facial hair: No back hair, facial hair is pretty solid around Go T but
blotchy everywhere else, hair on forearms and legs, small amount of chest hair.

-describe where you carry fat and how changed: always seem to have carried fat in abdomin and love handles some in chest. skinny everywhere else

-health conditions, symptoms:Dull pain in joints: forearms, wrists, hands, feet, ankles, knees. Knees and ankles feel week. Redness can be seen in knuckles more predominate at times.

Tingling in hands and sometimes feet

Rib pain: very frustrating, I find myself holding my breath as too not feel it when sitting, not even sure if its ribs or under ribs on right side feels like whole right side from hip to ribs is inflamed. Could this be or be combined with liver pain??

Strong hip pain right side: Hip flexor, groin, lingual area, outside of hip, seems to be gradually becoming worse and radiating more.

Low back pain: Extreme at times can't walk properly, trouble sleeping because of pain. As an example if I were to jump when feeling the pain it feels like something is bottoming out.
Muscle cramps, twitching, spasms, muscle loss.

Tooth decay: pieces coming off my teeth.

IBS: have been hospitalized with a pain below the belly button that put me out cold on the bathroom floor, woke up hours later.

Acid reflux; have had this for years

Umbilical hernia: upcoming surgery, surgeon said would only cause localized pain.

Cognitive issues: Slower thinking (brain fog). Find myself staring into space. Not retaining what I read very well or the same as I use to. Have trouble focusing while reading and words become blurred

Weight gain: mostly in abdomen love handles

Hair loss: After a bath can at times physically see a ton of hair in the tub. Plus hair is very much thining

Low body temps: have been as low as 94 degrees upon waking almost never getting to 98.. Excessive sweating while sleeping

Dry brittle toe nails. Split easy.

Calcium deposits or white dots on face under eyes

Have had some problems with boils have scars and have had to lance them. Also having issues with pimples that never come to the outside of skin and just stay there.

Blood sugar dropped to 2 in Edmonton at a concert, had eaten four times that day and had 2 beers max also has happened a few times since.

Headaches almost every day mostly temporal area but also in the back of the head, have had migraines in my life

Very foggy in the AM, takes hours to wake up (taken coffee out of diet)
Over sleeping

Yawning all day

Not hungry in the morning yet very hungry at night

Ear problems.

Extreme Hot flashes: I would have thought maybe andropause but still have them :(. They seem to come more with the pain or maybe even stress because of the pain??

Social anxiety: Decreased tolerance for people.

Complete lack of energy and fatigue most of the time

fatty liver and pancreas,scoliosis not really bad but about 25 degrees

-Rx and OTC drugs, any hair loss drugs or prostate drugs *ever*. NO

-describe training: not over training, finding it very hard to even work out

testes ache, ever, with a fever? NO, maybe since trt a little

how have morning wood and nocturnal erections changed: morning wood is improved since trt

I worked underground for 4.5 years on a tunnel project and was ingesting dust and diesel fumes. Also silica exposure may have been a factor.
Old labs prior to trt

LABs:Pre TRT

TT 18.0 ... M; 7.6 - 31.4 nmol/L
FT/ 17.8, 24.9, 27.0, 29.0... 31.0-94.0 pmol/L
LH/ 4 ... 2-9 IU/L

Estrodiol/ 128 ... <157 pmol/L
TSH 1.610 ... 0.35-5.00 mIU/L
prolactin/ 4 ... < 18 uh/L
fsh/ 6... 2-12 IU/L
DHEA-S never measured :(

fasting cholesterol 5.09 mmol ... Desired <5.20 mmol/L
fasting glucose serum/ 5.2 mmol/L .. 3.6-6.0 normal fasting glucose
cbc

LEUKOCYTES 10.8... 4.0-11.0 X10^9/L
ERYTHROCYTES 4.5-6.0 X10^12/L
HEMOGLOBIN 163... 135-175 GL
HEMATOCRIT 0.470.. 0.400-0.500 L
MCV 89... 80-100 FL
MCH 31.0... 27.5-33.0
MCHC 348... 310-360
RDW 11.2.. LOW 11.5-14.5
PLATELETS 252.. 150-400 x10^9/L
MPV 8.2... 6.2-13.4 FL
ABS NEAUTROPHIL 7.3... 2.0-7.5 x10^9/L
ABS LYMPHOCYTES 2.5 ... 1.0-3.5 x10^9/L
ABS MONOCYTES 0.6... 0.0-0.8 x10^9/L
ABS EOSINOPHIL 0.3... 0.0-0.5 x10^9/L
ABS BASOPHIL 0.1... 0.0-0.2 x10^9/L
SED RATE 2 0-20 MM/HR acth 2.7 ...<10 pmol/L
rhuem factor <10... <14
hydroxy VitD 67... insufficiency 25-75 nmol/L I supplement every day since this :)
antinuclear ab.. negative
glucose serum ..5.2......3.6-6.0 normal fasting glucose
cholesterol 5.09... <5.20
triglycerides 0.49... <2.30 mmol/L
hdl cholesterol 1.28 .. M: >=1.00 mmol/L
LDL cholesterol calc 3.59 ..... mmol
TC/hdl ratio....4.0
B-12....321 way above par
Farritin 141ug/L......80 to 300 Ug/l
Tsh... 0.62.......... 0.35-5.00 miu/l
hemoglobin aic 0.57.... 0.40-0.60 non diabetic
cortisol random 256.....65-540 nmol/L
psa 0.34ug/L

HEMOGLOBIN 147.....M:135-170
RBC.....4.77...M:4.20-5.70 X 10E12/L
HEMATOCRIT...4.77...m:4.20-5.70

Alt is a little bit high at times i also have a fatty liver and pancreas...

waking body temp: 96 and 96.8
mid afternoon body temp: 98.6
march 19 waking:96.7
mid afternoon: 97.8
march 20 waking 97.6 mid afternoon 97.8
friday march 26, waking 96.7 mid afternoon:97.1,97.8
I never get over 97.6 and waking is usually 96.7

NEW THYROID LABS

TSH (1.08)....35-5.00 mIU/L

T4 FREE (17)...12-22 pmol/L

FREE T3 5.8... 2.6-5.7 pmol/L HIGH

THYROGLOBULIN AB (<20.)....<41 kIU/L

THYROID PEROXIDASE (<10.)....<35 KIU/L

Doc tells me this has nothing to do with body temperature and this isn't a problem and he can't help me!!

Has no idea what RT3 is?

NEW LABS: after TRT (more to come)

PSA 0.36... UG/L

TT 33.5 ... 7.6-31.4 nmol/L HIGH
E2 124... <157
FT 62.1... 31.0-94.0 p,ol/l
GLOCOSE FASTING 4.9... 3.6-6.0 NORMAL FASTING GLUCOSE
CHOLESTEROL 4.27 < 5.20
TRIGLYCERIDES 0.52... <2.30 nmol/L
HDL O.99... >=1.00 mmol/L LOW
LDL 3.04
TC/HDL-C RATIO 4.3
AST 32...<37 U/L
ALT 59... <46 U/L HIGH
DHEAS-S 7.1..4.34-12.2 UMOL/L

Ok I just dosed .75 and will try 2 times a week. I have no option for hcg and I'm not buying from steriod dealers. I may just get off the shit all together. I can't get the labs I want or when I want them. Doc says free T is fine and will not budge on dose as total was over. And it was the sixth day.

I never said hcg or the protocol was bs just trying to find a different doctor but what can I do when they don't agree?

Dr E Berry Gordon says this protocol is bullshit. Find him on you tube.

Is it ok to inject .75 sub q?

Also do u think e2 will raise now with lowering the dose? I'm just not sure about anything. Why isn't it just a set protocol for everyone? I honestly wish I never started this shit. As you can see my e2 dropped four points after trt but ya not much. Concern about dropping dose two times weekly is that it will leave receptors open for estradiol to move in?? maybe sounds stupid but a concern as I don't want it higher.. Could high e2 cause muscle and joint pain?

NEW LABS: 2013/14/16

GLOCOSE FASTING 5.8... 3.6-6.0 NORMAL FASTING
CREATININE 85.. 60-100 UMOL/L
EGFR 89... > 60
CALCIUM 2.43..2.20-2.65 MMOL/L
MAGNESIUM 0.95... 0.65-1.05 MMOL/L
ALBUMIN 45...35-52 GL
BILIRUBIN TOTAL 10...<23 UMOL/L
URATE 236...200-400 UMOL/L
CHOLESTEROL 4.88...<5.20 MMOL/L ALL LEVELS HAVE DROPPED SINCE TRT WILL POST ABOVE AS TO COMPARE
TRIGLYCERIDES 0.93...<2.30
HDL 0.95...> 1.00 MMOL/L
LDL C CALC 3.50 MMOL
LD 150...110-215 U/L
CK 48...<225 U/L
GGT 20...<60 U/L
AST35...<37 U/L
ALT 49...<46 U/L
HEMOGLOBIN A1C 0.055 NON DIABETIC 0.040-0.060
HIGH SENSITIVITY CRP 0.9... LOW RISK <1.0 MG/L
HEMOGLOBIN162... M:135-170 G/L
HEMATOCRIT 0.50...M; 0.38-0.49 L/L HIGH AND ONLY SINCE TRT
RBC 5.42... M: 4.20-5.70 BY 10E12/L
FREE TEST 65.5... 31.0- 94.0 PMOL/L
MICRO ALBUMIN (RDM U) 10.
MICRO ALB/CREAT RATIO 0.3...<2.0 MG/MMOL CREAT
RHEUMATIOD FACTOR <10....<14 IU/ML
HYDROX VIT D 74. INSUFFICIENCY 25-75... TAKING 5000 IU DAILY CANNOT SEEM TO GET BEYOND THIS POINT
ANTINUCULAR AB (ANA) NEGATIVE
TSH 2.15...0.35-5.00 MIU/L
VIT b12 474 > 220 PMOL/L SUFFICIENCY
FERRITIN 74...31-79 REDUCED IRON STORES
SODIUM 138...135-145 MMOL/L
POTASSIUM 5.1...3.3-5.1 MMOL/L
CHLORIDE 100...95-108 MMOL/L
ALKALINE PHOSPHATASE 62...40-129 U/L

Just Diagnosed & Starting TRT, Questions

Mon, 20 May 2013 01:19:00 GMT

I'm a 31, 6'1" and 170 lbs. I've been having symptoms like brain fog, muscle weakness, can't gain any muscle/muscle loss and low libido for 4 years now. My new doctor asked if my T had ever been tested, and I said yes and told her what my previous results were. When I told her my last results (270 ng/dl, then 407 ng/dl after retest), she shook her head and said, "That's too low for your age. I'd like to retest." So I had my level checked again before I left the doctor's office.

I got a call about 4 days later saying my T was low and they wanted me to come in as soon as possible to get it checked again to "confirm" that it was low. Went in again, had it rechecked, and the doctor said "I'd like you to come in in a couple of weeks to discuss treatment options." I was never told what my levels were.

So here's my problem. My T has been consistently around 250-400 for the last year, so I'm assuming that's what my levels were when the doctor checked. If so, that doesn't seem all that low compared to a lot of the guys I've known who had to have TRT. Besides that, my testosterone was tested at 537 ng/dl shortly after my symptoms started. Is it even possible to be symptomatic with a T that high?

So what do you guys think? Should I go ahead and go through with the TRT like my doctor wants, or should I look elsewhere for the cause?

Sorry for the lengthy post and thanks for any help.

Symptoms -

-Brain fog
-Social withdrawal
-Rarely have morning wood
-Why do really hot looking women and girls now look like art instead of lust? <- This.
-I get cold easily
-Why do really stressful situations leave me feeling physically beat up. Adrenal fatigue. <- Also this.
-Dry skin, brittle hair and nails
-I am not depressed, I just don't care about anything, no joy, no motivation, no reward
-Muscle weakness.
-Normal physical activity (taking out trash, cleaning house, working on car) leaves me exhausted
-Sleep doesn't help. 6 hours, 10 hours, 3 hours, it's all the same. I feel tired from the moment I wake up til i go to bed.
-Non-existent libido. Can still get erections, but not in the mood. Just kind of going through the motions with sex.

LABS -

(7/25/12)

* Total T - 270 ng/dL (range 240 - 950)
* Free T - 7.4 ng/dL (range 9 - 30)
* Prolactin - 12 ng/mL (range 3 - 13)
* LH - 3.7 IU/L (range 1.8 - 8.6)
* FSH - 5.4 IU/L (range 1.0 - 18.0)

(9/11/12)

* Total T - 407 ng/dL (range 240 - 950)
* Bioavailable T - 147 ng/dL (range 72 - 235)
* LH - 3.9 IU/L (range 1.8 - 8.6)
* FSH 4.0 IU/L (range 1.0 - 18.0)
* S Estradiol - 18 pg/mL (range 10 - 40)

Pellets and E2?

Mon, 20 May 2013 01:49:00 GMT

So, first time posting and I'll try not to take up too much of you guys time.

Age: 35 Lab Range
T: 549-1471
E2: 17.6-59.9 (12-42.6)
Free T: 8.31-34.7 (4.7-24.4)

First time with HRT

For the most part this has been a god send! I read once that you don't know you have Low T until you have high T and it is so true. But I am 3 months in and already feeling some of the old lack of labido creeping back up. When studying all the articles and threads, I decided to call and see where my E2 was and as you can see it is up to almost 60. My doc is a great guy but as many have said about Pellet docs, he wants me to just try and control it with DIM (300mg) a day currently. Getting an AI is not an issue though, and I am thinking that I want to try Adex or Arimidex form what I have read. So, my question is simply what would one suggest as better for my situation and at what dose should I start? And how long before I get my blood work again to see how I am doing?

From my reading, I was thinking about Adex at .25mg twice a week.

Thoughts?

33 yo Hypogonadic Looking for Good TRT Dr

Mon, 20 May 2013 01:46:00 GMT

Hi all, this is my first post in this forum but I have been lurking in forums that discuss TRT. What brings me here is that I am frustrated with my current TRT regimen and my doctor. First off, I have no interest in bodybuilding. I am a hypogonadic male who wants to improve his quality of life and up his libido. I am very interested in finding a good and reliable TRT doctor that takes insurance and knows what he is doing.

Some background first:

Age 33 y/o
Height 5'11
Weight 172
Slender frame (think cyclist)
Lots of body/facial hair (think Mediterranean)
Body fat 15-20%, mostly around the belly

Health conditions: hypogonadic symptoms manifesting via ED (can get erection but not maintain it), lack of morning wood, sagging libido, low energy levels, difficulty in concentrating on tasks, etc... sometimes the ED and low libido gets bad enough that it causes problems in my marriage.

Diet: Pretty normal, trying to eat healthy and get enough protein through chicken, fish, and meats. Eat lots of fruit, but few veggies. Keep junk food to a minimum.

Exercise: Road cycling is my primary sport, although I hit the gym to do some strength training, stretching, or muscle toning. No bodybuilding.

My Story:

I was diagnosed with hypogonadism in late 2010 when I went to an urologist for ED/libido issues. The urologist checked my testosterone, and it turned out to be low: 307 in a range of 300-1000 ng/ml. The urologist said "although it is within the normal range, I feel it is too low for your AGE, so I will put you on TRT." Put me on the Testim 1% gel that came in tubes (50 mg in 5 g tubes).

At that point, I was happy to have a solution and I religiously used Testim daily, and it brought my T levels up into the 500+ range (after an initial peak of 728 three weeks into it). My libido was better, ED was very minimal. Started to get morning wood back, not every day, but rather 3x a week, more or less. My right testicle shrunk somewhat, but my left testicle's size stayed the same, if not gotten a bit larger. Asked my doc about that, and he was surprised that my left nut didn't shrink, and didn't know what to say about that.

However, the more time I went by, the more learned about TRT and I didn't realize that it was for life. I thought it was a temporary solution and I wish that the urologist further investigated into WHY my T levels was low in the first place. I also learned that it might be better to run HCG and AI while on TRT, both of which I am NOT currently running.

I was on Testim for almost two years, and then my insurance (damn insurance!!!) changed their drug list and started denying Testim. I refused to pay $400/mo, so I stopped taking Testim for a month. Then I went to the doctor with my concerns about a) insurance, b) fertility, so he prescribed me tamoxifen to try to "restart" my HPTA system. He did a full battery of tests after having been off T for a month and here are the labs:

LABS AFTER BEING OFF TRT FOR 1 MONTH, BEFORE TAKING TAXOMIFEN (aka Nolvadex):

FT 7.33 ng/dl (no ranges given?)
TT 334 ng/dl (300 - 1000)
E2 5 ng/dl (0.5 - 5.0)
DHT 199 pg/ml (106.0 - 719.0)
LH 2 mIU/ml (6.0 - 19.0)
FSH 3 mIU/ml (4.0 - 10.0)
DHEA-S 2369 ng/ml (1419 - 3867)
SHBG 27 nmol/L (10 - 55)

Hemoglobin 14.7 g/dl (13.0 - 17.0)
Hematocrit 42.8 % (37.0 - 49.0)
IGF-1 169 ng/ml (109-307)
Prolactin 14.2 ng/ml (3.0 - 30.0)

Cholesterol 190 mg/dl (<200)
Triglycerides 72 mg/dl (<150)
HDL 59 mg/dl (>39)
LDL 117 mg/dl (<100)
LDL/HDL Ratio 1.98 (<3.55)

That was 5 months ago. Then I took taxomifen for 2 months, and my nuts returned to normal size and hardness. But the ED/low libido black cloud came back, and now I'm on Androgel. But I don't think it is working as effectively as Testim has worked for me. My right testicle is a bit smaller again, but not as small as before when on Testim. I don't think my skin is absorbing Androgel like it's supposed to.

I'm a little frustrated with my current urologist as I don't think he knows everything about TRT (no HCG or AI?!?!) and his office doesn't communicate with my insurance well, resulting in denied claims or Rx delays at the pharmacy. He also drops the ball on the labs a lot.

I have an appointment with him tomorrow, and I'm thinking I'm going to give him one more chance while I ask about AI and HCG and more detailed lab tests.

But if I'm not satisfied with how it goes, is there a Houston-based TRT doctor who knows what he's doing and also takes insurance? I have Blue Cross.

What about TRT clinics? Like the Low T Center that just started in 2010 and opened a new facility literally 2 minutes from my home. Link: http://www.lowtcenter.com/ Are there others like this?

Low T and GH

Sun, 19 May 2013 20:44:00 GMT

Hi all,

To make a long story short I'm deficient in T and GH since birth due to a bad/lazy pituitary. I needed GH injections to get to my height of 5'8 and androgel to finish puberty. I stopped all hormones back in 2008. I tried weight lifting for 6 months with a trainer back in 07 and had I gained little muscle for my work.

While part of the reason could of been diet(not enough carbs, and possibly not enough calories overall since I believe I was right around maintainence) I'm thinking it was my low GH that was the problem because I wasn't on any GH during lifting just androgel.

I'm posting because I need advice on what I should do...I want to gain strength and muscle. I decided 3 months or so ago to get back into lifting (I know a lot more about nutrition/macro counting now), but before bulking I started cutting because my body fat was way too high. I've lost 30 pounds and my weight is 146 at Probably around 17-19% BF. Maybe a lil less.

I Mostly have abdominal fat/love handles with a lil chest (not gyno). My limbs, neck, face are very skinny.I basically have no muscle. I began lifting soon after I started my cut but I've taken a month break because of my joints and gonna start again. I'm actually happy with the strength gains for being on an aggressive caloric deficit. As an example my bench (don't laugh lol :p) went from 55 to 90 and curling 10 pound dumbbells to 30 pounds in just over a month. Took a toll on my joints though... I do low reps (6) so those numbers are heavy for me.

Is there anything natural that I can take to help out my low T and low GH? At least something I can do for my low igf-1? I'm thinking my igf-1 is my "bottle neck" even over the low T. What are my other options that aren't natural? Taking igf-1 shots? Also does anybody know of a very good endo (my endo is agaisnt putting me back on anything) who understands my issues in NYC?

Lastly if I choose to not take any shots and given my current hormonal profile can I at least expect to be 145-150 (Low goals i know, I'd prefer to be 180lb...) at 9-12% body fat if its possible to even tell? My last blood test taken a year ago is below. I'm sure it's still the same roughly... This is "my normal".

FSH 3.5 range 1.6-8.0 mIU/mL
LH 2.1. Range 1.5-9.3 mIU/mL
TSH 1.230. Range 0.470-4.680
T4, Total 6.14 range 5.53-11.00 ug/dL
Total testosterone 321 range 250-1100 ng/DL (test was sort of late in the morning, I've had 375 before natural)
Free T 42.1 range 35-155 pg/ml (I've had 47 before)
Igf-1, ECL 73 range 63-373 ng/ml

That's all I have hormonal wise...He didn't do anything else like estrogen, SHGB etc. I'm also borderline anemic due to the hormones, not because of iron.

Edit: I'm 28 years old
Edit 2: 33 inch waist just above belly button and 36 below going around the love handles.

-describe body and facial hair: I'm pretty hairy and have just gotten hairier with time. My facial hair is patchy at my cheeks the rest full. Mustache is full but never grows long, I don't really have to trim it like I do my beard. Although with time it has gotten a little longer where I may trim it slightly to keep it looking clean. My chin/behind chin hair is very full and kind of long. I have not shaved my chin just to see how long it gets the last 4 months, it's two inches long.

- health conditions, symptoms [history: other than what's already been said, last year a month before this blood test my right ear became highly sensitive to sound suddenly. Tv was on and had to turn it off and had ringing in my ear. It hurt quite a bit. Never had ear problems...so for the last year (was worse last year) I may get some ringing every now and then, or a feeling of fullness/pressure it fluctuates. Sometimes it may go to my left ear the fullness/pressure, left one rarely rings. My hearing in my right ear has gone down, but only noticeable if on the phone. Voices sound a bit distorted in my right and people tend to sound sick as if they have a cold. My left ear is normal. I won't notice any difference by simply being in conversation in person or watching tv, I have to hear you only with my right ear on the phone to notice my hearing loss/dmg. I went to the emergency room and they found nothing in my ear. While i have not gotten it properly checked out by an ear doc I self diagnosed myself with endolymphatic hydrops as the cause since symptoms matched. I was having a lot of sodium at the time and I blame that plus smoking. Also in early 2008 I got a case of terrible acne while on T and GH. The rarest form of acne called acne conglobata...scarred up my chest pretty good. That's when I stopped GH on my own. Before that for a lil over year-year and a half I was on Androgel. I had normal acne but when GH was introduced in combination forget about it...

-describe where you carry fat and how changed: abdominal fat mostly/love handles. Has been that way since around 10 years old. Always carried fat there.

-Rx and OTC drugs, any hair loss drugs or prostate drugs *ever* : don't take anything other than supplements such as whey, half serving a day of animal pak, fish oil, animal flex, bromaline, vit D, CLA, BCAA. I don't have male pattern baldness. No prostate drugs or any drugs of any kind.

-describe diet [some create substantial damage with starvation diets: my hormonal problems are not diet related. I'll just say that I ate anything when I took this blood test not starving. I am on a starvation diet now though for last two months. I'm about 45-50% below maintainence at 1000 cals. My macros are usually 60% protein, 25% fat, 15% carbs. I don't do cardio (ever) and I have not lifted in a month as I said above because I wanted to let my joints heal up. Also when I was lifting I wasnt eating enough for the intensity (heavy weight for me) that I was doing. I live a sedimentary life.

-describe training [some ruin there hormones by over training] : it's not training related either.

-testes ache, ever, with a fever? : the top part of my right testicle ached for 2 days when moving into certain positions a few months ago, no fever though. That same feeling has happened maybe twice before. One last year and maybe 2-3 years ago..They usually give me no problems.

-how have morning wood and nocturnal erections changed : I'd get it pretty often when on hormones. Usually now I may go over a week without morning wood. I believe it happened a bit more often before I started on my extreme cut, like one to three times a week.

Here are the rest of my labs:
Albumin 4.6 range 3.5-5.0 g/dl
Bilirubin total: 0.7 range 0.2-1.3 mg/dL
Alkaline phosphate 79 range 38-126 U/L
Protein, Total 7.0 range 6.3-8.2 g/dL
ALT 50 range 21-72 U/L
AST 31 range 17-59 U/L

Calcium 9.4 range 8.4-10.2 mg/dL
Sodium 143 range 137-145 mmol/L
Potassium 4.5 range 3.5-5.1 mmol/L
Chloride 104 range 98-107 mmol/L
Co2 29 range 22-30 mmol/L
Anion gap 9.0 range 7.0 16.0 mmol/L
Glucose 60 range 74-110 mg/dL (low) I fasted for this lab work.
Blood urea nitrogen 14 range 9-20 mg/dL
Creatinine 0.8 range 0.7-1.3 mg/dL

WBC 9.2 range 3.8-11.0 K/uL
RGC 4.43 range 4.20-5.80 M/uL
HGB 12.1 range 13.5-17.5 g/dL (low)
Hematocrit 38.2 range 38.0-52.0 %
Mean corpuscular volume 86.2 range 80.0-100.0 FL
Mean corpuscular hemoglobin 27.2 range 25.4-34.6 pg
Mean corpuscular conc 31.5 range 31.0-37.0 g/dL
Red cell distribution width 13.5 range 11.5-14.5 %
Mean platelet volume 9.4 range 6.9-10.8 fL
Platelets 285 range 130-400 K/uL
Neutrophils auto 61.4 range 45.0-80.0 %
Lymphocytes auto 32.3 range 16.0-41.0%
Monocytes auto 4.6 range 0.0-12.0%
Eosinophils auto 0.9 range 0.0-5.0%
Basophils Auto 0.8 range 0.0-2.0%
Neutrophils absolute 5.6 range 2.0-6.0 K/uL
Lymphocytes absolute 3.0 range 1.1-2.8 K/uL (high)
Monocytes absolute 0.4 range 0.0-1.0 K/uL
Eosinophils Absolute 0.1 range 0.0-0.5 K/uL
Basophils absolute 0.1 range 0.0-0.1 K/uL

19 and Possibly Low T

Sun, 19 May 2013 19:36:00 GMT

I'll just get straight to the info. I've read most of the stickies, so hopefully I did everything right...sorry if I didn't.

Age: 19
Height: 5'9''
Waist: size 32 pants, but if you mean my naval 37''
weight: 174lbs
Body hair is okay. Legs have been hairy my whole life. Chest hair is just small hairs in the middle. Some stomach hair, mostly in the middle. (weird because I'm of Iranian decent and both my dad and brother are extremely hairy, and all of my cousins). Facial hair sucks. I shave like once a week to once every two weeks (generally the latter). I have patches and they are bad to me (again weird because both my brother and dad shave daily, and same with all my male relatives).
- I carry most of my fat in my abdomen. I also have some large deposits in my thighs and hips.
- Only health condition (except this) is mild asthma. I have it under control, and barely use my inhaler.

Labs: test1: 1/8/2013
LH 6.5 range: <8.6MIU/mL
Prolactin 8.2 ng/mL (no units or range)
FSH 7.7 mIU (no range)
Test total 429 ref range: 300-1080 ng/dL
SHBG 22 range: 11-80 nmol/L
Free Test 97 range 47-244 pg/mL
%free test 2.3 range: 1.6-2.9
E2 26 range: <43 pg/mL
DHEA Sulfate 417 range: 88-483 ug/dL

Lab 2: 1/30/2013
DHEA Sulfate 345 range: 88-483 ug/dL
Total test 345 range 300-1080 ng/dL
SHBG 24 range: 11-80 nmol/L
Free Test 73 range: 47-244 pg/mL
Free % 2.1 1.6-2.9
Prolactin 8 (no range again)
E2 28 range: <43 pg/mL
LH 7.7 range: <8.6 mIU/mL
FSH 6.9 (once again...)

I had a third lab that just tested for TSH:
TSH 2.27 range: .27-4.20 ulU/mL

I had a lipid panel done about a year and a half ago, they're likely around the same as my diet and exercise hasn't changed at all:

CHOLESTEROL, TOTAL 128 125-170 mg/dL 11/5/2011 2:11 PM QUEST
HDL CHOLESTEROL 59 31-65 mg/dL 11/5/2011 2:11 PM QUEST
TRIGLYCERIDES 56 38-152 mg/dL 11/5/2011 2:11 PM QUEST
LDL-CHOLESTEROL 58 <110 mg/dL (calc) 11/5/2011 2:11 PM QUEST

Sorry I don't have more, I've been seeing a Urologist currently, and those are the labs he ordered for me. He's prescribed me Nolvadex 10mg 2x a day, and I'll write in symptoms what it has helped me with. Recently changed the Nolva to just 10mg once a day though, eventually having me ween off it in 3 months time.

Here are my symptoms:
- Brain fog for sure. It's not 24/7 but it's pretty often.
- Urologist actually felt me chest, I have gynocomastia
- Can't get it up a lot of the time. When I can, it's hard to keep it up. Putting on a condom has to be done insanely quick, plus I have to start bareback when having sex, then transition, otherwise I get soft while inside. Erections are fine now with Nolva. Only had one problem where I lost an erection.
- I get testicle pain in my right testicles once in a while. sharp for a few seconds, then dull. Never had a fever with the pain that I know of. Doctor checks for any masses, none there.
- I have nocturnal erections, and morning wood virtually everyday now with the nolvadex. Before, it was a few times a week.
- Daily fatigue. I need to nap almost every day even with 8 hours of sleep. I feel tired throughout most of the day, have to sleep relatively early.

Diet:
Generally have 3-4 whole eggs for breakfast, sometimes with bread. Lunch will be turkey or chicken, or beef, whatever I have on hand or my dining hall is serving. Dinner is the same. Generally eat plenty of protein and fats, I never avoid cholesterol. Carbs are usually 100g-150g a day.

training:
Generally lift 3x a week. Max 5-6 exercises per session. I don't test maxes often, I get plenty of sleep most nights. I haven't been to serious about it because it's hard to be motivated right now.

I realize my numbers aren't necessarily extremely low, but the symptoms really bother me. Like I said earlier, the doc prescribed nolva 10mg 2x a day, and it's helped my erections substantially, my problems come with the continued tiredness, fogginess, trouble concentrating, and lack of motivation. Doc has pretty much completely dismissed TRT, or doing a restart protocol with Clomid, Nolva and hcg even after asking him about that. I also started seeing a therapist and she says that she doesn't think it's depression, and neither do I. Trying to hit this from all angles (both physiological and mental) and see what end up happening. Help is very much appreciated, I can't say that enough. I'm sure many of you guys know the frustration of the symptoms.

If I need to add anything let me know. hopefully We can figure this out...

Edit: Waking body temperature today was 96.6, measured about 15 min after waking up. Temperature of 98.3 at about 14:46. Also added some reference ranges that I found on my tests.

T Cypionate Temp for Storage

Sun, 19 May 2013 18:27:00 GMT

I'm new to the forum. I've been prescribed T cypionate by my Dr. My question is; I live in Arizona. And it's approaching summer time. I had a power outage a few days ago. When I got home I checked the inside temperature with a digital thermometer. It was 95 degrees inside. And it was probably like that for 8 hours. Would that be enough to weaken the potency of my 10ml vial of cypionate? After that I kept it in a mini cooler wrapped in a towel for two days only while I was gone for work. When I got home I would take it out and store at proper room temp till the next day when I left again. Since its the weekend the AC has been on so I have had it stored properly. But for 3 days it was 95 degrees one day. And then 48 degrees for the two days it was in the fridge while I was at work.

Will this affect the potency? What can I do while I'm at work to maintain the proper temp. So I don't have to leave my AC on all day? Can anyone please help. Thank you in advance.

T Cypionate Temperature for Storage

Sun, 19 May 2013 18:05:00 GMT

I'm new to the forum. I've been prescribed T cypionate by my Dr. My question is; I live in Arizona. And it's approaching summer time. I had a power outage a few days ago. When I got home I checked the inside temperature with a digital thermometer. It was 95 degrees inside. And it was probably like that for 8 hours. Would that be enough to weaken the potency of my 10ml vial of cypionate? After that I kept it in a mini cooler wrapped in a towel for two days only while I was gone for work. When I got home I would take it out and store at proper room temp till the next day when I left again. Since its the weekend the AC has been on so I have had it stored properly. But for 3 days it was 95 degrees one day.

And then 48 degrees for the two days it was in the fridge while I was at work. Will this affect the potency? What can I do while I'm at work to maintain the proper temp. So I don't have to leave my AC on all day? Can anyone please help. Thank you in advance.

Testosterone Levels Before TRT?

Sun, 19 May 2013 15:54:00 GMT

Guys, what were your total, free and bioavailable testosterone levels BEFORE you began TRT? Also, how old were you when you began?

Starting Test-c Injections...

Sun, 19 May 2013 00:14:00 GMT

After reading the stickies, I figured it's time to start my own thread.

-age: 35
-height: 5'9
-waist: 36
-weight: 160
-describe body and facial hair: facial hair growth has always been slow - even during puberty. I can't connect a goatee between the edges of my lips and chin. I shave about once a week. Otherwise I have hair everywhere else.

-describe where you carry fat and how changed: All through high school and college I weighed 120lbs and had very low body fat. Over the last few years I've put on weight including some fat in my mid-section. When I last did a hydrostatic body fat test in 2005, it came back with 25% body fat. My weight gain started when I went on Lexapro (see below).

-health conditions, symptoms [history]: started taking sam-e back in 2002-2003 for depression after getting laid off. Once I landed a job in 2004 and had insurance, I switched to Lexapro 20mg q.d.. In 2007 my shrink put me on Wellbutrin XL 450mg q.d. to manage ADHD. It worked fairly well for some time. In 2008 we tried to switch to Straterra - which made me an emotional wreck. It also prevented me from having an orgasm. That was the first time I experienced sexual side effects from medication. I got off that and switched back to Wellbutrin, but my inability to orgasm persisted. Starting in February this year, my shrink and I lowered the Wellbutrin to 300mg and put Adderall XR 15mg q.d., which seems to work - but whenever I tell her that I'm still having ADHD symptoms, she tells me that we need to boost the dosage. I don't like the sound of that b/c I hear this can potentially be a very addictive drug. The sexual problems are still there. No interest, no motivation, no energy...

In 2009 I was dating a girl who told me that I snore pretty loud. I got a sleep study done, and it confirmed I have moderate sleep apnea. I've been on a CPAP at night (9 cm3/H2O) since. It's worked reasonably well if I stick to the same bed-time... otherwise I wake up feeling really groggy.

Fast forward to this year...I started dating a girl in January. Our sex life has been miserable. I have no interest or desire. I can get an erection but it takes some work to stimulate - both physical and mental. When telling a friend this, he suggested that I get my T levels checked. When they came back low, I found this site.

Lastly, I had surgery to correct a perianal fistula in June. It's almost completely healed. This is relevant because I had an MRI and CT scan done on my pelvis to determine the route of the fistula. I don't think the radiologist was looking for testicular trauma or prostate problems, but I would think that if it was there, it would be evident. If necessary I can have those images pulled for additional review.

-Rx and OTC drugs, any hair loss drugs or prostate drugs *ever*: I was told that I am developing male pattern baldness. I bought a minoxidil pack at the grocery store, but only used it sparingly. I haven't used any of it since April, and now won't touch it.

-lab results with ranges:

From 7/27/2012 Quest Diagnostics:

Hemoglobin A1C - 5.4% [<5.7 decreased risk of diabetes]
Mean Plasma Glucose - 115 mg/dL [no range given]

T-Total - 220 ng/dL [250-1100]
T-Free - 53.4 pg/dL [35-155]

After getting these numbers, I called the compounding pharmacies in the area and got the name of a urologist. His website indicates that he does do TRT for men and does research in men's health. I saw him earlier this week. He doesn't like that I'm an engineer and asks so many questions, but he did get SOME blood work done:

From 8/23/2012 LabCorp:

Albumin, Serum - 4.9 g/dL [3.5-5.5]
Testosterone, Serum - 307 ng/dL [348-1197]
Free T (Direct) 9.7 pg/mL [8.7-25.1]
LH - 6.0 mIU/mL [1.7-8.6]
FSH - 2.3 mIU/mL [1.5-12.4]
Prolactin - 9.1 ng/mL [4.0-15.2]

Next test was bio-available T w/SHBG using HPMS for improved accuracy:
Testosterone, Serum - 335 ng/dL [348-1197 for Adult males >18]
Bioavailable T - 206 ng/dL [128-430 for males 20-39 years old]
Bioavailable T % - 61.5% !!!
SHBG (TRMA) 14 nmol/L [20-60 adult males]

The doctor/idiot didn't include E2 or Vitamin D-OH like I asked him to... figures... He gave me some cialis and scheduled a follow up in September.

What I gather from this data:
-I don't get why the FSH is so low... not that I'm trying to get my gf knocked up or anything, but someday I would like to have kids. The doctor said this was one reason I don't qualify for TRT.
-The LH levels seem okay (if that range is meaningful). The bigger question is why are the total T levels so low.
-The higher (than typical) percentage of bioavailable T suggests that my body realizes the total T levels are low, and is therefore doing everything possible to make as much of that T available - hence low SHBG and slightly higher albumin numbers. That's a good indication that the feedback mechanism is working.

-describe diet [some create substantial damage with starvation diets]: Not the greatest. I rarely eat breakfast, but if I do it's usually cereal. For lunch I get an entree at our work cafeteria which has some healthy options. For dinner we usually eat out.
-describe training [some ruin there hormones by over training]: none
-testes ache, ever, with a fever? I had testicular pain in early 2010 and went to the ER in case it was torsion. They did an ultrasound and said everything was fine. The urologist did a quick exam and found nothing abnormal with my testes.
-how have morning wood and nocturnal erections changed. I used to get them in the late 90's when in college, but now I don't get them at all.

What I'd like to do is compile a list of additional tests that I think he should order. E2 is one of them, along with a thyroid panel. Are there any aromatase enzymes that are worth checking?

Thanks for taking the time to read my thread!

TRT After Testicular Cancer

Sat, 18 May 2013 23:11:00 GMT

In December last year i was diagnosed with testicular cancer ,had one testicle removed and went through chemotherapy and am now on surveillance for any possible relapse , before having cancer i
was diagnosed with secondary Hypogonadism and was on trt for a year and half then stopped for 6 month before having cancer because my blood tests showed everything is good ,i had a great help from ksman and he explained a'lot ,but my mistake was trusting my endo who didn't know shit ,now after i finished chemo am dealing again with low t ,and i was healthy person before cancer but now i gained a'lot of weight , so now i need all the help i can get to get back on trt but correctly ,am going to do blood tests this week and i want to know what what is necessary to test and what's not in my case

KSman is Here

Sat, 18 May 2013 22:48:00 GMT

I have not had have my own thread. Try this if I have missed your thread.

I can't tell if anything is going on in any thread that I should see without looking at all threads. I get spread out thin at times. And my responses can be fast short some times. I can't always remember the flow of the thread and do not always scan back for context. I do what I can. It is sometimes exhausting working so many case threads.

Doing the above is unfair to the other strong contributors here. I do not know how to follow threads without then dominating.

I try to get guys started, but after a thread racks up a large number of replies, I will let it go on its own. Good application of the 80:20 rule.

So what is on my mind lately? All I can see is thyroid problems. It must look ridiculous. I had read that iodine deficiencies were wide spread, but I never knew it would turn into this. If it were not for my own direct experience, I would probably not be so concerned. This is not a direction that I wanted things to go. Others here were leading the way on thyroid issues, it took me a long time to catch on. I certainly do not have the depth that others have in this subject. When it comes to thyroid diseases and auto immune markers, I do not know ying from yang. If someone will create material on deeper thyroid issues, with links to external sources, I would be glad to see that in the thyroid basics sticky as deeper subject matter.

For those who do not know: I am an old Mechanical Engineer - who started to take an interest in health issues in the 1970's. I suspected low testosterone for a few years and when I connected with my first and only TRT doc, he said that I knew a more than most doctors. Later he said the same thing much more forcefully. Doc learned a lot from me, his lab rat. And learned a lot as printed words became reality for me.

My dad led the way on nutritional issues and LEF magazine. He is 96, drives every day, buys food and cooks. He is a great cook! He has a social life and a GF. And he will tell you what he thinks he is doing that is keeping him going. He does not take any medications. He saw a doc a few years ago about a problem and became very pissed off at the doc and solved the irregular heart beat with vitamin K. He will bend your ear with organic chemistry.

As an engineer I did a lot of failure analysis and problem solving. So what I do here is partly explained by that.

I was inactive here for a while. I used to get upset telling every new guy to read the stickies and having to explain a lot of things. So now we have the advice for new guys sticky. And getting tired repeating thyroid issues, we have the thyroid basics sticky.

So this is all here on the WWW. Many of you would like to know me to pick my brains. But oddly enough, I do not know a single guy in real life who cares about of the issues that we discuss here. These forums are very selective. I have helped four women in real life.

Doing all of this makes me very clinical. I can walk up to a women I have just met and talk to her about progesterone, breast pain, PMS etc. You learn to set taboos aside. A bit leap for me in terms of that my basic character type used to be.

I will not discuss cases here, but you can direct me to those from here if needed. Anything else is fair game.

Testosterone Results

Sat, 18 May 2013 22:45:00 GMT

My numbers are in the parenthesis.
Testosterone
(379) 170 - 780 ng/dl

Plasma lipid Panel was great
Cholesterol (145) 100 - 200 mg/dl
Triglycerides (75) 10 - 150 mg/dl
High density lipoprotein (HDL) (49) 40 - 59 mg/dl
Low density lipoprotein (LDL), Calculated (81) 60 - 129 mg/dl

Here's the deal, I eat well (controlled carb intake, plenty of meat and veggies, lots of saturated fat and dietary cholesterol), I train hard and I'm only 22. My test levels are obviously lower than my liking. If anyone could offer me any recommendations on how to get my doc to prescribe me something, or recommendations on if I should attempt to get it illegally, I would really appreciate it.

Ps this also after running a D-aspartic acid supplement for 5 weeks. I've had noticeably higher libido, energy, and even a little acne for the first time in my life.

SERM Restart

Sat, 18 May 2013 21:30:00 GMT

I just finishing up a restart and not sure it really told me anything.

I have an old thread here somewhere. Summary:

36 years old. Verified low T for a few years now. Started with SSRI I believe. Recently tried SNRI and it tanked again. Been off that for awhile and just tried a restart. T levels over the last three years or so:
224 - on SSRI
327 - off SSRI. Fixed poor sleep. Cleaned up diet.
531 - AlphaMale
448 - Got DHEA up via transdermal Mag. Seemed to help. Fixed high E2 (edit: AI used to lower E2)
323 - on SNRI. Was sick so disregarded. Was trying to test the effects of DAA
298 - on SNRI. Still on DAA. Still on SNRI
All were Labcorp so ng/dl with range of 348-1197. Nothing but SNRI changed since 448 test.

I did 20mg of Tamoxifen for 4 weeks. Got tested week 3. Tapering and adding anti-E stuff now.

LH - 5.2 mIU/mL (1.7-8.6)
FSH - 4.2 mIU/ml (1.5-12.4)
Total Test - 429 ng/dl (348-1197)
Free Test - 9.2 pg/ml (8.7-25.1)
E2 - 48.6 pg/ml (7.6-42.6) expected this to be high. Wanted to test to verify SERM was good and see if I needed anti-E afterwards.

My E2 levels have been around 20 for a few years now, most recently even lower, so the SERM was good and did what it was supposed to. I am thinking LH should have been higher on the SERM. Any feedback on that? Am I correct in thinking I may have a bit of secondary?

I don't think primary can be ruled out given the lowish T with mid level LH. Could give HCG a run but am inclined to find out if/why I am secondary first. Guess I could have also run the SERM a bit longer to see if testes came back on line a bit more.

I don't feel terrible at 400, just not like virile man I was not too long ago. 400 feels a hell of a lot better than 200-300. Energy is ok and I'm not a complete sack of shit. Definitely not content to stay at 400 though.

Some crazy shit was happening at the end of my SNRI run. Really bad night sweats, even with the window open in the dead of winter. Blurred vision on and off. Really low T. I was expecting high prolactin, but that checked out fine when I got off the SNRI. Not tested during.

I have an appt with a new endo next month. Will probably get tested again before my visit. Hopefully this one knows his head from his ass. I'd like to get a comprehensive look at adrenals and thyroid. Not expecting much there, but would be nice to make sure. When my test was 323 last year I had the following:
TSH - 1.94 (seems to fluctuate between this and just below 1)
Free T4 - 1.29 ng/dl (.82-1.77)
Free T3 - 3.5 pg/ml can't recall what the range was but seems like 3.4-3.9 is pretty good.

New to HRT, Thyroid Issues

Sat, 18 May 2013 19:28:00 GMT

I am 42 yo, 5'10 195lbs. 36 waist, I run at least 2 times a week, weight train 3-4 times per week, I do yoga almost every day(got totally rid of ALL back problems), I usually weigh 180-185, been hitting the gym hard since starting hrt. My appetite is elevated since starting hrt, so I have put on some fat too. I look good and have been getting a lot of positive feedback about my musculature lately. I feel strong and confident, assertive and decisive. I think my problems have been around for a few years....I noticed lower libido and fatigue and fog...lots of fog and loss of memory.

I had diminished libido, overtook forever to orgasm,very tired all the time. Was not fat or out of shape....sort of pleasantly cloudy in my thoughts and now that I look back felt sort of female-ish. But something was wrong. Used a Florida clinic to start testosterone therapy here are my relevant numbers from that round of blood work.
TT,serum 390. 348-1197
Free 5.6. 6.8-21.5. Low
Estradiol 20.3. 7.6-42.6
TSH 6.9 0.450-4.500
WBC 7.4. 4.0-10.5
RBC 5.23. 4.14-5.80
Hemoglobin 16.6 12.6-17.7
Hematocrit 45.9 37.5-51.0
MCV 88 79-97
MCH 31.7 26.6-33.0
MCHC 36.2 31.5-35.7 High
RDW 13.2 12.2-15.4
Total cholesterol 190. 100-199
Triglycerides 167 0-149 High
HDL 66. >39
VLDL Cholesterol cal 33. 5-40
LDL Cholesterol cal 91 0-99
FSH 2.5 1.5-12.4
LH. 4.6 1.7-8.6
Hemoglobin alc 5.2 4.8-5.6
IGF-1 181 64-210
Alkaline phosphatase,S 63 25-150
AST (SGOT) 20 0-40
ALT (SGPT) 29 0-44

Started 120mg test in 60mg doses every 3.5 days. Started 250 hcg twice weekly as per protocol I learned here. Started Iodoral 50mg daily to try to improve thyroid function.
Decided to see local osteopath. She liked my Crisler protocol and agreed with taking charge of my own health. We continued iodine and tested again. I was aware that if Hashimotos is present iodine can accelerate the destruction of thyroid, not sure if she knew this however. I was prescribed adex but did not start to use it until week 5-6 as I didn't think I needed it yet. She also suggested I use chrysin TD daily instead of using adex. I had never heard of chrysin so I looked it up and did not feel great about what Crisler says about it. So I never used it.
Things really improved,sex was better, I really thought I was not "into" my girlfriend anymore and was questioning my relationship, that changed with my improved sex drive. I started to use adex, first .25mg every 3days.....sex drive waned, then tried every 5days....Things were better but not great so I thought .25mgs every 7 days. At about this point I went back in for labs. As follows
TT 1102(she likes this) 348-1197
Free 26.8(she wants this down into range) 6.8-21.5
Estradiol 11(of course higher)
TSH 8.9. 0.34-4.82
Thyroid perox ab H 96. 0-34. High
T3 107. 71-180
Thyroglobulin <20. 0-40
SHBG 29.3( she wants this up) 16.5-55.9

Ok, she was confused about the estrogen levels,I told her that I was not into using a transdermal and had not used the chrysin, I have full custody of my two young daughters,but did not mention(yet) Crislers statement about Chrysin being 'dead', I am open minded and want to see her wisdom and depth of knowledge. We talked all about my Thyroid,Hashimotos,etc. She thinks Hashimotos is frequently caused by Leaky Gut and we are doing stool samples and will attempt to stop my autoimmune response. Until then I am on 60mgs Armour.
I told her I would stop taking adex(not even sure I really need an AI), and try the Chrysin, at her urging. She also asked if I was at the 42nd day of HCG usage, if so I should stop for 30 days then resume, that HCG should be cycled on that schedule.
So I started chrysin, stopped my twice weekly hcg shots and ......felt bad. Depressed and unsexy. So today, a week and a half later, I gave myself a shot of HCG. Wow!! Feel great, and didn't rub myself with chrysin. Week and a half from today I am scheduled for new labs, I think I should take no AI and test myself with only testosterone and see where I am naturally. I also should say that the week of labs I took no hcg shots. Thoughts?
Here are some more relevant numbers again, from my last round
ANA reflex. Neg.
Free T3 3.05. 2.0-3.50
Free T4 .81. 0.45-1.63
Prolactin ,S 8 3-13
PSA-Screening 0.42 <4.0

So here are my concerns:
1) I do not want to use chrysin for these reasons: don't know if I even need AI, don't want to use it because it is a SERM and may give false Estradiol test results, and Dr. Crisler is hesitant to keep men on a SERM long term, dosing is not controlled enough, and finally it's transdermal.
2) Why get SHBG up? (she says it shuttles testosterone to tissues and receptor sites)
3)Why does she want my free T lower?
4)Why does she say to cycle HCG?
I am starting to think I may need to have that talk with her about...you know,..."Dr ____, how can I give you updated male hrt info and both of us feel great about it?"

I Take daily:
200mcg. Selenium
60mg zinc
10,000iu vitamin D3
50mg Iodoral
Subligual b6/b12
900mg Nettle root
Fish oil 1200mg(started as after those triglyceride numbers)

My diet is ok. Never eat total junk, no processed food or fast food.
I do own a bakery but don't over eat with white flour either. Lots of meat, fats, vegetables,salads. I am a single parent and so I do not eat like an elite athlete, sometimes my kids just need food, but we eat pretty well on the whole. Never drink soda, stopped diet soda.

Blood Work Shows Out of Range Without TRT

Sat, 18 May 2013 19:25:00 GMT

I'm 32 and work out regularly. I have a good physique but recently noticed the onset of Gyno. This worries me because I am NOT on any TRT or supplements. As I'm sure you all know, I have had no real luck with dr's about this. My blood work showed estrodial at 51, total test at 600 and total cholesterol at 103...Everything else was normal range and I can give you those numbers if you need them. These are the ones I figured might be out of range. I don't understand why my estrodial would be so high and I would get puffy sore nipples out of the blue. My PSA was normal, blood counts were all in range.

Can anybody offer any advice on this? Should I be concerned of some sort of Tumor, or would that throw other numbers off?? I have a long list of blood work I had drawn up and can post whatever may help, didn't want to post any thing unnecessary right away. Thanks for the help

Blood Work, Estradiol

Sat, 18 May 2013 17:16:00 GMT

Hi,

I'm on TRT and take a Nebido injection every 6-8 weeks.

I'm concerned with my increasing E2 levels. At this level should I consider an AI and if so any recommendations on initial dose?

My bloods are latest first, I'm from the UK but have shown the lab reference range. The bloods are taken on the day of the injection, i.e. at the end of a 6-8 week cycle so will show the lowest T level during the cycle.

T = 23.1 [9-30] pmol/L
E2 = 144 [40-160] pmol/L
SHBG = 22 [18-50]

and previously

T = 18.5, 20.4, 14.6, 14, 12.4, 7.6
E = 145 , 81 , 62 , 58, 58, 74

My earlier E2 levels were between 60-80 and are now around 140.
My T levels are building from an initial 7.6 to 23.1 (during the cycle it will likely be closer to 40.

Many thanks
Nick

23 Y/O After 1 YR TRT - Something Still Wrong

Sat, 18 May 2013 15:29:00 GMT

HISTORY:
I am 23 years old and starting experiencing symptoms of low T around age 17 or so; it was a gradual onset. By age 21 it had gotten so bad that I finally went in to get checked out by the doctor. At this point, these were my symptoms:
- slept 9-10 hrs/night yet was so tired I felt like I was in a waking coma
-brain fog, terrible memory
-freezing cold all the time
- libido was about a 0/10. Did not even notice pretty girls. Erections never occurred spontaneously. No morning wood
-worked out 3x/wk yet was gaining fat and losing muscle slowly but surely
-had lost interest in everything I used to enjoy. Had no joy left in life, really
-became so depressed that I struggled with very strong suicidal tendencies for the last 3-4 months before staring testosterone

Doc found T level of 280 ng/dL 1 year ago now and prescribed Test Cyp 120 mg/week (given bi-weekly). I soon felt markedly better than I had, but still lousy enough that I really didn't have much joy in day to day life. Honestly, I still felt terrible; just less terrible than before. This doc referred me on to an endocrinologist for further treatment. I had reduced my Testosterone to 100 mg/week (50 bi weekly) at this point on my own because for whatever reason it improved my symptoms slightly.

The endo ordered a MRI to rule out pituitary tumor, which thankfully was negative. He also started me on Levothyroxine 50mcg/day for somewhat low thyroid levels, which warmed me up and ramped up my appetite but improved mood and energy only very slightly, which were the main concern. He next ordered a sleep study, which I just completed and am now waiting to consult with that doctor (a Pulmonologist) before seeing my endo again in 10 weeks. I and the pulmonologist are pretty darn sure I don't have narcolepsy or sleep apnea; if there is actually a sleep cycle problem then it is something else.

CURRENTLY:
I am 5'11", 160 lbs., about 7% body fat. I have more body hair than most. I eat a healthy diet and weight train 3x/wk, run about 15 miles per week. I take no other medications besides the Test Cyp and Levothyroxine. Of possible note is that I have Tourrette Syndrome, which I have had since a young child. It is not bad enough that medication is necessary, however.

Most current labs:

TT: 635 ng/dL (241-827)
FT: not tested
E2: not tested
Prolactin: 6.7 (2.10-17.7)
Cortisol: 12.7 ug/dL (5-23)
TSH 2.12 uIU/mL (0.3-4.0) *all thyroid levels are before starting Levothyroxine
Free T3: 2.9 pg/mL (2.0-4.4)
Free T4: 0.71 ng/dL (0.8-1.8)
PSA: not tested
FSH/LH: my only records reported only that they were "in normal range" before starting TRT 1 yr ago

As far as the whole TRT thing, I honestly still feel terrible, something just is not right. This has gone on for years now and I'm really starting to lose hope of ever feeling well again and actually enjoying being alive .Here's what I've got going on right now:

I feel sleepy/groggy nearly all the time despite sleeping 8 hours per night. I wake up feeling not-well rested and stay feeling tired throughout the day, and I really crash by late afternoon. I really don't enjoy much of anything anymore, though I make myself do social things and get out even though I don't feel like being social. I feel about 50% better mood (and energy somewhat) when I'm around other people.
The biggest thing is that I feel just downright depressed and very sad for no apparent reason; my life is honestly good besides all this. I do feel strangely close to crying often when I never would have before, but no gyno or anything like that.

I notice girls mostly like works of art. I do have nocturnal erections now but morning erections I'm not sure; I don't think I usually have them. I will have to take note. I have very low libido; I have no desire to masturbate. If I make myself, the erection is weak, it takes awhile to ejaculate, and ejaculation amount seems pretty low in volume to me. Testes never ache and they are not retracted up close to my body. After 6 months of TRT, I asked my endo if I needed HCG to maintain fertility. He measured my testicles and said they were exactly average size for my age; said it is expensive and that we won't mess with it unless we have to. So we have not.
Lastly, and I think importantly, I always feel my worst 2-3 days after my injections. If I try a higher dosage, all the symptoms worsen together quite dramatically. All the symptoms seem to peak out and wane out together, but they are always there. If I give my whole weekly injection in one dose, all symptoms are much worse within 2-3 days, lasting 1-2 weeks before leveling out to where they normally are. At the same time, why should I feel markedly better (nearly 50% I would say) when around other people if it were an E2 problem?

Questions:
1) Could this simply be clinical depression??? Or does it sound hormonal?
2) Is estradiol a big concern for someone like me? Is it very likely that with such a level of T (635 ng/dL), E2 will be excessively high?
3) How essential are AIs and HcG for someone like me, and how expensive are they in the U.S.? If necessary, does anyone know of any literature that supports it that I could take to show my endo?
4) What could I change right now so that I don't have to live the next 2 1/2 months until my follow-up apptmnt) feeling absolutely terrible? Is it worth trying ing 3 injections per week and reducing to 80 mg/wk (as progressively higher T levels seem to make me feel worse?)

Thanks so much in advance, I really appreciate any advice anyone might be able to offer

Low T, High Cortisol

Sat, 18 May 2013 19:43:00 GMT

Hi, I am hoping to get some help even though I am a female and most of you guys are .. well guys. :)

I have been struggling with this for a long time, which means I have gathered some good information and have a lot to discuss and of course I am looking for answers (why isn't this common knowledge - yeah I know, nobody is dying from it and/or it doesn't make any pharmacies any money).

I recently determined I am low on testosterone - proven by experimenting with gel and finding that adding about 2 mg (in gel) daily makes a HUGE difference on how I feel.
I have known I had high cortisol since about 2003, though over the years my symptoms have changed and I have learned more about how to control it (more later), and some of this might always have been low testosterone (it was not tested when my cortisol was tested).

Below I will discuss my symptoms, my lab results, my experience so far with hormone supplements, and some questions about next steps.
I encourage any discussion, feedback, questions, shared experience about anything I write here, whether it matches what I am saying or is directly against what I write.
Teasing these things apart to figure out what causes what and what effects what takes time, effort, attention, any short cuts I might get from any of you is much appreciated. And hopefully I can help some with your symptoms.

SYMPTOMS: I have had/have now:

HIGH CORTISOL Symptoms:
I was diagnosed, by a functional Dr, with High Cortisol about 10 years ago when I was on the quest of why the normal model of lower calories and increase exercise and have a calorie deficit didn't create weight loss. Saliva testing was done over a day of DHEA & Cortisol (sex hormones were not tested). I was given DHEA (I reacted poorly to that with lots of anger, even on �?¼ of a baby dose. I was told it could also kick up progesterone and testosterone). I was given an herbal supplement which helped some.

Feeling the difference with the supplement in me, I could tell when my cortisol was high or low and the symptoms. For me, my high cortisol symptoms are that wide awake feeling, not needing a lot of sleep or not feeling sleepy even late at night and into the morning hours, just that wide awake feeling. I crave sugar (craving carbs is a standard symptom, for me it is craving sugar). Speedy inside, I call it like running at 5000 or even 7000 rpm inside. High cortisol feels great typically, I don't need to sleep or eat and I feel like I am riding in a convertible on a nice summer day out in the country with the top down. I have always been able to short change sleep, including multiple all nighters and still function pretty good. However it makes it harder to lose weight and I personally believe will have long term health consequences of some kind.

I do have a sugar spiral - High Cortisol makes me crave sugar but eating the sugar when my cortisol is high is never satisfying, I just want more. And eating sugar kicks up my cortisol. Nasty spiral. But if I grab a cortisol lowering supplement instead and hang on for 30 minutes, voila I could care less about sugar.

I have always had a tight posterior chain, it builds from calves up to hamstrings to hip area. As I got older and hormones became more unbalanced (menopause), that posterior chain tightness became worse. I think that cortisol or cortisol interacting with other hormones causes this and no I can't give any science that might back it up. But it is one of my symptoms that hormones are off and I have had this I think my whole life.

Note: I have read about adrenal fatigue, I have not had any of those symptoms (despite people telling me I must have them after several years of high cortisol). I do know what low cortisol feels like (when I have over controlled it) and that is not a common sensation for me. I think I was born with high cortisol (I can go into this more of conditions that might have caused it), or at least had it since early childhood.

My cortisol is raised by head down working hard days that are long, by food allergies, and by intense exercise without using weights (e.g. HIIT with body weight exercises kicks it up, but HIIT with a heavy weight in my hand doesn't kick up my cortisol). "Stress" such as a rough life event does not kick cortisol up for me. When I get sick (e.g. flu), my cortisol drops and stays low until I am better (nope, I don't know the science of why, but repeatedly this happens).
My cortisol is lowered by exercise with weights that really work my muscles (I am guessing this raises testosterone which lowers cortisol?), higher protein in a meal/day, and getting enough sleep & down time. Note: Deep sleep lowers cortisol, and higher cortisol makes it harder to fall asleep and stay asleep, another nasty spiral.

OTHER SYMPTOMS:
During menopause when the sex hormones started shifting (I am guessing testosterone lower, progesterone lower, and estrogen still fairly high because of being overweight), my symptoms got worse.
That first year, the muscle tension got worse. I realized that eating a cup of brown rice a day kept things at bay (manganese?). I really followed eating what I felt like (lots of soy, bitter salads) and kept the bulk of the symptoms at bay so other than the tension didn't have a lot of symptoms (but I worked it hard).

A year or two later, I got muscle burning like crazy, an acid burning feeling inside the muscle (not like the burn while working out). Sort of like after doing a huge workout the day before but worse and that burning sensation on top of it, and it was all the time even if I had not worked out for a few days. It got in the way of workouts and general life it was so bad. I found some better cortisol controlling supplements and stabilized things. I did go to a menopause naturapath and was given a long list of supplement to try. Massive Vitamin E made a big difference.

A few years later (about a year ago) things seemed to shift again. I had lots of muscle aches that were out of proportion for my workouts, again at a level that was interfering with life. I went looking for more cortisol info and found PS and started using that supplement. I think I have been low with PS my entire life.

Shortly after that, I had my sex hormones tested along with cortisol & DHEA - saliva tests. Yeah, I know you guys don't mess with those, but if anyone is interested check out ZRTLABS. They do a write up that is pretty complete that tells you where you fall and where different age people fall (just reporting the statistics of all the tests they have taken). I was taking Keto-7, which I thought was a DHEA substitute, but the lab said that Keto-7 can raise DHEA and can falsely report high Testosterone but also can actually raise testosterone . My lab results came back with cortisol controlled when I thought it was and high when I thought it was, with my estrogen high (for post menopausal non HRT female my age), and my DHEA high and my Testosterone thru the roof. So I quit taking the DHEA.

Over the next several months I think things got worse, I think the DHEA was raising my testosterone and it began to crash some after this.

I started feeling jittery/vibrating inside, something I had to be quiet and pay attention to my muscles to feel. Without focusing on this, I just felt not calm, not relaxed, maybe just a touch agitated. I also had the muscle achy feeling and something that I had felt over the year before that I call brittle bones feeling - it feels like if someone had a long bone of the arm/leg balanced with the middle on something solid and pressing down on each end so it felt like it was going to snap. I would feel this across my hips (posterior), in my longer bones, and in general. I was thinking cortisol and upping my supplements made it better but I felt like I was chasing after it and not winning (e.g. throwing in more and more pills to try to control it).

I started experimenting. Progesterone, nope, I didn't need that stuff at all (every time I try it I quickly feel bad). I tried some testosterone gel and voila, the muscle achy and brittle feeling all went away. The jittery/vibrating feeling went away. I slept great!!! And I could take about �?½ the cortisol supplements I was previously taking to control my cortisol.
With testosterone in me, my cortisol is lower and I don't have to use as many supplements to control it, I sleep better, I am much more comfortable in my body.

LAB RESULTS:
I recently went to a Dr that specialized in bio-available hormones, my first appointment was the day I had said hey, testosterone really makes a difference (I take something, quit taking, and take it again - several times, to make sure that is what is making the difference, not just a coincidence with something else making the difference).
This office is maybe better than a typical Dr, but still big problems, I need to remember don't believe what they say.

Lab results - from labcorp I believe (NOTE: I had no gel testosterone for 3 days prior, I was taking my cortisol lowering supplements, and yes I as feeling like crap.)

TSH 1.31 (.82-1.77)
T3 free 2.4 (2.0-4.4)
Reverse t3 serum 18.1 (9.2-24.1)
T4 free 1.310 (.45-4.5)

Dr determined by these test results that my thyroid was low. They said that T3 was low and TSH was high as it was kicking out a lot to try and raise T3.

TT (testosterone serum) 14 (3-41)
FT or bioT. Not tested - Note, I asked if this was tested and they said they look at this more for guys but don't test it in women at all (and sounded like not always in guys?). This forum seems to recommend this should always be tested.

Dr said I was about 10% of what I should be. Note: The nurse practitioner said that their men clients seem to feel best at 1200, and other things they have said have not turned out to be true and/or not true for me, so I am taking everything they say from now on with a huge truck of salt grains.

E2 11 (<6-54.7 postmenopause, 12.5-498 for different cycle phases for women still having periods)

Dr said this was low. I was suspicious as I am significantly overweight, but she said my fat cells must have stopped producing estrogen and I was definitely low.

The items below were tested but the Dr didnâ??t discuss them.

FSH 56.3 (25.8-134.8 postmenopause)
LH 34.4 (7.7-58.5 postmenopause)
[LH/FSH] .61 (< 2 normal? One study claimed this was accepted information).

Aldosterone serum lcms 5.4 (0-30)
ACTH plasma 24.1 (7.2-63.3)
Prolactin 6.6 (4.8-23.3)
DHT not tested

DHEA 49 (> 19 yrs old range is 31-701)
DHEA-Sulfate 67 (35.4-256)
Cortisol 5.9 (2.3-19.4) being lowered with supplements such as PS

Vit B12 1353 (211-946)
Vit D, 25-hydroxy 70.6 (30-100)

All other test results in normal ranges and cholesterol number are good (very low triglycerides and ldl, high hdl), which I credit to grass fed beef & hard exercise.

INFORMATION ABOUT ME:
Female,
Age 54
Height 5'7"
Waist 44â??
Weight @ 260, ideal 150 (low fat with good muscles)
Body & Facial hair - I always been on the light amount of hair for a women
I have never bulked even with heavy weight lifting

Thin as kid, gained the 10-20 lbs as young adult, went thru very stressful times in mid 30s and weight went on quickly. Since then I have to work about 3x as hard as someone else to lose and it comes back on very quickly when I am not sticking to my food & exercise plan (vacation, move, tragedy, etc).
I typically gain weight in hip/thigh area with a flat stomach and hourglass figure, but now I have extra fat everywhere and more lately I have more belly fat which is not typically where I carry fat.

health conditions â?? none, ever, except for cortisol and hormones - see more below
OTC - advil when needed for muscle soreness. Supplements - mostly for cortisol including Vit B & E & ZMA which high cortisol depletes. Vit D & coQ10 & general multi Vit cause it is supposed to be good for me (though there are mixed reviews about multi vitamins).

I eat what I call a fuel and fill diet - first I fuel my body and second I fill my stomach to a reasonable level. It is a quasi paleo diet, with high protein (120-140 g avg on a typical day). At least half is whole eggs & non fat Fage (greek yogurt). The rest is grass fed beef, pasture chicken, seafood (fish, calamari, etc). My healthy fat is coconut (oil to cook, coconut butter, raw fresh coconut) and avocado and occasionally olive oil. I don't do a lot of grains and they are always whole boiled grains (quinoa or brown rice short grain).

I eat beans when I feel like it, home made from dried beans, on and off as I feel like it but probably a couple of servings per week every other week. I don't typically eat potatoes but sometimes I will have them (I have been craving potassium, white potatoes, celery, and coconut water the month before I started supplementing testosterone, - things I normally don't eat, somehow related to the imbalances, as I get in more testosterone I desire less - go figure). I eat small amounts of fruit, mostly black berries about a cup a day and several times a week something else, typically citrus or apple or strawberries and sometimes melon.

I typically eat 5-10 servings of veggies most days, cooked or raw. I don't eat a lot of processed food; I am allergic to flour and stay away from sugar which cuts out most processed food, I get real consequences from eating it so it keeps me pretty good about it. My treat is a little 85% dark chocolate that I have as desired (on average about 150 calories worth a week). When I eat out, I eat at restaurant that cook (quality and type of food) like I do at home. Yes, sometimes I eat something "bad" for me, but not often, probably one a week on average (though I can go weeks without then might eat something 1-2 times on a bad week).
I eat about a 500-800 calories deficit a day.

Exercise I do: Crossfit type exercises with a trainer, sleds, sledgehammers on tires, Olympic barbell, dumbbell, kettlebell, pushups, pullups. He is a very good evil trainer (e.g. wear out your arms so they can't cheat and help you with barbell cleans so all they start feeling heavier). I swap out pure cardio like jump rope, running, jumping jacks with things like kettlebell swings as that works better with my cortisol issues. Workouts are typically 45 minutes 6 x a week. I also throw in other exercise, sometimes long slow recumbent bike ride or other ST exercise (sandbag, kettlebells, etc.).
I have always liked heavy weight lifting more than cardio (though I liked sprints and sprinting sports like racquet ball when I was young). I wonder now if it was because it helped increase my testosterone and so I felt better afterwards (I know I felt better afterwards).

BEFORE SEEING THE DR, TAKING TESTIM:
Before seeing the Dr I was trying most to get rid of the deep vibration in my muscles, with the achiness in my muscles an the brittle feeling in my bones/muscles.
I tested with natural progesterone and it made these sensations worse -? a clue.
I played with testosterone (I was nervous about this before, after all we hear women aren't supposed to need any testosterone, but I was desperate enough I experimented using a fair amount and was surprised it really made a difference. With testosterone in me I felt a lot better, I no longer felt any of the achy brittle feelings, I slept wonderfully, and I felt more settled in my body (no agitation, no vibration deep in the muscles, no jitteryness).
I was taking about 1/5 of a standard tube of testim gel. There is 50 mg in a tube, so I was taking about 10 mg. I read a few places (but not scientific research) that about 10% is absorbed, this means I got about 1 mg a day in me. Yes, I know this varies a lot.
When I had tried �?½ of that amount (@ .5 mg a day), it didn't really relieve my symptoms (barely any difference than no testosterone).
When I tried a little larger amount, I felt real hot all day long, I felt like there was an agitation more on the surface of my body (vs the deep vibration without any testosterone) and I felt uncomfortable. So I knew somewhere about 1/5 a tube/1 mg a day was a good amount for me. Of course I told the Dr all of this (no progesterone it made things worse, yes testosterone and this much is what seemed to help).

AFTER SEEING THE DR:
So the Dr pushed pellets for estrogen and testosterone. I had read just a little about them. I was unsure (you can't take them out), but I knew I needed the testosterone and they started on the low side, so I agreed with the pellets (big mistake, don't trust Drs - more later on that).
They put in:
E2 18mg
T 137.5 mg,
They proscribed Armour Thyroid 30 mg tablets.
They proscribed 100 mg progesterone (Note: I was told this was because they have to give this whenever they give estrogen to prevent uterine cancer, they didn't say anything about if I needed it or not). I believe the premise is flawed, it is based on a study where estrogen was given to women whether they needed it and about 1 in 1000 had a serious side effect -? cancer/heart attack/stroke, and I think but would have to confirm this, that these women were given synthetic estrogen. Whoever decided that giving progesterone would lower the risk. I don't know if significant studies were ever done to prove that progesterone with estrogen lowered the risks when given randomly to people whether they needed it or not.

I wanted to space things and not dump 4 things in at once, so I could tell what was doing what so I didn't take any progesterone or thyroid medicine for 2 weeks.
I overall felt a lot worse than before the pellets when I was adding in just testosterone, and I am not able to describe all of how I felt bad, but here is some of my new symptoms.
I had the same symptoms of not enough testosterone (achy muscles & the brittle feelings) as if I had no testosterone in me at all.
I was fatigued and had very low energy with the pellets in me, (both with just the pellets they put in me and also when I added more testosterone to what they gave me). I had significantly less energy than before I had pellets put in me. I am guessing this is a symptoms of too much Estrogen (it could have been because thyroid was lowered, but that didn't test out to be true, and it could have been that I didn't have enough T in me, but before I started to test with T I didn't have that very low energy feeling).
I had known symptoms of too much estrogen (swollen tender breasts and nipples, hmmm do guys get those same symptoms?). I also had uterine cramping, again I believe that is from too much estrogen as I didn't have them before even when I added testosterone.

I started adding testosterone, trying to get rid of the symptoms I had before I had the pellets put in. I had to use about the same amount I had been using before the pellets were put in to get rid of the achy and brittle feelings (about 1/5th a standard tube a day). But I didn't feel as good, I was hot a lot, I was uncomfortable, nothing like when I did this before the pellets and felt great.

I tried the progesterone pill - one pill made me feel awful right away, way too much. I waited a few days for it to ware off, and tried some natural progesterone cream. Starting at about �?½ a normal dose and going down from there. I took it at night (when told to as it has a sedative quality). I would wake up groggy and be feeling a little draggy and doped up all day. Even going down to 1/10th of the specified dose, I would be groggy during the day (progesterone has a sedative side effect). Overall I felt worse, not better with this in me so I quit taking it. I started waking up with a clear head without it.

I tried the thyroid pill, and one pill kicked up my heart rate 25% (from my typical @ 60 beats per minute, a result of my workouts). My pulse also didn't feel strong and solid like it typically does, it was wobbly/thready and not strong beats, more like sloshing water? It didn't feel good. Also overall I felt worse. I played with smaller doses and at 1/10th my pulse felt normal, but I didn't feel any better, so why bother. Note: It didn't improve the draggy feeling, even when it kicked up my pulse.

Information I found out about the pellet absorption rate:
For pellets of 75mg, "It has been found that approximately one-third of the material is absorbed in the first month, one-fourth in the second month and one-sixth in the third month. Adequate effect of the pellets ordinarily continues for three to four months, sometimes as long as six months." http://dailymed.nlm.nih.gov/...0d-a06e96cce9ef search for absorption to find this paragraph.
This is from one of the manufactures - testopel, and the compound pharmacy that created my pellets said that the absorption rates are the same for all pellets as they all have the same ingredients (what is added to the testosterone). Note: The size of the pellet makes a difference, so if someone had a pellet larger or smaller than a 75mg one, it might vary some. See http://endo.endojournals.org/...ontent/36/4/283 which gives a calculation based on pellet size.
As always it can vary some, putting the pellet in fat might mean it is absorbed into the fat and released into the body slower, but I have read things on the internet (not bothering to go look for them right now) where there was problems with natural hormone creams including testosterone that women used rubbing them into fat as directed (e.g. belly), and then there being a buildup of the hormone in the fat that took some time to get out of the body when the woman was overdosed with the hormone. I also saw something somewhere about injecting testosterone into fat vs into muscle saying it would be released into the body at a slower more steady rate than a shot that is put in the muscle every 1-2 days.

If I would have know that about 1/3 the pellet gets absorbed over the first month and �?¼ the next month with much less the following months, with a very small amount the 3rd thru 6th month, I would not have agreed to pellets. I had been told it was a steady release over time, like a pill that was time released.

Gel absorbtion - I have seen others talk about the variations in gel absorption. I find that if I do some exercising after applying the gel, that uses the muscles (for me a little weight lifting), my body absorbs and seems to process?? The T a lot better. That ties into for me that if my cortisol is high and flooding thru my body, if I am working my muscles (weight in my hand vs something like jump rope), I don't get that high cortisol hit. It is somehow absorbed and metabolized. I don't know the science behind this, I can just tell you it feels real different to me.

I am still playing with this as well as playing where I apply the gel (e.g. on a major muscle and then use that muscle for 10 minutes of exercise).
Also this month with things messed up, my legs have lost strength and my arms have lots. For example this week doing front squats with 60 lb barbell felt way too heavy, I couldn't go deep into a squat. But push pressing the same weight was piece of cake (ok not easy, I had to work but I was hardly doing any dip and push, mostly just pressing). The squats should have been much easier than the presses. In the past I have squatted more with a much better squat and not pressed as much weight. I had been putting the testosterone on my shoulders/upper arms. So I am playing now with putting it on my legs to see if that makes a difference, maybe - it has only been one day so hard to tell at this point.
Anyone else notice anything like this?

ANSWERS I STILL NEED:
For now, I am going to stick to the Testim gel, because it works for me and I can adjust it daily or even more often (e.g. not enough, add in a pea size more). I like the idea of adjusting based on symptoms, I understand there is absorption issues and I am willing to play with it to understand how it works for me better.

I see the Dr this week for a followup (labwork done last week at the 4 week mark).
I am going to insist on SERM (thanks you guys for this info), I strongly believe that I didn't need the estrogen they gave me, and I might have too much in me even without what they gave me. I will ask for it in a cream (vs a pill) as that is easier to play with smaller doses. Yeah, I know I will have to go in with exactly what I want (name, dosage) and expect resistance from them.
I probably should also get an AI, so I have that to play with also, just in case. And at some point I may need it.
I will work to feel my best with the SERM and T gel, then retake labs.

Thyroid - I understand the Drs argument that Tsh is a little high and T3 a little low. But from my tests of how I feel when taking even a small amount of the thyroid pill, I don't need the thyroid pills. I know that if my testosterone is low that can pull down my thyroid, so next test I will have my testosterone at a level I think is good and see what my thyroid numbers are then. Other than Armour thyroid, anything else to try if indeed my thyroid is low?

Could the Estrogen they gave me be causing the dragging feeling / fatigue I am getting. It has calmed down (now at week 5 after the pellets) to just wanting to sit and not move vs feeling weighed down/pulled down? If not this or thyroid, what could cause it to show up after they pellets were put in? I didn't feel it before the pellets, regardless if I was adding in some T or not.

Should I push for FT/bioT testing?

What are normal ranges for LB/FSH ratio? Or concerns for this if LH and FSH are both ok?
What role does Aldosterone, prolactin, and ACTH play (I know they are hormone related) and where in the lab range is more optimal?

DHEA -? what is the optimal number for this? Middle of the lab range?
Should I try taking some DHEA since it is low as well as T? Yes, I know that I responded poorly to this before but it has been over 10 years and my hormones have changed so it might be worth trying again. I know this is over the counter now, anything to watch for to get a good brand.

Thanks in advance for your help.

Endocrin - Beaumont

Sat, 18 May 2013 04:04:00 GMT

Anyone know of a good endo around Beaumont tx

Low Test, Advice

Sat, 18 May 2013 03:15:00 GMT

Recently, I had gotten my test results back. I had posted this on the bb.com forums but these topics are not usually allowed, so I was directed to this site. I was told the people here were more knowledgeable when it comes to this.

Age:16
Height:5'7
Waist:31.5
Weight:146lbs
Facial/Body hair:good amount of leg hair,barely any hair on arms. Little amount of facial hair.
Way I carry bodyfat: I carry it much like women. Most of it is in my upperthigh/ hip region and glutes.
Diet: Had a history of very low caloric dieting. Less than 1000 per day. Currently bulking on 2600

I always had symptoms of low test so I got it checked.

My symptoms:
trouble gaining muscle mass and strength
Fatigue
Trouble with concentration
Social Anxiety
Low confidence (I've read that this can be a symptom of low test)
Gyno
Trouble losing fat

My testosterone levels:Done at around 12 pm.
Total testosterone- 158 ng/dL Range only says < 1001
Free Testosterone- 21.9 Range:18.0-111.0 pg/mL

Would be appreciated if someone gave me some advice. I was planning on maybe getting an appointment with an endo as my doctors are not very helpful.

Lowering Estradiol

Sun, 19 May 2013 20:34:00 GMT

Guys, I'm not certain if this is the right place to post this question so please be gentle if I should have posted elsewhere. I just had a fairly comprehensive blood panel done (first one in a while) and I'm looking for some advice on how to improve some readings. In particular, my estradiol levels seemed quite high at 52.3 pg/mL while the top end of the normal range is 42.6. This concerns me because of the obvious health issues from high estrogen but also because it seems significantly beyond just high normal.

I'm still trying to decide the best course of action to take in light of this result. I'm 32, 5'7" 220 lbs and carry most of my bodyfat in my lower body (ass and thighs). Here are a few more figures from the panel to paint a slightly better picture:

Total T = 893 ng/dl [350-1200]
Free T = 11.4 pg/ml [8.7-25.1]
DHEA-S = 158.2 ug/dl [160-449]
Estradiol = 52.3 pg/ml [7.6 - 42.6]

TSH = 1.78 uIU/ml [0.450-4.5]
Thyroxine = 7.3 micrograms/dL [4.5-12.0]
T3 uptake = 35% [24-39]
T4, free = 1.38 ng/dL [.82-1.77]
Triiodothyronine, Free = 2.3 [2.0-4.4]

Hematocrit = 43.5 [37.5-51]
Iron = 88 ug/dl [40-155]

Cholesterol Total = 129 mg/dl [100-199]
Hdl = 55 mg/dl [>39]
LDL = 66 mg/dl [0-99]

Triglycerides = 39 mg/dl [0-149]

AST (sgot) = 41 IU/L [0-40]
ALT (sgpt) = 34 IU/L [0-44}

Vitamin D, 25Hydroxy = 46.0 [30-100]

Fasting glucose = 79 mg/dL [65-99]
Hemoglobin A1c = 5.0% [4.8-5.6]
Est avg glucose = 97 mg/dL

WBC = 3.3 x10E3/uL [4.0-10.5]

I guess mainly wondering if this figure is high enough to warrant skipping straight to medications like arimidex or clomiphene? I'm not opposed to trying that route if that is what is necessary. Any thoughts would be appreciated.

Also, I included my white count because it being low did catch my eye. The last time I had it checked was the day I had to have my appendix removed, but my white count was normal at that point. My doc almost sent me home because of the "normal" white count and a lack of significant pain. Luckily, he sent me for a ct scan and caught the acute appendicitis. The whole time I thought I was wasting my entire day at the hospital waiting for the scan lol.

Edit: As recommended in the stickies, here is some additional info about me:

-age: 32
-height: 5'7"
-waist: 36ish" (when I was fitted for a tux recently they said 35" but I swear when I use tape at home I get 37")
-weight: 220lbs
-describe body and facial hair
I'm not a very hairy guy. Some chest hair and hair on legs. Facial hair grows quickly enough to be make me shave every other day but grows very little beyond that. It would be impossible for me to grow a beard. I have something of a receding hair line. My dad was almost bald by the time he was 28 so I guess I should consider myself lucky.

-describe where you carry fat and how changed: Lower belly and especially ass and thighs.
-health conditions, symptoms [history]: I'm not really sure I have any significant health conditions.
-Rx and OTC drugs, any hair loss drugs or prostate drugs *ever*: I used propecia (1mg/day) for about 18 months when I was 21-22.
-lab results with ranges: posted above
-describe diet [some create substantial damage with starvation diets]:
I'm trying an IF diet for the past 2 months and I was only having small breakfasts prior to that. A typical day the past 2 months has been
lunch: 6oz meat, veges,and 1oz almonds
3:30 30 grams of whey protein
5:30 2 scoops of anaconda during my workout
7:15: 50grams of whey protein
8:00: a large dinner consisting of around 12oz meat, veges, rice or potatoes and an apple or two
All tolled it generally comes in around 2400 calories with about 40% protein/40% carbs and 20% fat.

-describe training [some ruin there hormones by over training]: Well, my new job makes it pretty tough to maintain a very strict regimen, but I've been in the gym lifting at least 3x/week every week and sometimes 5x/week this year. Prior to that I was in the gym 4x/week nearly every week the previous 2 years. Over those year I'd do 2 upper and 2 lower body workouts each week with rep ranges in the 5-12 range. This year I've been trying to lift heavier a little more frequently, and I've been trying Christian Thibaudeau's layer system for the past 2 months. Some additional conditioning work when I have the time or substituted on the days I cannot get to the gym.

-testes ache, ever, with a fever?: No, at least not that ever remember.
-how have morning wood and nocturnal erections changed: Well, was virtually on-existent in my 20's and is better now. Granted, I lived a VERY unhealthy lifestyle in my 20's so that's not saying much. I have morning wood a couple times a week I'd say.

I take no prescriptions meds at this time and have not with any regularity taken any in the past with the exception of propecia. I suppose I am something of a supplement whore though. I use fish oil, vitamin d, creatine, whey protein, anaconda, indigo-3g, and I just started using coQ10. Kinda silly I guess.

As for other lifestyle choices, I almost never drink and when I do it's a single over the course of the night. Sadly, I was probably an undiagnosed alcoholic from about 19-24. I haven't drank with any regularity in about 6 years. I just started using iodized salt about 2 months ago. Previously I used iodine free salt. Other than that, I probably do not eat any substantial sources of iodine. I usually feel pretty good in the mornings with the exception of being cold sometimes. In the afternoon, I usually get sleepy and cranky no matter what I eat for lunch. At first I figured it was because I used too many carbs at lunch but over the past couple months I've had virtually none during lunch so I'm stumped on that front.

Day 1 Morning temp: 96.7 degrees I did have to get out of bed because I forgot to leave the thermometer next to the bed.
Afternoon temp: I couldn't take it because I had ot attend my brother's graduation and it was 90ish degrees so I thought that might throw off the reading.

Day 2 morning temp: 96.8 degrees.
temp at 1:00 (pre-workout): 97.8
temp at 3:30 (post-workout): 97.7 I wore a light jacket through the whole workout. This was a little odd since I normally remove it once I feel like I'm sufficiently warmed up. I never felt the need to remove it today, but it was an upper body day so that was likely part of the reason.

Couple of Questions for a New Guy

Fri, 17 May 2013 06:23:00 GMT

Hello guys...new memeber here so excuse any...

I'm 40 years old
5'8"
220 lbs
very active
fairly fit
carrying extra fat that I can't shake
have only one testicle due to a childhood injury
I believe that I have had more than enough T despite the injury for most of my adult life - crazy sex drive, good erections, good muscle definition (until the last decade) - I have always competed at high levels in sports too.
With that said I have felt progressively crappier each year for about 6 or 7 years.

A couple of years ago I was diagnosed with low T my reading at the time was about 350 if memory serves me well. At the time I decided to do nothing about it as I'm not really into meds or doctors for that matter. Now after two years of denial I am back after being sick of falling asleep at night before my two year old (7:00) and not getting results despite a strenuous workout schedule.

I tested again with total T of 321. I started out with Androderm patches which wouldn't stay on during exercise or surfing switched to Axiron 2mg under the arm each morning.

After a week on the Axiron I felt like a rockstar all the sudden...erections like I haven't had since I was 20, mental clarity, tons of energy. Awesome... A few days later I started having a reaction under my arms which got very bad before I went back to the doc for a look, itchy red and swolen. Had to abandon the axiron. Tired of all the BS I said I would just do self injections.

Got on T-cyp 200mg per week. After the first injection I felt basically nothing...very dissapointed. Actually might have felt worse tired and low sex drive. Stuck with it for another three weeks and started to notice that I started feeling good about the time for another injection - nothing like my short stint on the axiron but better- immediately after each injection I was back to "not good". After the 4th week of this and the 4th injection I actually got much worse and experienced the first instance of ED in my life. Sorry for those that have lived with this longer - that sucks! This lasted for 3 days and gradually got better and better each day after.

Went back to my doc - who is a general family doc not a specialist - her response was "sounds like you are having an issue with absorbtion" - I said I didn't think that was the issue and that I am concerned about my esteridol levels spiking and negating the benefits of the T. She seemed a bit dumbfounded and said that is "interesting".

I suggested that I lower the dose of T to 100mg per week based on the feeling that I was seeing benefit 4 to 5 days post injection and seemed to be finding a sweet spot after the concentration had gone down. She said that was a great idea and happily endorsed it. I asked about another blood test and suggested including esteridol she happily agreed.

Tests came back today - blood was drawn exactly 1 week after my last weekly injection of 200mg T cyp.
Total T - 759
E2 - 46

Today I did my first injection at the lower rate of 100mg/wk - no ED yet but not feeling like a "rockstar either" sort of normal.

Im not thrilled about going on an Aromatase inhibitor as I would just rather keep things simple and it seems like there is some uncertainty about the long term effects of it.

I have 3 questions.

Has anyone else run into this type of scenario or know what is going on with me?

Has anyone here on the forum actually had long term stable results with HRT or is this going to be a constant roller coaster ride for the rest of my life? I am hating this.

Should I stick with my general doc who is happy to follow my suggestions or see a specialist like and endocrinologist?

Thanks for any input!!

So, What Now?

Fri, 17 May 2013 03:36:00 GMT

Hey all, looking for some insight into what is up with me. Would appreciate your advice.

Long story short, have been dealing with doctors for nearly a year and a half who look at labs with low testosterone and blow me off. I am assuming this is because I'm 23, and with no past history of abuse, they don't want to believe it. I don't know, it beats me.

Anyway, here's my history:

23; 5'11"; ~150 pounds; born with both testes undescended, but corrected around age 2;

May 2012 (Labcorp)

LH: 4.8 mIU/mL (1.7-8.6)
FSH: 2.4 mIU/mL (1.5-12.4)
TT: 244 ng/dL (348-1197)
FT: 5.5 pg/mL (9.3-26.5)
Prolactin: 20.5 ng/mL (4-15.2)

MRI ruled out prolactinoma. Was on SSRI at the time (for symptoms), and once discontinuing, prolactin leveled back off. Doctor was treating me with testosterone injections, but giving me way too much and I was getting labs back saying TT values were >1500 ng/DL. He never measured E2 or was concerned about testicular atrophy. No thank you.

I opted to find another doctor. Got referred to an endo and blown off, unfortunately.

January 2013 (Quest)

LH: 2.8 mIU/mL (1.5-9.3)
FSH 2.9 mIU/mL (1.6-8)
TT: 362 ng/dL (250-1100)
FT: 38.1 pg/mL (46-224)
Bioavailable T: 99.8 ng/dL (110-525)
Prolactin: 4.5 ng/mL (2-18)
E2: 21 pg/mL (<=39)

So I took these labs and found an endocrinologist here who I like very much. She put me on clomid (50mg/day for 25 days) to see how I responded.

These were the labs the day I took the last pill:

April 2013 (Quest)

FSH: 14.5 mIU/mL (1.6-8)
LH: 41.1 mIU/mL (1.5-9.3)
TT: 408 ng/dL (241-827)
FT: 67.9 pg/mL (46-224)
Prolactin: 3.4 ng/mL (2-18)
E2: 30 pg/mL (<=39)

So it seems my brain responded to the clomid treatment, given it ballooned LH/FSH levels. However, it looks like my testosterone production was barely effected. In fact, I've seen higher a slightly higher TT lab without any medication at all... Does this essentially mean I have some primary issue going on at this point, or are there other options to see if I can't produce naturally? Do I need to perhaps be on clomiphene longer?

I realize that some of my labs fall within the normal rage (if only barely), but at my age and given that I'm symptomatic (no libido, no secondary sexual characteristics, no energy, etc.), it's definitely having an effect on me.

I'm sorry for the wall of text. I would appreciate any insight/opinions on my situation. I have just been dealing with this for so long that it's starting to wear me down emotionally and physically.

Low T Diagnosed in 2008

Fri, 17 May 2013 02:57:00 GMT

I live in southwest Florida and have finally started to get serious about getting my levels where they should be. I was diagnosed with Low T in 2008, initial TT was below 100 (I will update all of my levels over the years as soon as my chart arrives). I have a varicocele and have recently heard that having it removed can increase your T levels. I am in the process of locating a doctor who will perform the surgery.

History:

I got diagnosed shortly after I got married. I was having some difficulty maintaining an erection. I went to my GP and after a full blood panel the Low T was discovered. At that same time the GP noted that I had a varicocele, but stated that it would not affect T levels. Went to an endocrinologist for an MRI with contrast to check my pituitary. MRI showed a normal pituitary.

Prior to my diagnosis I was having difficulty with motivation, feeling very lethargic and generally melancholy. I would have difficulty staying awake at work or in school even after a full eight hours of sleep. It was also very difficult to maintain concentration on certain tasks.

I was initially prescribed Androgel 1% at 4 pumps/day. My T levels slowly crept into the bottom end of the normal range so my doctor said that dosage was fine. Because I felt better than I had in years, I assumed this was as good as it could get, even though I still had days where my symptoms would return. For many years I never pursued things any further.

Now, because of cost, I have started to look into alternatives for the TRT. As a result, I realize I have been a negligent patient and am hoping to get my meds straightened out. Accordingly, shots seem like the only way to go. I will need to find a doctor in SWFL who will buy into the treatment plan. If anyone knows of one, please pm the name.

Age: 29
Height: 6'2"
Waist: TBD
Weight: 235

Body and Facial Hair:

Hairy chest, arms and legs. I have a full beard and have for almost 7 years. Facial hair did not start to come in until I was 17 or 18.

Body Composition:

Overweight. Mostly carry the fat in my stomach and love handles. Weight loss has been up and down the last few years. Heaviest was 260 and lightest was 220. During some of the up and down my butt disappeard. It is now so small I can barely keep a pair of pants up with a belt (I now understand why suspenders were invented).

Health Conditions, Symptoms:

Prior to Diagnosis:
Extreme fatigue, even on full rest
Unable to focus on tasks
Melancholy
Social - I am a people person, but generally didn't feel like going out with a big group or to crowded places.
I dealt with some acid reflux for two years. Under control with prilosec. Started gluten free diet in 11/2012 and ceased prilosec shortly thereafter and have not needed it since.

After Androgel
Mitigation of all symptoms mentioned above. Some days better than others. Anytime I am off the medication for a period of time, the symptoms return in full force.

Rx and OTC Drugs
I took acutane when I was a teenager. Only antibiotics as needed. I had bad allergies when I lived in North Florida so I was on Claritin and Flonase for several years. Prilosec in 2010 and 2011. Now the only med with regularity is Androgel 1%.

Lab Results:

A more complete history will be added upon receipt of my medical file. Also, many of these will be simple TT/FT tests. I didn't realize what I needed to be requesting until reading this forum.

Blood Test 4/24/13
TT: 335 ng/dl (280-800 ng/dl)
FT: 1.24 ng/dl (.56-2.7 ng/dl)

Diet:

3-4 meals per day. I am now gluten free. Usually 2 eggs with bacon for breakfast, salad or steak with green vegetables for lunch, and protein and vegetables for dinner.

I do eat quinoa pasta and some gluten free bread products on occaison.

Supplements:

Multivitamin
Omega 3
Vitamin D - 5000iu

Training:

Lacking. I have recently started Stronglifts 5x5 three times per week. Just looking to get back into the habit of working out.

Testes ache, ever, with a fever: Not that I recall.

How have morning wood and nocturnal erections changed: occaisonal 1-2/month.

Let me know if missed any information you need.

Need Doc in NorCal

Thu, 16 May 2013 22:28:00 GMT

Does anyone know of a good HRT doctor in Sacramento, CA or anywhere near that area? I will be returning there for summer, and can't find a good doctor in Spokane, WA where I currently go to school. The Bay area might work as well.

Mind you I'm 20 years old, and have been unresponsive to HCG and Axiron, both separately. Looking for someone who would prescribe Test+Anti E+Hcg possibly.

Thanks.

-age: 20 years old
-height: 5'8"
-waist: 30
-weight: 175
-describe body and facial hair: normal facial and body hair
-describe where you carry fat and how changed: I've been carrying fat around my hips and legs for a few years now, upper body is fairly lean
-health conditions, symptoms [history]: low testosterone, diagnosed one year ago, high cortisol, low natural killer cells, low platelets, high eosoniphils, high Epstein-Barr marker
-Rx and OTC drugs, any hair loss drugs or prostate drugs *ever*: took HCG for a few months but levels only slightly improved, took axiron for 3 months and testosterone dipped to pre-baseline levels
-describe diet [some create substantial damage with starvation diets]: 3000 calories to maintain weight, fairly balanced diet, 1g/lb protein, .45g/lb fat, rest is carbs
-describe training [some ruin there hormones by over training]: 3 day split with upper/lower/upper
-testes ache, ever, with a fever?: no
-how have morning wood and nocturnal erections changed: occur less frequently than in my earlier teenage years

20 YO Who's Tired All The Time (With Labs)

Fri, 17 May 2013 02:41:00 GMT

Hello,

-age
--20

-height
--5'10

-waist
--34-36

-weight
--215

-estimated body fat
--24-28%

-Blood pressure
--127-63

-Temperature readings
--Will post when I have. Need to buy thermoter

-describe body and facial hair
--Probably shorter legs. 32 inch inseam. Big Rib cage and joints. Small wrists though. Narrow Shoulders. 73 inch wingspan. Consider myself small in frame but hold weight very easily. People will often call me a "big dude" I disagree. Very endo.
--Facial hair still doesn't come in much. It's getting better as I get older. It's not patchy anymore. Just doesn't grow long.

-describe where you carry fat and how changed
-- *Current* Carry fat in mid section, chest, ass, all over legs. That is where most of my fat is. From certain angles I could probably bullshitt looking way leaner than I am. No love handles really, leaner shoulders, back, face and arms. When I get fatter the places I mentioned tend to get really big.

-health conditions, symptoms [history]
-- Was morbidly obese from the ages 7-15. Age 15 280 pounds 5'5 43% body fat. Lost 100 pounds in 11 months time while growing a couple inches. Current symptoms below.

-Rx and OTC drugs, any hair loss drugs or prostate drugs *ever*
-- Never been on any medication. Have never taken anything more than Tylenol and cough syrup. Have had one doctors visit in the last ten years.

-lab results with ranges
-- Lab Results Attached

-describe diet [some create substantial damage with starvation diets]
-- Used a 40/30/30 to lose the first 80 pounds. Then played with low carbs to lose the rest. Had cheat days and re-feeds every weekend. Weight loss was maintained at 1.5-2 pounds a week for the last 60 pounds. Gained back a lot of weight over the past few years. Age 20 5'10 270 pounds. Started losing again recently using a half day timed carb diet. Re-feed every 3-4 weeks. Lots of oils and nuts. Plenty of lean meats and fish. Green veggie shakes post workout. Down to 215 in about 8 months.

-describe training [some ruin there hormones by over training]
-- Started training at 15 by myself with typical body building magazine stuff. Found body building websites. Did some more strength oriented stuff. Rippetoes, Madcows, 5/3/1. I was benching 95 pounds when I was 15 and weighed 280 pounds. Best lifts to date, Squat 385(Deep squat)(Have posted on Rippetoes board), Bench 245, Dead 455)

-testes ache, ever, with a fever?
-- They keep to themselves. Never give me problems.

-how have morning wood and nocturnal erections changed
-- Never were that consistent, doesn't happen all that often anymore.

*Current Symptoms"

I seem to nod my head at every thyroid, low test and adrenal fatigue symptom.

-Fatigue (All the time. Takes and hour to wake up. Need naps at noon. Walking and talking slow. Sometimes feels hard to move. This has been going on for years.)
-Mind is always foggy (As long as I can remember)
-Wired at night time. Mind races. (As long as I can remember)
-Increased sensitivity to cold (Recently. Seems I'm the only dude who gets cold)
-Sleep never feels good
-Dry skin
-Puffy face (I do have puffy face days)
-Hoarseness (Have a had a very deep voice for a while. Sylvester Stallone ish. Some days more so than others)
-Muscle weakness (Do not feel strong under the bar anymore)
-Pain, stiffness or swelling in your joints (Recently)
-Thinning hair (Recently)
-Slowed heart rate
-Depression (Been depressed for a long time)
-Impaired memory (A well knows fact about me in social circles)
-Dark rings under eyes (Had these forever)
-A yellowish tint to the skin (Could be my natural skin color. Although some days I am very pale)
-Salt and sugar cravings at night
-Feelings of apathy (Very long time)

These are not exaggerated. Some things I thought were personality traits that I now think are symptoms of something. Bottom line is I am getting tired of it. I don't feel good. I haven't for a very long time but I never had insurance or money to figure it out(still don't) I just thought everybody lived likes this.

A pharmacist friend of mine firmly believes that I have adrenal fatigue. We tested my morning cortisol ( attached) expecting to find something. Sure enough the morning we tested I felt fine. Woke up without an alarm clock and had a great day. Timing was awful. Despite the normal results he still believes that adrenal fatigue is the culprit.

I've began a little supplement routine. (Magnesium, zinc, vit-c, licorice, DIM, grape seed extract, inositol, lots of fish oil, and b vitamins) I only recently discover this forum and the iodine recommendation. Will add to routine and post progress as well as temp readings.

My lifestyle is somewhat stressful I guess. Nothing I would complain about though. I work 40-50 hours a week (good job but demanding) and have a sick mother. But I am very apathetic to most things. Try not to let things get me down.

My bloodwork and saliva test are attached. I didn't want to discuss them in my post because my opinion about it doesn't really matter and I haven't had any others besides the pharmacist. The only thing I can say is that I think my testosterone is to low and despite the results, believe I have some sort of underlying thyroid issue. I just don't to assume things.

I would appreciate any feedback. I really am at my wits end here. I can't afford to see doctors and the testing has emptied my wallet for several months to come. Thanks to anyone who takes a look.

If you need any more info please let me know.

- Intentions of Intimacy

Coming Off TRT - Help

Thu, 16 May 2013 15:25:00 GMT

I am fully prepared to be slammed by everyone that says it is for life, but here we go!! I have been on TRT for about a year. I have gotten my T levels and E2 dialed in well, but if I look at it objectively the only benefit I have seen is:
- quick and noticeable response to working out (easier to put on muscle)

Here are the negatives
-no increase in libido
- no increase in energy levels
-the creams didn't work and the injections leave burning, red, itchy lumps no matter where I place them, both with T Cyp and T Enan. I have even tried smaller doses 3x/week to no avail.
-Elevated Hematocrit and Hemoglobin
- Very greasy skin
-bad body acne flare-ups
-all in all just no real qualitative benefits
-A cost of about $100/month for the T, HCG, and AI
-Time spent

I started TRT because my TT was not great and I had numerous symptoms that mimicked this, but I truly believe it was due to long-term prescribed use of xanax and the daily withdrawals I was going through until my evening dose. I switched to valium and am tapering off of that and it made a world of difference. With that said I want to be as gentle on my body as I can so I need a good PCT so I don't crash anymore than I already am from the benzo tapering.

Prior to TRT my numbers were (sorry I lost the ranges but they were fairly standard that I have seen most report)

TT 419
FT 69.6
E2 16
LH 1.1
FSH 2.1

My LH has been below normal for at least a decade (late 20s until now age 39) so I guess I have always been secondary to some degree.

Any helpful tips, advice, protocols, etc for coming off TRT? I have read so many different variations of just HCg, HCG+SERM, HCG+SERM+AI, HCG+2SERMS and on and on that I am royally confused. Thanks in advance.

Experience with Clomid?

Thu, 16 May 2013 14:19:00 GMT

I posted my full lab workup here a few months ago:

http://tnation.T-Nation.com/
hub/
TheRedneck#myForums/thread/5143242/

Short story is (probably secondary) low t at age 27. Level was 215 this spring. Now, after some exercise, weight loss, stress reduction, better diet etc., it is 265.

Endocrinologist said this was not serious and showing improvement, so wouldn't do anything. Went to a TRT specialist who prescribed 50mg Clomid MWF.

I've been taking this for about a month, and it's like I'm taking nothing...no side effects, and no positive results either. Will get labs done in several weeks to check.

I'd be interested in hearing any anecdotal info that people have about this. Does it usually take a while to work? Thanks

Need Advice on Treatment Routes

Thu, 16 May 2013 02:45:00 GMT

Hi everyone, this is my first post and I was hoping someone could point me in the right direction with TRT.

Background: I'm a 27 year old male. I've done oral on PH/DS/dbol cycles in the past. I probably did 3 or 4 cycles from the time I was 22 to 25. Most of these were just 4-6 weeks. I did not however, use proper pct. I only used OTC aromatase inhibitors and OTC ptc crap. I did have clomid and nolvadex somewhere but I can't find them. I've had symptoms that may have been low testosterone from about the time I was 16or17.

I was always extremely tired even in my teen years. I feel like my nuts have always been small and my sack tight (which is another sign). I've also been dealing with depression and anxiety from around the same time. There was definitely a noticeable change in my high school years. I never had the proper blood work before taking orals, but I felt freaking great while on them.

I've been dealing with different types of doctors on this fatigue issue. I've done tons of tests for asthma, sleep apnea, etc. My doctor just wasn't cutting it so I switch. My new doc ran the blood work and told my test levels were extremely low. He put me on androgel and set me up with an endo. The gel worked at first but it doesn't do anything now. I have recent blood work from when I was taking adrogel. My insurance quit paying for it, so it gave me the chance to switch.

I have blood work form a few weeks ago when I was on androgel.
Total Test: 148ng/dl (lab range 300-1080)
Free Test: 38 pg/ml (lab range 47-244)

It was over a year, almost 2 years, since I took dbol and finally went to this new doc and was put on gel. The numbers weren't that much lower before the gel. So even with the gel it's extremely low in my opinion. I finally convinced the doc to let me self inject cypionate, and I'm taking 200mg bi-weekly right now.

I feel like my GP is good but is somewhat uncomfortable with me self-injecting. I think that bi-weekly is not going to be enough so that will be the next battle. I was on injections before that the nurse had to give me. I would feel awesome for 3-4 days after the shot and then start to drop off.

I have another appointment with my endo in a few weeks and need to get some more labs done since I've switched to cypionate.

I have a couple questions I was hoping someone here could help me with.
1. Is there really anyway to tell if these low levels are drug induced or if I may have just always had low T? I did get my pituitary and adrenal gland checked. No problems there.

2. Should I pursue restarting my natural levels or continue the TRT route?

3. How the hell do I find a doctor that really knows about this? Most endos seemed to be diabetic focused. Any suggestions in the Pittsburgh, PA area?

4. If I find a specialist out of state, how often do you really need to make office visits. I'd be ok with driving ~8 hours but I couldn't do it for each appointment. Do they ever just order labs and evaluate them remotely?

5. Anything else I should discuss with my endo?

Any other suggestion would help to. Thanks a lot.

edit: The next labs my endo has me doing are: Comprehensive Metabolic Panel, Prolactin, Lipid Panel, Ceruloplasmin, Iron Panel, and Free + Total Test.

When to Do Labs for SubQ Test?

Wed, 15 May 2013 22:21:00 GMT

Hi,
Two weeks ago I went from two IM shots a week of my test to 3 SubQ shots a week. I used to do Sunday/Wed IM shots, if SubQ will work as well which I know some on here get great results, I am willing to give it a shot and talked to my doctor about it.

We want to do labs, how long should I want, a month? So it will be accurate as to how the SubQ is working.

Thanks

Long Time Lurker

Wed, 15 May 2013 19:09:00 GMT

Thanks KSMAN and everyone else who contribute to this site, I've been lurking for a while and learned a lot. If you're ever in my neck of the woods KS, beer is on me :) At age 20 I had been feeling pretty much all of the classic low T symptoms except for libido, on my physical I asked for a T test, the doctor refused so I made up a story that I had tested low before and wanted to see where I was at. Got the test and sure enough TT came back at 240 ng/dl. At the time I was studying medicine and knew this wasn't right, of course I wasn't as educated on this as I am now and I got the usual, "you're only a little low, there is no problem." So I ignored it for a while.

-age 23
-height 6'3
-waist 34
-weight 180

-describe body and facial hair
Naturally strong and muscular legs, but weak upper body
hard time gaining muscle, very thin forearms, arm is 12.5 flexed :( Also have asymmetric pectus excavatum. Facial hair began at about age 14, can grow a beard, goatee, sideburns.

-describe where you carry fat and how changed
Mostly lower abs. Fat has always been mostly around the gut area since before puberty.

-health conditions, symptoms [history]
Just the Pectus.

-Rx and OTC drugs, any hair loss drugs or prostate drugs *ever*
Never no meds.

-describe diet [some create substantial damage with starvation diets]
Never been on starvation diets. I get around 2,500 to 3,000 calories a day. I try to avoid all processed and frozen food as well as simple carbs. Consist mainly of meats, vegetables, and some complex carbs. Supplements B comlex, multi minerals, krill oil, 5,000 IU vit D

-describe training [some ruin there hormones by over training]
Began training 1 year ago, 45 minutes weights. I do 10X10 then increase weight and do 5X5. I mostly use isolation machines which I know are not good for mass, but my back is messed up from the pectus and I can't work my chest because I'm trying to get surgery and already have a hard chest according to surgeon as it is. I do every isolation machine that doesn't target chest for now.

-testes ache, ever, with a fever?
No.

-how have morning wood and nocturnal erections changed
Incredibly inconsistent. I can go almost two weeks of nothing or weak and 1 week decent.

-lab results with ranges A bit old have been without insurance for long periods of time.

4/10/10
Cholesterol 180 (125-200)
HDL 35 L (> =40 mg/dl)
LDL 110 (<130 mg/dl)
Glucose 104 (65-99)
TSH 1.0
Creatine .67 L (.80 1.30)
WBC 5.5 (3.8-10.8 Thousand/UL)
RBC 4.50 (4.20-5.80 Million/UL)
Hemoglobin 14.7 (13.2-17.1 g/dl)
Hematrotic 42.7 (38.5-50.0 %)
MCV 94.9 (80.0-100.0 fl)
MCH 32.3 (27.0-33.0 pg)
MCHC 33.9 (32.0-36.0 g/dl)
RDW 12.5 (11.0-15.0 %)
Platelet count 216 (140-400 Thousand/UL)

2/13/11 Went to another GP who gave me a lab printout he refused to check anything aside from TT again so I added a few things on the slip.

HGBA1C 5.8 % 4.0-6.0 I have a strong hereditary tendency for diabetes my HGBA1C is at risk level and yet knowing this these docs tell me there is nothing to worry about. I put myself on a low carb and sugar diet.

Prolactin 14.8 ng/ml 2.5-17.0
TT 295 ng/dl (241-827)
FSH 1.6 (1.6-8.0)
LH 4.0 (1.5-9.3)
Progesterone 0.9 (<1.4 ng/ml)

After this I told the GP I seem to have secondary hypogonadism, he had no idea what I was taking about so I tried an endo. Mistake number 2. Ran a few more test and told me my HGBA1C is nothing to worry about and my T is perfectly normal and "not that low."

I suggested we try to find the root cause and check the adrenals, thyroid, pituitary, again I found no support and didn't get proper labs, they were in office so I could add nothing else.

TSH 0.967 (0.340-5.600)
Free T3 3.3
Free T4 1.4 (0.8-1.9)
Testosterone free pg/ml 16.00 8.8-27.0
Growth Hormone 8.2 ng/ml <10.1
IGF-1 411 127-424
Cortisol 29 H 8.7-22.4
Adrenotopic hormone 27 6-46 pg/ml

In these labs free T didn't look too bad, but I know free T works in spikes. Cortisol concerned me, but again I got the its perfectly fine answer.

I now tried an endo specialized in reproductive medicine. Heard some pretty questionable things. "I see nothing wrong with your total T levels" "you are not that low, this is a wild goose chase" and the strangest quote "Testosterone tests are useless, the only way to get an accurate reading is with a dialysis machine in and academic medical school." "If you really want to be sure I'll run a sperm test and if that's normal your T is normal"

So they sent me on my merry way with a lab form for:
FSH LH FT TT progesterone SHBG VIT D 24 urinary aldosterone 24 hour free urine cortisol.

Convinced him to add vit D, but no luck with estradiol or dhea-s. I have the print out and am wondering if I should add them, I don't see it as doing something bad after all I'm paying for it. What's the worst that will happen, they run me out and tell me never to come back again? I need proper tests. I will push for MRI if FSH comes back low again.

BTW I use a lot of the knowledge if got from KSMAN and others here and some of these docs were actually impressed, wondering if I'm a med student. That's a testament of how knowledgeable you cats on this site are. Taught an actual med student about igf-1 as indicator of HGH levels and its production by the liver. :P Keep at it guys.

23, Starting Clomid+T3

Wed, 15 May 2013 19:02:00 GMT

Hello everyone. I have had a history of hypothyroidism (took Armour Thyroid for about a year but my thyroid hormone levels barely rose and I didn't see much benefit so I stopped...) also I had low testosterone at 21 and estradiol was at the top of the range. I have high body fat...even when I went to the gym to stack up my body fat increased (along with muscle mass but not as quickly)...I also had a trainer.

Anyway, the doctors were not very helpful. I must have done a million tests. So I stopped caring for a while and things are fine. I am not having a lot of symptoms so to speak...except now I want to get in shape. But I do believe I need some help to at least normalize everything. I order Clomid, 50mg and T3...I am taking 25mcg of T3 a day and will go up to 50mcg. I do not feel better or worse.

I have always been overly emotional...recently I could burst out crying if I hear a sad story lol. I have also been more 'feminine' emotionally speaking. So I may naturally have high estrogen, which is fine. Also my body fat percent doesn't help matters in increasing estradiol conversion (my body fat is like 18-20%)...The endocrinologist said it could have been the thyroid but even with supplementation, my T3 and T4 was the EXACT same on 1 grain of Armour, but my TSH went down to like 2.5 so she said she wants to keep me there.

MY QUESTION: Can Clomid help to restore more normalized hormones? Like 50mg every day? I am also taking a diet pill but that is whatever. I am going to the gym 4 days a week, a least an hour and a half a day. I have very low exercise tolerance and last night fell over due to low blood pressure. Which was embarassing...so I need to work myself up.

I gained like 20lbs due to binge eating. My diet is changing, but I won't be strict because eating is fun for me. I don't need a perfect body, but I don't want a lot of fat.

Here are some numbers from labs a yr ago:

TSH: 6.2 (.4-4.5Miu/l)
tESTOSTERONE: 204 (241-827ng/dL)
FSH: 2 (1.6-8 mIU/mL)
LH: 3.3 (1.5-9.3mIU/ML)
T3, total: 80 (76-181)
T4: 8.2 (4.5-12)
Estradiol: 48 pg/ml (13-54)
Prolactin: 32ng (4-30)

These are all the labs I could find. I definitely have some sort of estrogen dominance issue. My cholesterol is totally perfect, all in the low range with hdl good. I cannot find all the other labs throughout the time I went. Hopefully Clomid will help decrease the estrogen negative feed back on my T.

****Also I have done 50mg of iodoral+ 200mcg of selenium....I have taken kelp regularly and take 2 drogs of Lugol's once in a while. So it isn't a iodine deficiency. I have loaded up a lot on iodine but I did find it to be helpful which is why I continue it! I don't have any mental or lethargy issues though I did suffer from severe depression at one point in my life I am not depressed now. Morning erections occur sometimes but not all the time.

Libido overall is good, though I don't have a lot of sex because I find sex with people I don't love weird! But I get erections when I want to and they are maintained.