Running on fumes, hoping to refill tank

[wyuoiea]

Hi. Been reading the site for a week now and am learning a lot but so much is still unclear. I have read most of the stickies and relevant threads but I thought I’d ask for guidance to try and get a head start on a treatment plan.

48 year old male. Never used steroids of any kind. Only became interested in physical fitness in the last 5 years or so. In that time began general strength and conditioning, began eating right and recovering ok. Was fairly happy with my progress. In Sept ’11 I entered my first martial arts competition (stickfighting) and was happy with my performance. Felt happy training specifically for the competition six weeks prior to it (felt like I was motivated, was training hard enough, accomplished the goals I had set) and felt like I was making good progress in my general strength and conditioning training prior to that.

I think the completion was motivating and focusing me to work hard in spite of what I later found were low testosterone levels. Literally the day after the competition I felt like I crashed. I couldn’t work out, had no energy, no motivation, started eating and drinking. Was exhausted even though I was sleeping more (cuz I wasn’t working out) and was practically falling asleep at my desk. I also really don’t give a hoot about my job anymore and was kinda letting people know it and in general was and continue to be tired, unmotivated, confused, depressed, and not a fun guy.

Had blood work done in the morning on 11/29/11 by Quest and results are as follows:

Testosterone, Free, Bio and Total, LC/MS/MS Testosterone, Total, LC/MS/MS
479 250-1100 ng/dL

Total Testosterone was measured by LCMSMS. The LCMSMS method correlates well with our extraction/RIA method.

Testosterone, Free 51.2 46.0-224.0 pg/mL
Testosterone, Bioavailable 105.2 L 110.0-575.0 ng/dL
Sex Hormone Binding Globulin 43 10-50 nmol/L
Albumin, Serum 4.5 3.6-5.1 g/dL

CBC (includes DIFF/PLT)
White Blood Cell Count 4.4 3.8-10.8 Thousand /uL
Red Blood Cell Count 4.91 4.20-5.80 Million/uL
Hemoglobin 15.3 13.2-17.1 g/dL
Hematocrit 44.9 38.5-50.0 %
MCV 91.4 80.0-100.0 fL
MCH 31.1 27.0-33.0 pg
MCHC 34.0 32.0-36.0 g/dL
RDW 12.9 11.0-15.0 %
Platelet Count 209 140-400 Thousand / uL
Absolute Neutrophils 2913 1500-seventyeight hundred cells/uL
Absolute Lymphocytes 1078 850-3900 cells/uL
Absolute Monocytes 308 200-950 cells/uL
Absolute Eosinophils 79 15-500 cells/uL
Absolute Basophils 22 0-200 cells/uL
Neutrophils 66.2 %
Lymphocytes 24.5 %
Monocytes 7.0 %
Eosinophils 1.8 %
Basophils 0.5 %
PSA, TOTAL 0.4 < OR = 4.0 ng/mL
This test was performed using the Siemens chemiluminescent method.

Vitamin D, 25-OH, Total 43 30-100 ng/mL
Vitamin D, 25-OH, D3 39 ng/mL
Vitamin D, 25-OH, D2 4 ng/mL
TSH, 3rd Generation 2.16 0.40-4.50 mIU/L

Doc said I’ve just stopped producing testosterone. Didn’t think it was related to any specific issue (said he didn’t think I had a pituitary gland or prostrate issue). Said that I’d never start producing on my own again. Had no problem offering me a prescription – said it’d be for the rest of my life.

Doc prescribed Androgel 1.25gm, 1 pump. Offered me this or a patch. He was opposed to injections. I should have the gel in a few days. Said I should come back for new lab work in 3 months to adjust dosage.

Some questions:

• Is there any way I can restart producing on my own? No specific objection to taking steroids other than I’d rather not be dependent upon them. HRT Info (Part 2) sticky has a protocol for restarting low test, but I’m not sure if it would help me (because I can’t interpret my lab results and because I’m not sure if my low numbers are irreversible as my doctor said.)
• Should I monitor or consider estrogen levels? Not sure if this is necessary in my case.
• Should I retest sooner than 3 months. Kelkel’s protocol suggests in a month. Am willing to do it on my own if necessary.
• I don’t see a few substances in my results (LH, DHT, Estradiol, FSH, etc.) and don’t know how important they are to my situation and if I need to specify them in my next test.
• I’ve expecting the Androgel to have a certain placebo effect so I will use the inception of usage to 1) get back to my clean diet 2) cut waaaay back on my drinking 3) restart a 3x weekly lifting program (specifically Starting Strength) 4) restart 2x weekly skill training (stopped Dec 25, '11).

Any other advice? I know I’ll have more comments as I go on and appreciate how useful this site has already been.

[steroid.com 1]

Welcome Wyuoiea (what ever that means?)! See bold.

Doc said I’ve just stopped producing testosterone. Didn’t think it was related to any specific issue (said he didn’t think I had a pituitary gland or prostrate issue). Said that I’d never start producing on my own again. Had no problem offering me a prescription – said it’d be for the rest of my life.

And you accepted this as an accurate diagnosis? Sudden onset Hypogonadism and he doesn't "think" you have a pituitary gland problem and what's the prostrate have to do with it???

Doc prescribed Androgel 1.25gm, 1 pump. Offered me this or a patch. He was opposed to injections. I should have the gel in a few days. Said I should come back for new lab work in 3 months to adjust dosage.

IMO, until you get a more thorough and accurate diagnosis of your problem I wouldn't take anything...nothing! You could end up hurting yourself more.

Some questions:

• Is there any way I can restart producing on my own?
  
  You need a proper diagnosis to uncover why you just out of know where shut down...some thing is wrong...and no way to answer this question.
  
  No specific objection to taking steroids other than I’d rather not be dependent upon them. HRT Info (Part 2) sticky has a protocol for restarting low test, but I’m not sure if it would help me (because I can’t interpret my lab results and because I’m not sure if my low numbers are irreversible as my doctor said.)
  
  You need to know why you just shut down! This is not age related.
  
• Should I monitor or consider estrogen levels? Not sure if this is necessary in my case.
• Should I retest sooner than 3 months. Kelkel’s protocol suggests in a month. Am willing to do it on my own if necessary.
• I don’t see a few substances in my results (LH, DHT, Estradiol, FSH, etc.) and don’t know how important they are to my situation and if I need to specify them in my next test.
• I’ve expecting the Androgel to have a certain placebo effect so I will use the inception of usage to 1) get back to my clean diet 2) cut waaaay back on my drinking 3) restart a 3x weekly lifting program (specifically Starting Strength) 4) restart 2x weekly skill training (stopped Dec 25, '11).

Any other advice? I know I’ll have more comments as I go on and appreciate how useful this site has already been.[/QUOTE]


PLEASE find another Doctor and get an confirmed diagnosis as soon as possibly. Sudden onset HPTA shut down is not an age related symptom. Some where in your HPT Axis something stopped working abruptly and you need to know why. There are a number of diseaces and turmors that can cause that to happen and you need to know why.

[Vettester]

OP, GD is spot on with this advise. Please seek another doctor and explore your conditon a little deeper. Your condition should have warranted an immediate MRI.

Also, just an FYI for future reference ... Anytime a doctor says they're opposed to injections is usually a good indicator that they're winging it. 9 out of 10, these types of doctors will never discuss AI's or HCG with you either if in fact HRT is the right thing for you.

[Bonaparte]

You didn't "stop producing testosterone". Your test is just on the low side and your SHBG is high, which lowers free test.
This is a normal part of aging, though yeah, you're doing a bit worse than average.

Now if you want to get on HRT, go for it, but don't blame your midlife crisis on low test.

And I doubt there is anything you can do to bring your natural levels up permanently, as this was from natural causes.

[bullshark99]

W, unless I'm missing something here, what are you comparing this with????? Total T 479, prob not too many people on this board with a level that high prior to starting TRT. Yes Free is def low side and Bio is under range, other than that everyone of your panels is in Range. Personally I would folow the advice given above and seek another opinion and run all new labs and see where they fall. You very well may be a canadate for TRT, but remember it is for life so I would make damn sure you are getting good medical advice.

[Vettester]

My bad, I was multi-tasking when I first read this thread, and I grabbed the free test as being the total test ... Anyways, your condition probably isn't as bad as my original thoughts. As mentioned above, your score isn't all that bad, maybe a little lower than what you would really want, but not suppressed. SHBG and Albumin tie up the free testosterone. A lower SHBG score will give you more free test, which in your case would make a ton of difference.

[SEOINAGE]

Stick fighting? did you get hit bad on your head or your balls?

[ecdysone]

Beginning to think there's some slight misinterpretation here. Your Doc probably ignored the comment about you crashing and was simply referring to the normal slowdown of test that occurs with age.

Your SHBG is on the higher side, but pretty much as expected.

You might respond just to HCG but would have needed FSH/LH levels to see if there's much of a chance, too late now to tell unless you stop the Androgel.

With regard to follow up testing, it can be done in as little as 2 weeks after you start/change a transdermal dose, certainly a waste of time to wait more than a month.

A more comprehensive hormone panel would have been nice to have initially.

[wyuoiea]

Wow, nice responses and you guys seem to have collectively put more time thinking about my situation than my doctor has. My responses to questions and comments:

• Haven’t taken any hits to the balls or skull and no other known physical trauma that would mess me up.
• Doc said he could tell this wasn’t caused by pituitary from the lab work.
• I mentioned prostrate was fine because I’d heard TRT could increase prostrate problems.
• Haven’t yet started any TRT.

I found lab work from 10/1/08. Haven’t had any between then and now. Doc didn’t mention labwork of ’08, and don’t know if he was comparing the numbers.

10/1/08 from Quest:

Testosterone, Free, Bio and Total, LC/MS/MS Testosterone, Total
612 250-1100 ng/dL
Testosterone, Free 65.1 46.0-224.0 pg/mL
Testosterone, Bioavailable 133.9 L 110.0-575.0 ng/dL
Sex Hormone Binding Globulin 45 9-45 nmol/L
Albumin, Serum 4.5 3.6-5.1 g/dL

So comparing the numbers from ‘08 to ’11 the differences don’t seem that dramatic.
Total - 612 to 479.
Free - 65.1 to 51.2.
SHBG - 45 to 43 (but lower is better, correct?)
Available - 133.9 to 105.2

So now I’m asking: Is this just age related decrease?

Perhaps I was just tired from training, since I’ve never before trained specifically for an event or worked out at that intensity before? Maybe I just needed a 2 week rest?
I’ll also say that I’m not real happy-go-lucky and currently have work and other personal issues that are stressing me out.
Perhaps I was just emotionally worn out, physically tired, got lazy and unmotivated after my fight and that synced up with my annual physical where I saw low numbers and panicked? Maybe it’s not too little testosterone, it not enough balls and I just need to STFU and start working out again?

Next steps:

• I need to figure out how to lower my SHBG to free up my available Test. A quick Google shows there are herbal and fish oil procedures. I’ll do more research here.
• I’ll reset some training goals. That will get me motivated and keep me focused and moving heavy weights will all help get my juices flowing.
• I'll clean up my diet and stop drinking which will both make me more physically fit and motivate me to be more fit.
• I haven’t yet and won’t be starting TRT/Androgel until I have a clear idea of what’s going on.

Any other ideas?
Thanks for all the input!

[sparverius]

It's typical to have a big let down after a major goal event that you've been training for. Especially when you are new to the sport. You've been focused on that goal and now there's nothing.

Also, stress will lower your T levels and increase depression. If you can fix some of the work and personal stress that will help. Stress is probably what pushed me over the edge into low T land.

I'd rather have a natural 479 than be on HRT.

[bass]

welcome here Wyuoiea. When SHBG levels are increased beyond what is expected, there is likely to be less free testosterone available to the tissues than is indicated by the total testosterone. If SHBG concentrations are decreased, more of the total testosterone is “bioavailable” - not bound to SHBG. so to answer your question is Yes, lower is better!

[bullshark99]

Just an observation W, people typically lose between 1-2% of Total Tes per yr every yr after age 30, you actually lost 21% in a matte rof 3yrs! Free T down 20% as well. More experienced guys than me can chime in on this better than I, but that was the first thing that jumped out at me. If this pattern holds up, what are you gonna feel like at age 55???????

[HRTstudent]

Regarding testing, blood levels on gels can be stable in as little as 2 weeks. So I would advise waiting 4 weeks at most to get tested. 3 months, after an initial setup is absurd and only subjects you to potentially more suffering and wasted dollars/medication.