One month on TRT with no change?

[MrManGuy84]

Hi guys.

Low T at just under 300. Prolactin slightly high at like 14.6 where 14.2 is the high end. All the symptoms of low T are there... tired and depressed, missing libido.

Doctor put me on 200mg shots of Cyp weekly. Today it has been exactly 1 month since the beginning of treatment (this afternoon I did shot #5).

I'm a bit discouraged because I don't feel any real difference. My erections have sometimes been better, maybe a BIT more energy. My nipples might be a little bit sore... but I am not sure about that either, as it could be from a new shirt (this has happened to me before without any kind of TRT. I get scratched up there easily). Regardless none of this seems to be certain or very significant.

Shouldn't I feel something by now? What do I do? I can keep being patient if that's all this is. But I'm really worried that nothing is going to happen. I thought I was supposed to have at least something by now.

The plan was to keep up with this dosage for another 6 weeks and then go to my appointment where we'll do a bunch of tests.

Thanks guys... really scared. I'm so tired of feeling this way. I can't imagine living the rest of my life like this.

[Times Roman]

Welcome to the boarrd mate!
Well, I'd say give it two more weeks and then see.
Additionally, the symptoms you describe could be attributable to other things, like clinical depression. did you discuss this with your doc before going on trt?
---Roman

[steroid.com 1]

Read the sticky on how long things take...

Can you post your pre protocol BW complete with ranges?

Did the Doc discuss with you the use of an AI to manage E2 conversion?

Are you on HCG to preserve HPTA and your testicles?

[MrManGuy84]

Roman - Depression is certainly a possibility as I've been treated for depression/anxiety for a long time, long before the disappearance of libido and these other new issues. However, over a decade of various anti-depressants and therapists have not alleviated these symptoms. That's why a low Testosterone reading seems like the most reasonable culprit. But even now I'm on Wellbutrin (not known to cause any side effects fitting of my symptoms) and seeing a therapist. It doesn't do anything really.

gdevine -

The doctor talked about AI, yes, but it's not something we'd do until I get some more tests after being on TRT for a while. Right now I'm scheduled to see him in mid-September and having a bunch of bloodwork done just before that, and that test includes E2, so we'd probably do an AI if that is higher than it should be.

Not doing hcG as the intention of this is only a theraputic trial for 2-3 months. If we get me feeling better, we'll be exploring other options of raising testosterone as I still want to have kids. Aside from that, it is cost-prohibitive and my insurance is not going to help with it. I would have to go into debt for hcG... the money just isn't there. Both the endos I've talked to say that permanent damage after just 2-3 months is highly unlikely. I know that you and other board members are proponents of hcG in every case, but that's just where we're at right now.

Prolactin 15.6 (ref 4-15.2)
Serum Testosterone 297 (ref 348-1197)
Free Testosterone (direct) 9.0 (ref 9.3-26.5)

FSH 6.1 (1.5-12.4)
LH 4.2 (1.7-8.6)
TSH, Reflex to T4 2.32 (0.34-4.82)

Here is my bloodwork. Total and Free T low. Prolactin slightly high. I had an MRI 4 years ago to rule out pituitary tumor. Since then my prolactin is only a slight bit higher so a tumor doesn't really make sense, especially since they almost always drive prolactin up quite a bit higher than where mine is at. Lowering prolactin still might be a good course of action anyway, though, and that's on the list of things to try should TRT fail. However TRT seems like by far the most likely thing to work...

That's what's got me worried. Everything I've read seems to indicate that I should at least feel SOMETHING by the 1-month mark. Has it taken longer for any of you guys?

[xcraider37]

Roman - Depression is certainly a possibility as I've been treated for depression/anxiety for a long time, long before the disappearance of libido and these other new issues. However, over a decade of various anti-depressants and therapists have not alleviated these symptoms. That's why a low Testosterone reading seems like the most reasonable culprit. But even now I'm on Wellbutrin (not known to cause any side effects fitting of my symptoms) and seeing a therapist. It doesn't do anything really.

gdevine -

The doctor talked about AI, yes, but it's not something we'd do until I get some more tests after being on TRT for a while. Right now I'm scheduled to see him in mid-September and having a bunch of bloodwork done just before that, and that test includes E2, so we'd probably do an AI if that is higher than it should be.

Not doing hcG as the intention of this is only a theraputic trial for 2-3 months. If we get me feeling better, we'll be exploring other options of raising testosterone as I still want to have kids. Aside from that, it is cost-prohibitive and my insurance is not going to help with it. I would have to go into debt for hcG... the money just isn't there. Both the endos I've talked to say that permanent damage after just 2-3 months is highly unlikely. I know that you and other board members are proponents of hcG in every case, but that's just where we're at right now.

Prolactin 15.6 (ref 4-15.2)
Serum Testosterone 297 (ref 348-1197)
Free Testosterone (direct) 9.0 (ref 9.3-26.5)

FSH 6.1 (1.5-12.4)
LH 4.2 (1.7-8.6)
TSH, Reflex to T4 2.32 (0.34-4.82)

Here is my bloodwork. Total and Free T low. Prolactin slightly high. I had an MRI 4 years ago to rule out pituitary tumor. Since then my prolactin is only a slight bit higher so a tumor doesn't really make sense, especially since they almost always drive prolactin up quite a bit higher than where mine is at. Lowering prolactin still might be a good course of action anyway, though, and that's on the list of things to try should TRT fail. However TRT seems like by far the most likely thing to work...

That's what's got me worried. Everything I've read seems to indicate that I should at least feel SOMETHING by the 1-month mark. Has it taken longer for any of you guys?

What's your E2 level? Is the 297 test level on 200 mg of test? Still low t but since your on shots probably depends on when your BW was done. Need E2 and shbg

[MrManGuy84]

E2 has not been tested in some time. A few years ago it was low enough, but of course my T was also low. E2 is scheduled to be tested before I see the doctor again in mid September. I think sbgh was on there, too, though I'm not certain.

I suspect E2 might be high since my nipples have been kind of tender. But on the other hand, erections in general are actually improved (those account for the only differences I've pinned down).

The 297 was my score prior to any shots. We haven't drawn a new level yet. We were supposed to do that in mid-september as well. I'm getting antsy, though. Wondering if I'm just wasting time at this point. Will probably call the doctor soon.

But I'm still wondering... has it just taken anyone more like 6-8 weeks to feel better? Because I can wait if that's all this is. But everything I've read seems to indicate that my libido at least should have showed signs of life by now.

[xtitan1]

Isn't a prolactin of 15.6 a red flag?

[xcraider37]

E2 has not been tested in some time. A few years ago it was low enough, but of course my T was also low. E2 is scheduled to be tested before I see the doctor again in mid September. I think sbgh was on there, too, though I'm not certain.

I suspect E2 might be high since my nipples have been kind of tender. But on the other hand, erections in general are actually improved (those account for the only differences I've pinned down).

The 297 was my score prior to any shots. We haven't drawn a new level yet. We were supposed to do that in mid-september as well. I'm getting antsy, though. Wondering if I'm just wasting time at this point. Will probably call the doctor soon.

But I'm still wondering... has it just taken anyone more like 6-8 weeks to feel better? Because I can wait if that's all this is. But everything I've read seems to indicate that my libido at least should have showed signs of life by now.

Libido can be tough to figure out. If your getting erections then your getting turned on. Without current e2 and shbg will be impossible to guess what is going on.

[MRNJ1992]

Had the same problem, low T 117 total T. Was on Cyp at first then androgel. Now Waiting on BW. Not on any. Should start to feel better, better energy. Would think you need AI as well. My doc said I didnt but I think its necessary. Estrogen can be a problem. Good luck...

[Dpyle]

Don't get discouraged with it just yet. In the 4-8 week range you should see some effects taking shape. However if you're one that converts to E fairly easy the rising E2 can throw off some benefits you are looking for at this time.

There have been some guys here stating a time frame of almost a year to get their protocol tweaked to fit them. It's just one of those things that takes a little time, but when you get it dialed in for YOU the benefits are worth every penny. At least they were for me.

[JAMIE07652]

For me it took about 3 months before I really could look back and see the changes ..

[JAMIE07652]

I forgot to mention .. It's worth the wait !

[MrManGuy84]

Thanks guys.

xtitan - yeah, high prolactin is a little odd. A tumor is highly unlikely since there was none 4 years ago on an MRI and prolactin has only raised about 1 point since then.

It's odd to have high prolactin without a tumor. I don't know of any other cause, but those almost always raise prolactin quite a bit higher. That made us think it might not be a big deal.

The doctor was willing to give me something to lower the prolactin, and I almost did. But we figured that it was best to do/add one thing at a time. So if on the next bloodwork if Total and free T are looking ok, that would be a possible next thing to try. We did Testosterone since it seemed like the most likely thing to work and the plan was to figure it out from there (lowering prolactin, doing clomid, etc are all alternate possibilities to raise it and get me feeling good).

I have also read that high prolactin can interfere with absorption of exogenous T, so it's a possible culprit if my numbers don't look good despite a pretty solid dosage.

xcraider - When I say "libido" I mean more the desire and drive part. I can get an erection and function, but the desire and enjoyment just isn't there. That's been the most identifiable problem this whole time. I can get it up and get it off, but I never really feel horny. There's and the whole exercise just feels like I'm going through the motions. There's also no afterglow, which is odd.

Sometimes after I get off, that whole "ok you're done" feeling has been really intense. Like almost painful in a way. Makes me think the prolactin being too high might be a significant issue.

The next worst has been a loss of drive for life in general, and always feeling tired and just blah. Nothing is fun or exciting. Better erections is good - before it had been tough to maintain one. But usually it's been tough to maintain since it's tough to maintain desire, not because things don't physically function.

We'll be getting E2 at the next bloodwork. Not sure if we're doing sbgh. But can't you figure out sbgh based on your FreeT numbers anyway? Not sure what you think sbgh would tell us?

Ddpyle - what kind of adjustments did you have to make? Would really be comforting to hear some good stories right now... I'm just so afraid I'll never feel better.

JAMIE - what was your before and after like? You're the first person to say it's taken 3 months. I do have one friend who said it was more like 6-8 for him, but he wasn't having any sexual issues to begin with, just the whole "life is blah and I'm tired" thing. Although even if just that resolved for me, it would be a huge improvement.

I guess the main thing I'm wondering is if I should just give it more time and wait for the appointment (mid September, bloodwork a few days before) or if going this long without noticeable changes means I should be more proactive and try to do the bloodwork/appointment sooner.




Thanks a million everyone. This is all super scary. The thought of never feeling better is truly devastating. It's enough to make me question the entire point of my life and anything that helps me hang on right now is a big deal.

[Dpyle]

I have added an AI and it's helped a bit next round of labs is a few weeks away and that's when I'll know where my E is sitting. It was on the high end last time labs were done but the doc still didn't feel there was a need for the ai so I added it myself and noticed a change pretty quick, but I'm still trying to get totally dialed in. Had to drop my hcg because the doc won't cut a script for it and only offers it purchased in office already mixed with b12 and I don't trust that. I'm coming up on about 8 months since I started and although I can't say I have it dialed in just yet I've noticed a huge difference from me a year ago.

Just keep with it and you'll get there. In the beginning it's a game of patience.

[xcraider37]

Thanks guys.

xtitan - yeah, high prolactin is a little odd. A tumor is highly unlikely since there was none 4 years ago on an MRI and prolactin has only raised about 1 point since then.

It's odd to have high prolactin without a tumor. I don't know of any other cause, but those almost always raise prolactin quite a bit higher. That made us think it might not be a big deal.

The doctor was willing to give me something to lower the prolactin, and I almost did. But we figured that it was best to do/add one thing at a time. So if on the next bloodwork if Total and free T are looking ok, that would be a possible next thing to try. We did Testosterone since it seemed like the most likely thing to work and the plan was to figure it out from there (lowering prolactin, doing clomid, etc are all alternate possibilities to raise it and get me feeling good).

I have also read that high prolactin can interfere with absorption of exogenous T, so it's a possible culprit if my numbers don't look good despite a pretty solid dosage.

xcraider - When I say "libido" I mean more the desire and drive part. I can get an erection and function, but the desire and enjoyment just isn't there. That's been the most identifiable problem this whole time. I can get it up and get it off, but I never really feel horny. There's and the whole exercise just feels like I'm going through the motions. There's also no afterglow, which is odd.

Sometimes after I get off, that whole "ok you're done" feeling has been really intense. Like almost painful in a way. Makes me think the prolactin being too high might be a significant issue.

The next worst has been a loss of drive for life in general, and always feeling tired and just blah. Nothing is fun or exciting. Better erections is good - before it had been tough to maintain one. But usually it's been tough to maintain since it's tough to maintain desire, not because things don't physically function.

We'll be getting E2 at the next bloodwork. Not sure if we're doing sbgh. But can't you figure out sbgh based on your FreeT numbers anyway? Not sure what you think sbgh would tell us?

Ddpyle - what kind of adjustments did you have to make? Would really be comforting to hear some good stories right now... I'm just so afraid I'll never feel better.

JAMIE - what was your before and after like? You're the first person to say it's taken 3 months. I do have one friend who said it was more like 6-8 for him, but he wasn't having any sexual issues to begin with, just the whole "life is blah and I'm tired" thing. Although even if just that resolved for me, it would be a huge improvement.

I guess the main thing I'm wondering is if I should just give it more time and wait for the appointment (mid September, bloodwork a few days before) or if going this long without noticeable changes means I should be more proactive and try to do the bloodwork/appointment sooner.

Thanks a million everyone. This is all super scary. The thought of never feeling better is truly devastating. It's enough to make me question the entire point of my life and anything that helps me hang on right now is a big deal.

It's good to have your shbg for a number of reasons, if its high it is hurting your free t. Also for many men shbg is a good target range for e2. Why not get it? Take control of your health. As you describe your libido issue, sounds like a clear sign of elevated e2.

[juice2012]

I was diagnosed with idiopathic hyperprolactinemia, (high prolactin without a cause, IE no tumor). My number was 30 and the range went up to 17.7. I was put on Cabergoline and my testosterone went up about 100 points just from that. Doctor said I'm going to have to keep taking Cabergoline for life though. I didn't really notice much in feelings of well being after I took it though.

[HRTstudent]

Hi guys.

Low T at just under 300. Prolactin slightly high at like 14.6 where 14.2 is the high end. All the symptoms of low T are there... tired and depressed, missing libido.

Doctor put me on 200mg shots of Cyp weekly. Today it has been exactly 1 month since the beginning of treatment (this afternoon I did shot #5).

I'm a bit discouraged because I don't feel any real difference. My erections have sometimes been better, maybe a BIT more energy. My nipples might be a little bit sore... but I am not sure about that either, as it could be from a new shirt (this has happened to me before without any kind of TRT. I get scratched up there easily). Regardless none of this seems to be certain or very significant.

Shouldn't I feel something by now? What do I do? I can keep being patient if that's all this is. But I'm really worried that nothing is going to happen. I thought I was supposed to have at least something by now.

The plan was to keep up with this dosage for another 6 weeks and then go to my appointment where we'll do a bunch of tests.

Thanks guys... really scared. I'm so tired of feeling this way. I can't imagine living the rest of my life like this.

One month is relatively nothing

Avoid falling victim to the incredible stories we often hear. The "overnight" miracles are the exception and not the rule.

[MrManGuy84]

One month is relatively nothing

Avoid falling victim to the incredible stories we often hear. The "overnight" miracles are the exception and not the rule.

Thanks HRT student. Can you offer a more realistic timeline?

The main reason I'm concerned is that all the studies I've read seem to show a big jump in libido by the 3 week mark. Since that's one of my main problems and I haven't seen any real improvement, it's got me worried. :/ The anecdotes I've found from patients online seem to support this, usually saying 3-4 weeks. Sometimes a little longer, but not often.

I can be patient as long as I'm confident I'm on the right track...

[JAMIE07652]

You asked what my before was like .. I was tired , brain fog , had. I sex drive . The after me is the exact opposite , I wake up ready to go , I'm at the gym 6 days a week and have in creased my strength by 30 percent , and my wife suggested I take on a girl friend to lighten her load in the bedroom .. Give things time , stay here and read , I hope what happened to me happens to u .. It's a real game changer !

[Brazensol]

Between Androgel and T cyp I have been doing trt ~2 months. Still no major changes but I know I am not dialed in yet. It sounds like your E2 levels are trending high based on your sore nipples comment. Need to get follow up bloodwork.

[HRTstudent]

Thanks HRT student. Can you offer a more realistic timeline?

The main reason I'm concerned is that all the studies I've read seem to show a big jump in libido by the 3 week mark. Since that's one of my main problems and I haven't seen any real improvement, it's got me worried. :/ The anecdotes I've found from patients online seem to support this, usually saying 3-4 weeks. Sometimes a little longer, but not often.

I can be patient as long as I'm confident I'm on the right track...

Once you get your hormones in the right ranges, then start counting... within a few months of being on the RIGHT therapy you should see some changes.

Unfortunately, I know from experience that simply being on TRT for X amount of time is no way to see progress. If you're doing the wrong things it doesn't matter how long you stay on course.

[ZenFitness]

I've been on Testopel (pellets) for two months now. I have had some ups and downs during this timeframe, but I feel pretty good now. My weight has gone up from 200 lbs. to 212 lbs. (as of this morning) but I'm still fitting the same in my clothes. This leads me to believe that I'm gaining muscle as my lifts are slightly better now (just slightly, but there). My wife has commented on how I look bulkier in a muscle type of way and I'm seeing veins and more roundness in my shoulders that didn't use to be there. I know my squat is definitely stronger and I've been focused on it. However, I am drinking more beer over the past few weeks as well as a few late night A1 Thick and Hearty Whataburgers (after heavier drinking and partying), so I expect some of this is fat gain. I'm also not hardcore cardio like I was prior to TRT.

Vanity aside, my overall mood and libido is up after being on it two months. I also am taking daily Cialis at 5 mg which has helped huge in the erection department. I'm not sure if I still need it, but I say why eff with what is working. The vascular and mild anti-depressant effects of Cialis are overall helpful, so I'm happy with being on it.

I'm probably going to switch to injections instead of staying on pellets when these wear off, but that is still up in the air.

As others have said - be patient. Two weeks in I had a surge of energy and mood that promptly cratered two weeks later and I felt like shit and became somewhat desperate feeling. A couple weeks after that things were looking up, and now I feel fantastic.

[TheSpoonyBard]

[QUOTE/]When I say "libido" I mean more the desire and drive part. I can get an erection and function, but the desire and enjoyment just isn't there. That's been the most identifiable problem this whole time.

This is all super scary. The thought of never feeling better is truly devastating. It's enough to make me question the entire point of my life and anything that helps me hang on right now is a big deal.[/QUOTE]

It's scary how alike we feel. I'm in the same boat. September 3rd will be 2 months since I started my protocol, and I still feel just like what you've stated above. The biggest bummer is that around week 3 of treatment I started to feel much better, hornier, happier, energetic, etc and it just quit on me. I cannot get the same feel from week 3 back no matter what. On the bright side for you though it seems like you've found a keeper in your Doctor! My Doc has insisted on 200mg test cyp once monthly. Plus not even wanting to hear the words HCG, estradiol, or cortisol come from my mouth without totally dismissing me as not knowing anything about TRT protocol. She won't even have the proper tests done. But my hands are tied by money, and insurances so I'm fukked for a while. I can only hope she sees the light of day if my next BW shows very low t #'s AGAIN. I hope with my all that you feel better than ever soon. Wanted to let you know you're not alone in feeling the way to do, it's eerie how similar we feel...

[steroid.com 1]

"My Doc has insisted on 200mg test cyp once monthly. Plus not even wanting to hear the words HCG , estradiol, or cortisol come from my mouth without totally dismissing me as not knowing anything about TRT protocol. She won't even have the proper tests done. But my hands are tied by money, and insurances so I'm fukked for a while. I can only hope she sees the light of day if my next BW shows very low t #'s AGAIN."

Seriously, and you wonder why you feel like you do?

She harming you more then she's doing you any good...and there is nothing good about her NOT KNOWING WHAT SHE IS DOING!!!

You'd be better off getting off of this ridiculous and irresponsible protocol...can you even call it a protocol?

You need to find another Doctor in your network who understands TRT in men.

You need to stop what this women is doing to you...

Nuff said.

[Shol'va]

[QUOTE/]When I say "libido" I mean more the desire and drive part. I can get an erection and function, but the desire and enjoyment just isn't there. That's been the most identifiable problem this whole time.

This is all super scary. The thought of never feeling better is truly devastating. It's enough to make me question the entire point of my life and anything that helps me hang on right now is a big deal.

It's scary how alike we feel. I'm in the same boat. September 3rd will be 2 months since I started my protocol, and I still feel just like what you've stated above. The biggest bummer is that around week 3 of treatment I started to feel much better, hornier, happier, energetic, etc and it just quit on me. I cannot get the same feel from week 3 back no matter what. On the bright side for you though it seems like you've found a keeper in your Doctor! My Doc has insisted on 200mg test cyp once monthly. Plus not even wanting to hear the words HCG, estradiol, or cortisol come from my mouth without totally dismissing me as not knowing anything about TRT protocol. She won't even have the proper tests done. But my hands are tied by money, and insurances so I'm fukked for a while. I can only hope she sees the light of day if my next BW shows very low t #'s AGAIN. I hope with my all that you feel better than ever soon. Wanted to let you know you're not alone in feeling the way to do, it's eerie how similar we feel...[/QUOTE]

Wow what a coincidence! I go to the same doctor and she writes me my doctors excuses. See below

[TheSpoonyBard]

Ha ha!! That's what it feels like at this point Shol'va. I feel like I'm being treated by either Dr Nick from the Simpsons or Leo Spaceman from 30 Rock. It would actually be pretty funny if it wasn't for the fact that she's probably harming me more than helping me according to most everyone. Plus I'm not feeling too up for a good laugh with the way I've been feeling. Btw, sorry to the OP for the thread jack.

[MrManGuy84]

Ha ha!! That's what it feels like at this point Shol'va. I feel like I'm being treated by either Dr Nick from the Simpsons or Leo Spaceman from 30 Rock. It would actually be pretty funny if it wasn't for the fact that she's probably harming me more than helping me according to most everyone. Plus I'm not feeling too up for a good laugh with the way I've been feeling. Btw, sorry to the OP for the thread jack.

It's cool. I've had a lot of problems finding a good doctor, so identify. In fact, the doctor I saw just previous to this one was really really bad. Finally finding one who is taking me seriously is an enormous relief.

As for me...

Well, I'm partway through weekly shot #8 now, and nothing has really changed. The unusually hard erections I was sometimes getting for a while have gone away. The nipple soreness comes and goes. That's... about it. That's the only thing I'm positive it's done other than give me a sore bum one day a week.

I'm able to do tests whenever starting next week, so I guess we'll see. My doctor was awesome and ordered a large battery of tests, along with the question "anything else you want to look at?" I told him I wanted to look at estrogens and he agreed that was a good idea... but then I realized there's a difference between "total estrogens," which he marked, and "estradiol," which he didn't. I'll call before I get bloodwork to ask if he doesn't mind me checking that other box since I meant to ask for it.

So I'm interested to see what happens here. There are a few possibilities at this point:

1) For some reason the shots are not sufficient and test is still low.
2) Estradiol proves to be high.
3) Both are in check and we consider driving down prolactin, since that was slightly high.
4) None of the above, investigate thyroid issues further.

I thought I had ruled out thyroid problems in the past, but the doctor was suspicious that there might be something there if the testosterone does not work (which he felt was a possible outcome). Looking more into thyroid stuff, I've found that some of my past levels were actually out of the recommended "normal" range by the American Association of Clinical Endocrinologists. However, the results in general are kind of topsy-turvy and seem to contradict one another. I can post them if anyone is interested/aware of thyroid stuff.

I learned since then that elevated prolactin is one indication of hypothyroid. That's very interesting to me since I am not aware of anything else other than a tumor that should be making this high in a man, and a tumor is unlikely after my MRI showed none.

I know a couple people who have tested "normal" on thyroid tests but have felt a billion times better after finding a doctor who will treat them for hypothyroid anyway. I'm glad I have a doctor who seems willing to give things a shot.

If it turns out to be a thyroid thing, that would actually be great. Much simpler to treat. So testosterone not doing much MAY be a blessing in disguise. I guess time will tell.

That's it for now. Will keep you all posted.

[MrManGuy84]

Here's my thyroid test results in case anyone is interested/knowledgeable:

Aug 2007:

TSH 4.62 (0.45-4.67)

Sep 2007:

TSH: 2.84 (0.45-4.67... in reality 0.3-3.0)
Thyroxine, Free. T4Free: 0.93 (0.71-7.85)

April 2008:

TSH: 2.18 (0.45-4.67)
T4Free: 1.26 (0.71-1.85)

Later in 2008:

Free T3 4 (2.3-4.2)
Reverse T3 295 (90-350)
DHEA 829 (209-771)
Vitamin D 22 (32-100)

May 2012:

TSH: 2.32 (0.34-4.82)

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

Now, as I understand these values, it doesn't make a ton of sense.

TSH has always been pretty near down the middle, except for the very first one which would be an indicator of hypothyroid.

Free T4 has bounced around a little, but it's been down the middle or on the lower side. Also consistent with hypothyroid, if not obviously so.

But then the Free T3 is near the TOP of the normal range... wtf?

As I understand it, it works this way...

TSH: pituitary stimulation of thyroid hormones. Like FSH or LH in application to Testosterone.
T4: The stuff the thyroid actually makes.
T3: Mostly converted from T4, the active stuff the body actually uses.

So apparently my body's ability to make the basic stuff is questionable, but its ability to convert it into the usable form is really amazing...? It's like the fishes and the loaves over here...? When I saw my Free T3 as being near the top, I gave up on the thyroid thing and haven't looked at it since. Maybe I was wrong to do so.

Anyhow, if my friend is right, the ranges may not matter and maybe we should just go for it. Moreover, in some places I'm reading T3 may not be that useful... I'm lost.

Free T3, Free T4, and anti-thyroid antibodies will all be done in the next bloodwork, so I guess we'll see.

Hypothyroid does match the symptoms and would account for the testosterone and prolactin abnormalities. If this is it, fine by me.

[xtitan1]

Couple of things here.

Right now there is a controversy between conventional doctors like those at the AACE and the more "pioneering" doctors out there. Conventional guys say TSH is the only blood test required to diagnose as well as dial in treatment. These are the ones who say tests like Free T3 are unreliable and/or unnecessary. If the thyroid is not producing enough hormones, the TSH will be high (hyPOthyroid). If the thyroid is producing too much hormone, the TSH will be low (hyPERthyroid). In the case of hyPOthyroid, simply administer T4 medication like Levothyroxine (generic for Synthroid) and the thyroid will convert what it needs to T3 and store the rest as T4. TSH will come down since the thyroid is now producing enough hormone and there you go.

The pioneering guys say that TSH is insufficient to diagnosing and treating thyroid problems. The argument here is that the above trial assumes everything is working correctly, except for the body's ability to make T4. It assumes the Hypothalamus-Pituitary-Thyroid axis is working properly, which it may not be, it assumes the thyroid is perfectly able to convert T4 to T3, which it may not be, and it assumes that reverse T3 isn't really important, which it may actually be.

They argue that since T3 is the most active form of thyroid hormone and some studies have shown that free T3, the T3 that is unbound and therefore available to the body, is most closely correlated to how well patients feel, this is really the important level to check. It could be that your body has low free T3 because your pituitary/hypothalamus is not giving the right signals to make more T4. TSH would therefore be totally a totally useless test except when in combination with free T3 to show this indeed is going on if T3 were low and TSH were normal. Or it could be that your body is not able to convert T4 to T3, in which case giving more T4 only medication wouldn't get you anywhere. In fact, the body may recognize too much T4 and then tank your TSH in response, even though you are not getting enough T3! Your conventional doctor would see the low TSH and say holy moly, I made you hyPERthyroid and we need to reduce your medication, when what he really needs to do is give you medication with T3 in it.

Lastly, the pioneering doctors say that your Free T3 to Reverse T3 ratio (Reverse T3 is thought to 'undo' the effects of Free T3) is important. One may have a good free T3 number but really high RT3 (short for Reverse T3) and therefore still be feeling hyPOthyroid symptoms.

You can calculate this ratio here: http://www.stopthethyroidmadness.com/rt3-ratio/

I came up with 13.6 for you if I got the units right. You want to be over 20. So even though your FT3 looks good, your RT3 could be lower. Is this explaining your symptoms? I don't know. I think it's not nearly as glaring a problem as your low T. I understand you are now on TRT, but given we have no idea what your E2 levels are for all we know it's all being converted to estrogen.

Are you currently on thyroid medication of any kind?

Also, your Vitamin D levels are terrible. I would start getting on at least 5,000 IU D3 daily (it's OTC) or if your doctor is comfortable I know Kelkel recommends sometimes people get a script for Drisdol, which is a prescription strength vitamin D that's 50,000 IU

Get those E2 numbers with a fresh total and free T level pronto!

[HRTstudent]

I would not be worrying about anything else until I know I have had good testosterone levels AND good e2 levels for a couple of months.

Of course, if your thyroid is shit then attack that too. But if it's good and you have no reason to suspect it, then leave it alone for now. Too often we chase numbers. In this case, it looks like you are chasing numbers for XYZ when you are still working on ABC... and haven't even had follow up labs yet.

I wasted a lot of time on TRT with bad T and E2. I knew my therapy was poor so why would I expect to feel any better? That would be unreasonable. That's why follow up labs are critical, and then you make changes. And give things time to work. TRT is not an overnight process.

[xtitan1]

I would not be worrying about anything else until I know I have had good testosterone levels AND good e2 levels for a couple of months.

Of course, if your thyroid is shit then attack that too. But if it's good and you have no reason to suspect it, then leave it alone for now. Too often we chase numbers. In this case, it looks like you are chasing numbers for XYZ when you are still working on ABC... and haven't even had follow up labs yet.

I wasted a lot of time on TRT with bad T and E2. I knew my therapy was poor so why would I expect to feel any better? That would be unreasonable. That's why follow up labs are critical, and then you make changes. And give things time to work. TRT is not an overnight process.

Very true

[juice2012]

xtitan1 - 50,000 UI vitamin D supplements are available on amazon. Way cheaper than what the pharmacy charges for the prescription.

[xtitan1]

xtitan1 - 50,000 UI vitamin D supplements are available on amazon. Way cheaper than what the pharmacy charges for the prescription.

Wow I didn't know that. Do these have the same kind of absorption or bioavailability as drisdol?

[ozzie43]

Welcome home!

Real cheap advice for you. Listen to the pros here! GDevine has a sticky with timelines, but remember that everyone is different so don't give up.

There's a ton of great information here that you can learn from.

[MrManGuy84]

Thanks guys.

I am aware that I'm thinking ahead while the jury is still out on what I'm doing. Mentally that's something I feel I need to do to prepare myself. I've tried so many things that haven't worked. If something doesn't work and I don't have any other ideas of things to try, I start losing hope, and suicidal thoughts creep in, and it's just really bad. I'm just trying to be prepared. I see a shrink and all that to help deal with that stuff too.

I'm aware of the timelines in the sticky. I'm quite a bit over most of the landmarks without real improvement now, which is what concerns me.

Like I said in my post before, it could be still low T, high e2, or possibly a thyroid thing... just outlining the next course of action.

Thanks for the help and good info everyone.

Also, no, I'm not on any thyroid medications. Never have been.

[MrManGuy84]

Sorry for double post. Browser is doing something odd when I try edit.

About the Vitamin D - for a while after that test I took supplements regularly, but didn't notice any difference in how I felt. Lately I have been avoiding supplements of any kind because I thought it might mask problems in blood results. Is that a bad approach? I'll ask the doctor about re-testing that one, too...

[juice2012]

Wow I didn't know that. Do these have the same kind of absorption or bioavailability as drisdol?

Here is what I was talking about:

http://www.amazon.com/Bio-Tech-D3-50...min+d+50%2C000

Not sure about the bioavailability but I paid > $20 just for 8 drisdol. would have much rather got 100 for the same price.

[MrManGuy84]

Hey guys. Today I got the results from the blood draw taken one week ago. Doctor's appointment on Monday. As for what it means... I am at a loss. I'll just post the numbers and text as they appear. Would love some input - there's a few outcomes I thought were possible, but this particular combination does not make sense to me.

This draw was taken on a Friday morning a little after 8am. I do my shots on Monday mornings. I was not fasting. Lots of tests run here. It is quite thorough. Note that there are 2 different measurements for Estradiol. One is at the very top and one is at the very bottom of the list.

------

ESTROGEN, SERUM FRACTIONATED
Estradiol by tandem mass spectrometry. 45.8 Unit: pg/mL

(NOTE)
REFERENCE INTERVAL: Estradiol by TMS

Access complete set of age- and/or gender-specific
reference intervals for this test in the ARUP Laboratory Test Directory (aruplab.com).

Estrone by tandem mass spectrometry. 46.9 Unit: pg/mL

(NOTE)
REFERENCE INTERVAL: Estrone by TMS

Access complete set of age- and/or gender-specific
reference intervals for this test in the ARUP Laboratory Test Directory (aruplab.com).

Estrogens, Total. 92.7 Unit: pg/mL

(NOTE)

Reference interval of estrogens in serum in adults.

Males 18 and older:
Estrone - 9-36 pg/mL
Estradiol - 10-42 pg/mL
Total Estrogens - 19-69 pg/mL
REFERENCE INTERVAL: Estrogens Total Calculation

Access complete set of age- and/or gender-specific
reference intervals for this test in the ARUP Laboratory Test Directory (aruplab.com).

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

Free T4: 0.9 [0.71-1.85] ng/dL
Free T3: 3.7 [2.4-4.2] pg/mL
Prolactin: H 36.9 [3.5-19.4] ng/mL

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

Testosterone, Total Serum: 979 [280-1100] pg/mL
SHBG: L 12 [13-71] nmol/L
Testosterone, Free: H 306.8 [47-244] pg/mL
Testosterone, % Free: H 3.1 [1.6-2.9]
Testosterone, Bioavailable: H 800.5 [131-682]
Albumin: 4.2 [3.3-4.8]

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

Thyroglobin Antibodies: 2.1 [0-14.4] IU/mL
Thyroid Peroxidase @ <0.5 [0-3.9] IU/mL

Insulin Like Growth Factor: H 544 [112 to 402] ng/mL

(NOTE)

Repeated and verified.

------

ESTRADIOL, MALES, CHILDREN, POSTMENO
Estradiol by tandem mass spectrometry 61.1

Unit: pg/mL
Duplicate request, charges credited.

(NOTE)

Reference interval of estradiol in serum in adults.

Males 18 and older:
Estradiol: 10-42
REFERENCE INTERVAL: Estradiol by TMS.

Access complete set of age- and/or gender-specific
reference intervals for this test in the ARUP Laboratory Test Directory (aruplab.com).

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

That's it.

So a few things...

1) For one, the shots are working. There's about 3 times as much testosterone in my body as there was before.
2) SBGH is a little bit low. I don't know what that could mean or do.
3) Insulin like growth factor is high. I don't know what is or what it means.

4) Estradiol is high. No question. The question is, by how much? For some reason the test appears to have been done twice. I THINK they may have ordered the wrong test at first, and then did the right one afterward. Regardless, it is high.

I'm not sure if it is inappropriately high or not, though, since right now my T is also above normal in most respects. Maybe the balance is right? Not sure how all that plays out.

5) Prolactin is high, this time noticeably so. This one puzzles me. I know that lowering Prolactin can raise Testosterone, but I was not aware of anything that would drive it up by raising Testosterone. So once again, not sure what this could mean.

6) Thyroid stuff is about how it was before. Free T4 near the bottom of the range, Free T3 near the top. Disappointed to see that Reverse T3 isn't on the results. For some reason I thought it would be.

As far as how I feel, it's been pretty much the same as the previous posts. Not a lot to report. Sensitive/sore nipple issues have come and gone but never been more than a minor annoyance. For a while I was having extra hard/slightly painful erections and was a little bit concerned, but then they went away. Sometimes it's a been much easier to keep it up, but this has been on and off as well. A few times I've thought the clouds were parting just enough to start so see some of the missing feelings of excitement, libido, enjoyment of life, etc, but it has never passed much beyond a glimpse. These glimpses have been more common than they were off the therapy, but things are still not normal or right or good. It's a bit easier not to just lay around and mope, though. I've been a bit moody/emotional but there's a lot of confounding variables with changes at work, life, etc so it may not be related. I've gained a little weight, which may be muscle as my pants seem to fit about the same, or maybe not. Wife thinks I might have gained a little muscle (I don't work out).

Overall, the changes have been pretty unimpressive and vague.

So, that's it. I'd love any thoughts/input on what the tests might mean or how to proceed. Right now I'm pretty puzzled.

[juice2012]

Wow, sucks to hear. Your T level looks nice but you still aren't feeling decent. I'm in the same boat at week 5 right now. No idea what my level is though. As for the prolactin, mine was high, I was put on caberoline, .5mg twice a week. Which lowered it to almost 0.

[TheSpoonyBard]

Hang in there buddy. I keep telling myself that it takes a while to get hooked up and dialed in. I still don't feel anywhere near what lots of the other forum members describe feeling like, but I've made a small amount of progress with my protocol and quack of a doctor. She actually raised my test cyp dosage from 200mg/once monthly, to 200mg/twice a month, AND SHE GAVE ME THE SECOND VIAL OF TEST CYP TO TAKE HOME WITH THE PINS TO ADMINISTER IT MYSELF! Progress in my book, lol. Also, I asked for a referrral to an Endo or a Urologist and she also agreed to that as well. Stay positive and everything will work out. Celebrate the small victories. I know it's hard to do at times, but I'm wishing the best for you.