TRT Frustration

[Nighthawk4184]

Hello everyone! I am new to these boards... Just signed up after countless hours of reading many of the threads and sticky's here. I will tell you a bit about myself and then leave some blood results. I'm currently 24 Years old (25 in Nov.) and have been on/off TRT since 2005. I'm currently a manager of a supplement store and have decent knowledge of how the body works and deals with alot of ingredients, but of course I am no expert! In approx. 10th grade i tipped the scales at 301lbs, decided i had enough torture from society and dropped 80lbs . Upon waiting to have gynocomastia surgery and breast reduction surgery (alot of extra skin) i had to go through the processes of seeing an Endo and getting results in order for the insurance company to back most of the surgery. During that time the endo diagnosed me with hypogonadism.. Now i am pretty sure its primary but i do not have that on paper. What i do have are some of the notes and tests from the endo from 2005. These results were as follows...

Estradiol less than 20
FSH - 2.9 (1.0-12.0)
LH - 2.3 (2.57-10.13)
Total Test - 251 (241-827)
Free Test - 7.8 (no range given)
Cortisol - 12.8 (was a concern to her)
DHEAS - 421

I had a pituitary MRI which was normal, as well as a testicular ultrasound which only states left testicle is slightly smaller than the right with a small variceal below the left testicle.

Over the next number of years my doctor expirimented with androgel (up to 2 packets per day) and once my levels seemed to meet the high 300's he took me off of it. Just for the levels to drop significantly over the next couple of years. Leading me to 2012-2013 timeframe. Last year I went back to the doctor and told him about all of my issues i was having again. (low sex drive, no energy, muscle weakness and fatigue.) during the year of 2011-2012 i reached my lowest weight of 175 and was almost anorexic looking. But over this time no matter how much protein i took in my muscle seemed to deplete rather than grow, as well as my strength. Again... my doctor put me on a gel form of TRT this time Testim. I just discontinued the testim about a week ago upon request of trying injections, as i have read how well it has worked for many others and a few people that i have come to know over the years. My doctor just prescribed me 200mg of test cyp EVERY TWO WEEKS. And i administered my first injection this past thursday. Over the past two days i have developed some aching pain in my testicles... mostly feeling it when i lay on my stomach in bed, sit down, or walk. (i guess thats most of the time ha) and im not sure if that is atrophy occuring or something else going on... it's quite worrisome though. I want to say ive had this problem before though, as i have done 2 pro-hormone cycles with proper PCT, however im sure PCT did next to nothing with having hypogonadism. I've also tried over a dozen natural test boosters in the past 3 years rangin from tribulus, d aspartic acid, fenugreek, or dhea based.. to no real avail. What is most troubling to me is through self education... I realized my doc hasn't even been tracking E2, LH, FSH, levels when he gets my blood work done to check test levels. My last labs were as follows...

PSA .32 (<4.0 ng/ml)
T4 - 1.5 (.ng/dl)
Magnesium (reason why i am adding this is because its really low for some reason?) - 1.9 with magnesium supplement (1.8-2.4 MG/DL)
Prolactin - 8.3 (2.1-17.7NG/ML)
Free Test - 9.2 (9.3-26.5 pg/ml)
Total Test - 345.0 (348-1197)
T3 - 80.9 (60.0-181.0 NG/DL)
TSH - 1.52 (0.358-3.740 iIU/ML)

This is truly getting frustrating needless to say, and my wife and I have hopes of starting a family in a couple of years. When i mentioned the addition of HCG to my test cyp injections the doc just kind of smiled (idk if he was impressed at my knowledge or what)
but said he has guys who get it from mexico... and that he wasnt against it but wanted to start with this first and go from there. Also because the HCG could cause my gyno to come back. I also mentioned adex with the HCG and test... didnt really mention too much. I realize he is a primary healthcare physician and not an expert in this field but i do feel more educated than him at times on the topic, and am getting to the point of almost self medicating with TEST/HCG/ and ADEX. So out of frustration and stress.. I created an account and though maybe i could get some pointers and knowledge on my situation from you experienced guys out there... seems like there isnt much hope at times....

Current stats
5'11
204lbs
unknown BF% if i had to guess i would say 15% range
lift 5 days a week
2-3hrs of cardio per week
230-240g of protein per day
100-130g carbs per day
70g of fat per day

[Moparman]

Hcg causes gyno???

[Nighthawk4184]

Thats what doc said, i have read that because it stimulates more test to be produced that it can also raise estrogen levels. so if youre prone to gyno already it could cause it to flare up. but maybe i am mistaken. hopefully so

[jomamma007]

I believe Gdevine said,it can increase intratesticular e2 which an ai is not great at controlling.
Anyways I used to get more gyno from hcg then test enth.

[steroid.com 1]

Nice first post and nice start to your case.

Using the edit button please add the ranges to the labs in your post.

You say you think you are Primary; why?

Primary Hypogonadism is a medical condition where the testes don't function correctly or at all. So why do you think you are primary?

Your testes are aching because your are most likely HPTA suppressed due from the TD and injections and you are experiencing the atrophy that goes with the pain...why we need low doses of HCG on a frequent injection schedule.

I don't see you estrogen lab, can you post that if you have it; this one is very important as you know.

I am going to ask Kel and Vette to jump in here as well as this post continue.

[Nighthawk4184]

ok just went through and added ranges and units. and thats one of the troubling issues... all this time (i didnt really know any better until these past few months) he hasnt been tracking estrogen in my labs, nor has he been tracking LH or FSH. Just treating me with testosterone . My past visit was last week, i asked him to track all of these for me starting asap, but he wanted to wait on more bloods until 5 weeks from now (on off week after injection of test). So i am scheduled to go back 5/5. and i figured thats what the pain was from. Also no concrete reason why i stated primary, other then having all of these issues at such a young age, up until this current time and being diagnosed with hypogonadism in general.

[Moparman]

Thats what doc said, i have read that because it stimulates more test to be produced that it can also raise estrogen levels. so if youre prone to gyno already it could cause it to flare up. but maybe i am mistaken. hopefully so

Ahhh yes. I just googled it and that's what they said. I'm glad I'm getting my blood tested tomorrow. I would hate to get gyno.

[Nighthawk4184]

Don't remind me.. I'm pretty confident I have gotten it back again from using topical gels and with poor guidance by my doctor. Everytime I asked him about it and said "I'm pretty sure I'm getting it back" he would do his "examination" of the areas and say... "Oh I think it's just access fat, like a fat patch" while in the meantime never checking my estrogen levels either... SMH

[HRTstudent]

If you're actually interested in treating the low testosterone you need to see a real doctor.

While you may be educated more than him, you certainly are not the most educated out there and it is in your best interest to find a true expert in male HRT.

I think the biggest travesty of all of this is the fact that you've been "on" TRT for 7 years or so and you've never seem to have been treated properly.

[powerlifterty16]

yup you need a competent dr.

[Nighthawk4184]

I am in the process of trying to get referred to an endo at this point. Trouble is, there are none in my area. I just was hopeful that maybe some of you could enlighten me on my current situation.

[powerlifterty16]

idk your financial situation, but the admin of this site runs a testosterone service with competent doctors for 199 per month plus about 50 bucks per month for prescriptions.

[Nighthawk4184]

If it came down to that I could afford it, however I would love to take advantage of having good insurance coverage until I'm 26 and get everything covered if I can. But if I have to go that route ill have to go that route. I don't want you guys to think by my post that I am deeming myself some sort of expert either, I just wanted you to know that unlike some individuals who come on here lost, I have been putting the time and effort into researching as much as I can about my condition. So that I have a decent understanding about what the ins and outs, dos and donts are if you will. I have some liquid Adex on hand, and also am getting some HCG sent to me this week. I'm not sure if I should start using 250iu 2x per week until I can get into an endo in Syracuse or if I should just keep waiting...

[Nighthawk4184]

Going in at 3 today for the testicular pain (although we already know what's causing it) but using that as my ticket for a referral to the endocrinologist. Anyone else have any insight besides finding a new doctor? And of it would be ok to start using 250iu of HCG per week to avoid atrophy?

[steroid.com 1]

I am suspecting Thyroid.

T3 is low for a man your age.

What is the range for T4?

You need a complete Thyroid work-up done including:

TSH
FT4
FT3
RT3
Thyroid Antibodies

This will give you a better picture. You're T3 (or better Free T3) is best at the mid to upper end of the reference range and you're not.

Hypothyroidism will cause Secondary Hypogonadism.

[jasondd1]

I am suspecting Thyroid.

T3 is low for a man your age.

What is the range for T4?

You need a complete Thyroid work-up done including:

TSH
FT4
FT3
RT3
Thyroid Antibodies

This will give you a better picture. You're T3 (or better Free T3) is best at the mid to upper end of the reference range and you're not.

Hypothyroidism will cause Secondary Hypogonadism.

Will correcting hypothyroid correct test levels usually or are they usually treated congruently?

[Nighthawk4184]

Interesting you mention thyroid, my labs in jan. we're contaminated I'm pretty sure... Because my levels suddenly came back skyrocketed to 1,500 total test and everything else was high, t3 went up to 92 and he said it was "elevated" which makes no sense if you're saying 80 is low.

[Nighthawk4184]

Looking up symptoms of hypothyroidism I have many of them, sensitivity to cold, insane dry skin, puffy face, joints crack and ache, and have struggled with obesity all of my life

[steroid.com 1]

Will correcting hypothyroid correct test levels usually or are they usually treated congruently?

Correcting Thyroid generally corrects Hypogonadism.

[steroid.com 1]

Interesting you mention thyroid, my labs in jan. we're contaminated I'm pretty sure... Because my levels suddenly came back skyrocketed to 1,500 total test and everything else was high, t3 went up to 92 and he said it was "elevated" which makes no sense if you're saying 80 is low.

T3 - 80.9 (60.0-181.0 NG/DL)
How is 80.9 NG/DL elevated?

What's the range for T4 in your labs above???

[steroid.com 1]

Looking up symptoms of hypothyroidism I have many of them, sensitivity to cold, insane dry skin, puffy face, joints crack and ache, and have struggled with obesity all of my life

Sounds about right...most Doc's don't know how to test for Hypo/Hyperthyroidism nor treat it successfully as well. Most have no clue that Hypothyroidism will cause Secondary Hypogonadism as well.

[Nighthawk4184]

There was no range on my paperwork for T4 , I apologize... Wasn't ignoring your question!

[Nighthawk4184]

Update: went to docs office.. My doctor is in a months vacation because he just had a new baby. Saw a PA today and he determined I have epididymitis... Since the discomfort wasn't actually of the testicle but ontop/behind it. So he prescribed me an antibiotic for 2 weeks. He also reffered me to the joslin research center in syracuse to see an endocrinologist (finally) In the meantime I have pharma grade HCG arriving tomorrow or we'd. And was curious if starting a low dose would be ok to keep atrophy from occurring until I am able
To get an appt.?

[Vettester]

OP, thanks for posting the nicely detailed information regarding your situation.

First, on thyroid, I agree with GD that you really need a complete, comprehensive thyroid panel, as he described in Post 15. This will give us a better idea with the actual condition of the thyroid gland itself, it will help explore other pathologies that might be present. Additionally, in conjunction with other labs (CBC's, metabolic, lipids, Cortisol, Iron/ferritin, B12, D3,). This will give us a look at the liver (crucial for T4 to T3 conversion and carrier proteins to transport T3). Some of the thyroid numbers could easily be markers that are relative to a condition elsewhere. E.g., I am a carrier for hemochromatosis. My situation is was not discovered until my 30's, which by then I had developed arthritis due the excess iron in my body. My ferritin levels were >1,500, and my liver and other organs were taking a toll. There's much more to it, but my physicians are pretty certain that this condition is probably the factor for my hypothyroidism, which started in the liver, NOT the thyroid.

So, the collaboration of other labs are essential to tell us about your organs, blood counts, enzymes, and other hormones such as D3 (yes, it's really a hormone). I didn't see a current E2. or maybe it was overlooked !?!

There is still a lot needing covered with your program, including free & bio test in relation to total serum, SHBG (can be relative to everything else tied in with the thyroid, D3, liver condition, etc.), and other hormones upstream. I'm sure this thread will encourage a variety of discussions. I also concur that you probably should be keeping your physician options open. Whether it be the sponsor of this board (LT.com), or even an A4M certified doctor, you NEED someone who knows their stuff!

Also, before I forget ... Don't get worried or fixated on the LH or FSH labs. Those values are reflective of your HPTA being shutdown, and will remain so (regardless of your HPTA condition) as long as you are administering exogenous testosterone . The negative feedback loop process will not be a factor with TRT. We can talk about fertility options as well if that's something you are looking at. At your age, I would imagine it is.

[Nighthawk4184]

OP, thanks for posting the nicely detailed information regarding your situation.

First, on thyroid, I agree with GD that you really need a complete, comprehensive thyroid panel, as he described in Post 15. This will give us a better idea with the actual condition of the thyroid gland itself, it will help explore other pathologies that might be present. Additionally, in conjunction with other labs (CBC's, metabolic, lipids, Cortisol, Iron/ferritin, B12, D3,). This will give us a look at the liver (crucial for T4 to T3 conversion and carrier proteins to transport T3). Some of the thyroid numbers could easily be markers that are relative to a condition elsewhere. E.g., I am a carrier for hemochromatosis. My situation is was not discovered until my 30's, which by then I had developed arthritis due the excess iron in my body. My ferritin levels were >1,500, and my liver and other organs were taking a toll. There's much more to it, but my physicians are pretty certain that this condition is probably the factor for my hypothyroidism, which started in the liver, NOT the thyroid.

So, the collaboration of other labs are essential to tell us about your organs, blood counts, enzymes, and other hormones such as D3 (yes, it's really a hormone). I didn't see a current E2. or maybe it was overlooked !?!

There is still a lot needing covered with your program, including free & bio test in relation to total serum, SHBG (can be relative to everything else tied in with the thyroid, D3, liver condition, etc.), and other hormones upstream. I'm sure this thread will encourage a variety of discussions. I also concur that you probably should be keeping your physician options open. Whether it be the sponsor of this board (LT.com), or even an A4M certified doctor, you NEED someone who knows their stuff!

Also, before I forget ... Don't get worried or fixated on the LH or FSH labs. Those values are reflective of your HPTA being shutdown, and will remain so (regardless of your HPTA condition) as long as you are administering exogenous testosterone. The negative feedback loop process will not be a factor with TRT. We can talk about fertility options as well if that's something you are looking at. At your age, I would imagine it is.

Thank you for the detailed response. It certainly opens up many more paths then I ever thought were possible... I'm not sure if they had checked any of this before (over the past few years) but I will look into it. I will post my entire blood work results in the morning from top to bottom and maybe that will raise some more questions or even some answers. And yes fertility is DEFINETLY a concern. I am very much a strong family man, and my wife and I plan on having children.

[Vettester]

Great, I'll look forward to your post.

Also, I got typing a little fast ... The liver was one primary area of focus that I mentioned with the thyroid paragraph. I was also wanting to emphasize the adrenals in the conversation (hence the cortisol assay)...

Yes, many guys are successful with having children on HRT. Keeping the testicles healthy with a HCG protocol will be essential. When the time comes you will want to look at also implementing HMG, which will promote both analogs of LH and FSH. We can discuss this more. In the meantime, get your labs, and let's get you dialed in!

[steroid.com 1]

Great, I'll look forward to your post.

I was also wanting to emphasize the adrenals in the conversation (hence the cortisol assay)...

BINGO as usual Vette!!!

Also, needs to see DHEA-S. Adrenal disorders will convert more Pregnenolone into Progesterone to support the adrenals than DHEA and can be a sure fire symptom of adrenal distress, fatigue or pathology of some type.

[Nighthawk4184]

Alright, so here are my latest blood labs that i have, i would like to say i had them redrawn within 2-3 weeks after this one, but i do not have a copy in my posession. I will advise you that i believe this test was either contaminated or fluked because my testosterone levels jumped up insanely high all of the sudden by over 1,000 ng/dl.... at the time i was supplementing with testim, DHEA, fenugreek, tribulus, ZMA. Doctor seemed to think the DHEA caused the influx, i was thinking more maybe i touched my arm in the drawing location and contaminated the needle with testim.

1/25/13

PSA 0.46 ( < 4.0 NG/ML)
Free T4 Direct 1.9 (.ng/dl) no range
Magnesium 1.9 (1.8-2.4 MG/DL)
Prolactin 8.3 (2.1-17.7 NG/ML)
Free Test Direct 48.1 ///// 10/18/12 was 9.2 (9.3-26.5 pg/ml)
Total Test 1,500 ///// 10/18/12 was 392.0 (348-1197 ng/dl)
Total T3 96.1 (60.0-181.0 ng/dl)

WBC 4.9 (5.0-10.0 k/mm3)
RBC 5.04 (4.70 -6.10 M/mm3)
Hemoglobin 15.2 (14.0 - 18.0 g/gl)
Hematocrit 45.6 (42.0-52.0 %)
MCV 90.3 (80.0-96.0 fl)
MCH 30/2 (27.0-33.0 pg)
MCHC 33.4 (32.0-36.5 ng/dl)
RDW 12.6 (11.5-14.5%)
Platelet Count 291 (172-450 k/mm3)
Neut % 56.4 (36.0-66.0%)
Lymph % 33.9 (24.0-44.0%)
Mono % 4.7 (0.0-5.0)
EOS% 2.7 (0.0-3.0)
BASO % 0.3 (0.0-1.0%)
NEUT # 2.8 (1.8-7.7 k/mm3)
LYMPH # 1.8 (1.5-6.5K/mm3)
MONO# 0.2 (0.0-0.8 k/mm3)
EOS# 0.1 (0.0-0.50 k/mm3)
BASO# 0.0 (0.0-0.2 k/mm3)

Glucose 86 (70-105MG/DL
BUN 25 (7-18MG/DL)
Creatinine 1.0 (0.8-1.3MG/DL)
Glomerular Filtration Rate >60.0 (>60)
Sodium 142 (136-145 meq/l)
Potassium 4.2 (3.5-5.1 MEQ/L)
Chloride 103 (98-107 meq/L)
Carbon Dioxide 28 (21-32MEQ/L)
Calcium 9.2 (8.5-10.1MG/DL)
AST/SGOT 16 (15-37 U/L)
ALT/SGPT 40 (12-78 U/L)
ALK PHOS 62 (50-136)
Bilirubin, Total 1.70 (0.2-1.0 MG/DL)
Total Protein 6.8 (6.4-8.2 GM/DL)
Albumin 4.5 (3.2-5.2 GM/DL)
ALB/GLOB Ratio 1.96 (1.00-1.93)

Iron 139 (65-175 UG/DL) 8/10/12
TIBC Iron Binding Capacity 394 (250-400 UG/ML) 8/10/12
% Saturation 35.3 (19.7-37.4%) 8/10/12
TSH Ultrasensitive 1.520 (0.358-3.740 uIU/ML) 8/10/12

CK 344 (39-308) 8/10/12
Ferritin 188 (5-244 NG/ML) 8/10/12
Hemoglobin A1c 5.3 (4.5-6.2%)
Est Ave Glucose 105 (60-110 MG/DL)

Wow, i need to make some sort of template for all those ranges... that was painful lol. You now have everything that i have as recent as possible.

Thought i would include a few more snippets of information just to give you as much detail as i can.

OTC Supplements (CURRENTLY)

Multivitamin
Fish Oil
750 MG Magnesium/ED (was 500, i bumped it up due to muscle cramping and still low levels on bloods before that. Use Super Mag from GNC)
Gaspari Nutrition "Detonate"
Biorhythm "Ultra Lean FX"
Biorhythm "Regenerate"
BPI "Pump-HD"
L-Carnitine 1,000mg 2xED
Whey Protein
BCAA
Casein Protein

I usually always cycle on and off my caffeine based products... 1-2 months of use followed by 1 month off. I use low amts. (1-2c) of coffee during that time.

Generally I have noticed over the years that i have really intense senitivity to cold in my hands, they are in pain and almost seized up it seems in a short period of time. EXTREME dry skin... all of my life since i can remember. Seasonal Allergies, Struggle with obesity since i was a child, Fatigue (general daily), ive never been good with endurance of any kind.. running, muscular endurance, ect. I have noticed a decrease in memory function over specially i would say the past year, maybe 2 years. I forget things easier now, i do suffer from stress very easily, and tend to make not such big deals into big deals at times... anger outbursts, emotional ups and downs at times, Lean muscle mass seems to come and go as it please.... at this time i have had pretty good luck maintaining what ive been building in the gym. However my diet has been 90% consistent with some cheat days. This part drives me CRAZY!!! I have noticed that after a "Cheat meal" or "cheat day" my body is EXTREMELY sensitive to water retention and bloat. I blow up like a fish if i eat out or enjoy something i usually dont eat. Its more than frustrating at this point.. I also seem to be very sensitive to carbohydrates of any kind, and sugar... well... my body hates sugar. If i eat sweets my body temperature always rises (i know it generally will do this to process the simple sugars) and again.. ill blow up like a blow fish with water. Puffy cheeks, love handles barge out an inch.. ect.

I usually sleep from 10:30pm to 6:45AM everyday excluding weekends. My wife and I keep a good schedule going, but at times that still seems like its not enough. Like this morning i DID NOT want to roll out of bed. I felt like i could sleep another 8 hours. I work 40-45hrs per week, retail, I am a manager at a high volume GNC.
I will add more as i can, was going to add on daily diet routine but i need to head out for work.

[Nighthawk4184]

Here's the LATEST test levels. Luckily my mother is a nurse at the clinic I currently
Go to so she sent me my latest results


TESTOSTERONE FREE (DIRECT) 6.8 L 9.3-26.5 pg/mL

F TESTOSTERONE TOTAL FOR T&D 357.0 348-1197 ng/dL

[Nighthawk4184]

Any further thoughts gentlemen?

[Vettester]

All and all, I don't see anything severely standing out on your metabolic or CBC panels, nor anything sounding the alarm with your iron & ferritin labs. BUN is a bit high, but that can simply be protein and hydration related. Again, nothing on that end that is turning my head. I'm hoping some of the other guys will take a look and put their .02 on it as well.

There's still the dilemma of the thyroid. Your T3 is on the low end, and your magnesium is also on the low end, indicating the possibility of hypothyroidism. However, the FT4D appears to be on the higher side, which could very well be the culprit for the TSH not secreting at higher levels, thus the problem at hand is the conversion from T4 to T3. IMO, you really need the RT3, FT3 and antibodies to draw a better conclusion, and I REALLY stress that you get a cortisol and ACTH panel taken. Something tells me there might be something going on with the adrenals.

Lastly, keep in mind, these are just speculative thoughts. I highly suggest that you get with a highly qualified physician that can guide you further, and who can interpret your labs with full authority. Low T Mike over at LowTesterone.com appears to be one of those exceptional physicians who has this department dialed in. I ultimately think you will need to deal with someone of that caliber to advance your cause. Most GP's will drop the subject after TSH and total T3. That's my story and I'm sticking to it!

[Nighthawk4184]

I should've mentioned that i have gilberts disease (elevated billirubin) but all in all, I can say that i have learned more about my condition, as well as what has been done wrong in these past 7 years.... in one week, rather than what i knew for the past 7 years lol. You guys have surely given me many questions to ask, things to look for, and alternatives to choose from. I should be getting a phonecall from the endocrinologist's office any day now to setup an appointment. If all goes south with even them, I am planning to take a drive down to Allentown PA. There is a Lowtestosterone.com clinic there... i believe clinic 1888....? and give them a shot.