My struggle with Low T and TRT failure.

[hammerheart]

I'm a young man of 26, average physique, normal %bf, relatively lean, no major health issues.

Diagnosis of low t dates to back to 2014. Symptoms: fatigue, muscle weakness, exercise intolerance, painful brain fog, bad anxiety with high BP, hair loss (body and facial), nipple discharge, total loss of libido, ED with genital "anesthesia" sensation. Autoimmune thyroiditis diagnosed at the same time.

First bloodwork:

CBC as a pic for convenience. Microcytic erythrocytosis is due to hereditary beta-thalassemia.

Total T: 1.5 ng/ml
Free T: 8 pg/ml (no idea about the method)

Cholesterol 209.

Iron studies, kidney and liver function normal.

TSH 5.76, FT4 0.65 ng/ml (0.7 - 1.6), FT3 3.00 pg/ml (3 - 5), elevated ab titers (currently on 125mcg LT4).

FSH 4.2, LH 1.7, PRL 12.41.


Had a MRI done and again one year later: a rather small, stable pituitary "lesion" of ~0.5cm is appreciable. Not big enough to induce hypogonadism, according to my endo. Also not of the secreting type.


TRT: Tostrex gel, 20mg/die, morning application.

At the very start, it was feeling better, but as the weeks progressed, I gradually became even more lethargic, slouchy, and weak than before. Dizziness all of the time. Developed dark urine and light colored stools. However, anxiety subsided, and dick felt actually as being "there". BP normalized. Body hair increased.

Successive BW showed reduced RBC, hemoglobin, and hematocrit. Two hours-post gel application T levels were 731 ng/dl.

What's worst, brain fog got somewhat extreme. Eventually lost appetite and thirst sensation. Ended up pretty much crippled, malnourished (looked like a zombie), and dehydrated. Dropped about 10Kg/25lbs. Lethargy was severe enough to impair my ability to understand what was going, and docs were of no help (actually, I was referred to a psychiatrist). Yet, somehow I managed to see things through, and to recover my condition. Worst summer of my life so far...

In autumn, had BW again. CBC unchanged, Hgb 12.0, Total T with no prior application of gel was 0.75 ng/dl!

Realized how much of a mistake was made, and went searching for a new endo. Eventually found a prof, whom started me on Nebido and thyroid hormone.

Huge improvement! Prior to Nebid I was having achy muscles and joints all over my body. Energy and lethargy lifted a bit. However, it did only last about 5 weeks, and the pattern represented itself with each pin, in a slow crescendo over time. Libido took a whole year to make a shy appearance.

Side effects: depression (was really anxious pre-TRT, but NEVER depressed), lot of bloating, water retention, debilitating dizziness. Swollen ankles.

What's more interesting, I immediately experienced a rapid worsening of symptoms after each pin, only to feel better two weeks later. If I had morning boner until pin day, tomorrow it disappeared.

Had multiple BWs while checking for thyroid: RBC mostly the same, Hct raised by 2%, Hgb 12.7. Overall, CBC was still better pre-TRT, until thyroid finally stabilized (this year). Total T ranging from >13.50 to 600. SHBG 66 to 40 (last reading whilst on nebid). NEVER pulled E2. Vit. D3 and B12 OK. Zinc kinda low at 54mcg, after months of supplementing. Cholesterol normalized.

At one point, serum Iron was down to 19 mcg/dl, although ferritin was normal. Made me feel really lousy and had to supplement, and still I'm to the present day.

Energy and mood never lifted to pre-TRT levels. Lack of consistent results thus drove me to reconsider Nebid , so approached my endo again. He stated Nebid is the "most advanced TRT available", refusing any alternative other than gels, which I refused. Asked for HCG , but he was unwillingly because its use is for fertility, and not everyone tolerates it well. He labeled most of the side effects as "strange" and didn't offer significant help.

Last pin of Nebid was 5 months ago.

So, I'm trying TRT on my very own now. I didn't await passively for symptoms to subside but actually researched a lot, and mostly important, I do accept every risks that came with this decision.


Most recent BW in the attachments.


Current protocol: 150 mg Test E, IM, E5D. UGL grade.

I'm targeting the vastus lateralis, rotating sides. I'm kinda thin, but I know how to do it. I'm having lot of fun with pinning, actually.

Also, I realized most of the side effects experienced with Nebid COULD have been due to excessive oestradiol, but impaired liver detox is also an option. Anyway, I've included 6.12 mg exemestane EOD.


Almost a month so far. Not sure how I feel. Will be pulling bloods this week. As an additional challenge, sensitive oestradiol isn't available here. Not sure if Free T is reliable either.


Thoughts?

[Mr.BB]

Why arent you on thyroid meds????

[hammerheart]

I'm on 125mcg LT4 (levothyroxine), I wrote it above.

[Mr.BB]

I'm on 125mcg LT4 (levothyroxine), I wrote it above.

Sorry, bad insomnia today

So the bloodwork you posted you are T4, right?

You should first fix your thyroid and only after stable with thyroid see if you really need testosterone .
Fix it making the FT3 close to the upper limit of range (last quarter) and FT4 about mid range. You might need to take some T3( which might be a challenge as european docs tend want only use sinthetic T4 (levothyroxine)). Dont use TSH to adjust dosages, use FT3and FT4 and your symptoms.

Fixing your thyroid might fix your testosterone, if not libido is the way to go.

Also supplement b12, zinc, folate and vit c and d, I know you said it was normal but it will help with your blood and you will feel better faster.

[hammerheart]

Thyroid is stable now... check last bloodwork. TSH is < 1.

I tried thyroid-first, route, two years ago. Went to an endo whom stated my T of 150 was normal (...), and prescribed 25mcg levothyroxine instead.

IT WAS HELL. Anxiety skyrocketed, palpitation all day along. After a visit to the emergency room (respiratory alkalosis->tetany..) I had to drop it. Remember that thyroid hormone increases SHBG.

Taken along with nebid, it gave no issues. It seems the two conditions are unrelated. However, independently of TSH, free values of thyroid hormone varied A LOT whilst on nebid. I've witnessed FT3 ranging from 2.2 to 3.5. Endo negated any relationship, but I do think the upregulating effect of E2 on binding proteins (SHBG, thyroxine-binding globulin, etc) is a potential cause. Likely, in a healthy individual, this isn't an issue, but with underlying thyroid dysfunction I do suspect it's possible (couldn't find a study).

I tried liothyronine, but it isn't for me.

I'm supplementing with B complex, zinc citrate, selenium, vit c, d, krill oil and choline (this one got rid of pale stools, oh my liver).

[hammerheart]

I might also add I've tried methylfolate.. had strong sedation feeling from it. Magnesium does the same. I've experimented with loads of stuff, including prohormones, aminos, and pharmaceuticals, but I guess this is OT here.

[Mr.BB]

TSH is not really good indicator on hashimotos.

And yes, testosterone will influence thyroid hormones, hence why in my opinion you should get it stable before thinking of testosterone.

Natural thyroid, which have both t3and t4 might be an option. In the bloodwork you posted, your ft3 and ft4 are too low.

Thyroid regulation can be hard, but it is your best bet to better health.

[hammerheart]

Dude I'm on a full replacement dose. Hashimoto is an autoimmune issue, and best dealt as one. High iodine foods were a trigger for me, so I had to cut these away from my diet, as well as iodine salt.

I don't get what you mean by "before thinking of T" since I've been on TRT for the last two years. Balls feel like half the size. I will probably try to reboot in future, but for the time being TRT is my way to go.

Yes, FT4/3 are lowish, but just 6 months ago they were top range on 100mcg LT4. I don't even seem to have a conversion issue.

As is wrote above, I do suspect E2 could be affecting Thyroxine-binding globulin. If I'm right, the problem is E2 management (bloods will tell). T, if anything, could enhance T4 conversion to T3, and inhibit TBG.

[hammerheart]

And besides, I draw last bloods just after starting with test enanthate . What is VERY likely, that the system was trying to regain homeostasis after T was introduced. It strongly inhibits TBG, so in the case free hormones were top range just before they could have hit hyperthyroid-ish values thereafter. As a result, TSH went down, and so FT4, thus FT3. It's just a temporary fluctation IMHO.

A better indicator would be the CBC, especially the relative lymphocytes/neutrophils ratio. Until I reached the dose of LT4 I'm on now, I always had relative lymphocytosis with neutropenia. RBC, Hgb and hematocrit were never as high as now...

[hammerheart]

Got BW back.

Current protocol is Test E 150mg E5D, exemestane 6.25 EOD. Blood was draw on day 5, ie pin day.

Didn't care to ask but method for oestradiol is very likely by immunoassay.


Test came out at >13.50 (2.3 - 10.3)

E2 32.83 pg/ml (7-43)

SHBG 27.2 (13-71)

Wasn't expecting that high T. SHBG used to be 40 so I'm contented with this one. As for E2, an overestimation is to be expected with immunoassays, so perhaps it's just fine.


Both absolute and relative count for neutrophils is much lower compared to one month ago. Perhaps thyroiditis is at it again..

[hammerheart]

Well well well I wasn't expecting any huge improvent since I've been off Nebido for a while.

Most of the symtomps are still there (some even worse). As for lethargy, fatigue and weakness, no improvement. Anxiety is down a bit. What's most noticeable is beard growth, even by acquaintances, so apparently T is doing it's work. Exemestane got rid of the dizziness I was experiencing post injection (with Nebido it lasted weeks), and most of the bloating/water retention.

As for oestradiol, I've jumped on aro today and I'm feeling a lil better, libido also is up a tiny bit, dosage likely needs adjustement.

Tapering down test E to 125mg E5D, exemestane 6.25 e3d.

Going to check for CBC, T, E2, lipids and thyroid function again in a month.