31 and bad start on trt

[dizzyiggy]

Hey, I'm a 31yo male, 145lbs, 5' 11", trouble gaining weight (low body fat obv/weak facial hair). Haven't woken refreshed since middle school, horrible concentration, take 60mg adderall xr to stay awake for work (truck driver). So the last 10 years or so I've been seeing doctors and researching into my ADD/lack of energy/ED/mild cystic acne on jawline (course on accutane in high school) and i recently saw a new doctor who tested my test and its real low, which was actually a relief because I've gone down many different avenues w no luck. I spent my 20s drinking lots of alcohol and smoking lots of pot eating the SAD, but one year ago i read Nutrition and Physical Degeneration and I quit drinking and smoking, cleaned my diet up and joined the WAPF and started eating grass fed beef, organ meats, fish and vegetables, but it didn't have any noticeable improvement (after a good 6 months). I'd also been taking supplements (from vitamins to herbs to nootropics) for a good 10 years, always with the hopes of some improvement in concentration/focus but nothing ever helped. My GP suggested it could be depression about 10 years ago, which i found hard to believe as i never felt depressed, but saw a psych and resisted ssris for awhile due to the side effects and that i didn't believe i was depressed, but finally tried them. I had zero reaction to the first few (wellbutrin, zoloft), but then i had very robust response to prozac which subsequently diminished a few months later, but nonetheless it gave me hope. I had felt like myself for the first time i could remember and i was actually waking up early. I kept trying others seeking that lust for life prozac fleetingly gave me, including a bunch more ssri's, snri's, tca's, and even the 3 maoi's. Nothing ever helped and surprisingly most of these gave no side effects whatsoever, sometimes I even got improved sexual function. So now, I have a bunch of blood work, and I'm hoping you guys can give me some direction, because after reading Crisler's TRT, it seems like my most recent doc (anti aging/hrt specialist) doesn't seem like he knows what he's doing. Here's my most BW (while on 40mg adderall xr) from the summer:

FEBRUARY 2015

Lipid Panel (Ref Range)
Total Chol 125-200 194
HDL (> or =40) 81
Tri (<150) 90
LDL (<130) 95
CHOL/HDLC ratio (< or = 5.0) 2.4
non HDL Chol (target is 30 higher than LDL) 113
Glucose (65-99) 83

JUNE 2015

Ferritin (30-400) 160.9
Vit B12 (211-946) 1220
T3 Free (2-4.4) 2.3
T4 Free (.82-1.77) 1.4
T3 Rev (9.2-24.1) 13.1
TSH (.45-4.5) 2.08
_______________
VitB12 (300-900) 817
Methylmalonic Acid (MMA) (87-318) 119
Vit D 25-Hydroxy (30-100) 88.7
Folate RBC 422 ng/mL
Lymes Ab C6 w/Reflex (0-.90) .90
<=.90 Negative
.91 to 1.09 Equivocal
>=1.10 Positive
CK Creatine Kinase (38-174) 147
Sedimentation Rate (2-10 mm/hour) 2
ANA Index (0-.89) .22
ANA Screen (negative) negative

AUGUST 2015

Cortisol panel (Diagnos-Techs): (I work 2nd shift, so i shifted the times back)
12pm (when i wake) 14
4pm 18
9pm 3
1am 2

8.26.15
Sodium (136-145) 138
Potassium (3.6-5) 4.3
Chloride (98-108) 100
CO2 (22-32) 26
Glucose (70-100) 93

BUN (6-22) 10
Creatinine (.7-1.2) .96
Calcium (8.7-10.2) 9.4
Protein Total (6.3-8) 6.5
Albumin (3.5-5) 4.2
Bilirubin (0-1.2) .15
ALT (0-45) 37
AST (0-35) 29
Alkaline Phosphatase (30-115) 109
Anion Gap (7-14) 12
eGFR (>60mL/min/1.73M2) >60

NOW on Nature-throid 32.5mg and 60mg Adderall XR

NOVEMBER 2015

WBC (4.0-10.0) 5.7
RBC (4.2-5.7) 5.25
Hgb (13-17) 15.8
Hct (39-51%) 48.7
MCV (80-99) 92.8
MCH (28-34) 30.1
MCHC (32-36) 32.5
RDW (11.5-14.5%) 13.5
Platelets (150-400) 228
MPV (7-11) 9.7
Segs (42-70%) 44.3
Lymphocytes (20-45%) 39
Monocytes (4-11%) 11.6
Eosinophils (0-5%) 3.8
Basophils (0-2%) 1.3
Segs Absolute (1.7-7) 2.5
Lymphocytes Absolute (.8-4.5) 2.2
Monocytes Absolute (.1-1.1) .7
Eosinophils Absolute (0-.5) .2
Basophils Absolute (0-.2) .1

Free Testosterone (.87-5.47) .91
Total Testosterone (175-781) 420
Estradiol <20
ACTH (6-50) 25
TSH (.34-5.6) 1.52
T3 Free (2.5-3.9) 3.2
T4 Free (.6-1.4) .8
Thyroid Peroxidase Ab <1
EBVCA IgG Index (0-.89) 5.48
EBVCA IgG POSITIVE
EBVCA IgM (0-.89) .18
EBVCA IgM NEGATIVE
Vit D, 25-Hydroxy (30-100) 83.3
Vit B12 (300-900) 791
Zinc, Blood (60-130) 87
Iodine (52-109) 56
Selenium (63-160) 122
DHEA Sulfate (106-464) 326

Upon these results he prescribed me 100mg Bio Test with 37.5mg Chrysin, which I didn't use yet as I wanted to research it more, and ended up getting more blood work.

DECEMBER 2015

FSH 2.4
LH 2.6
Prolactin 15.9
CRP .63
SHBG (pending)
DHT (pending)

After I gave blood for those last tests, i tried the cream and now I can barely get an erection! I've been using it for 5 days and am now using it twice a day, so 200mg test and 75mg chrysin (he prescribed once a day but i doubled it to see if it will help erection - no sir). But it's just pathetic so far, much, much worse. I see the doc on Tuesday, but I'm thinking i want to add hCG, and hopefully you guys can tell me if maybe that chrysin is unnecessary and causing E2 to go too low? I'm brand new to this hormone stuff so any help is greatly appreciated.

[dizzyiggy]

I made up a spreadsheet so hopefully its easier to read.

[kelkel]

That's a lot to digest dizzy! I'm going to jump to your last blood work. LH is low thus your endogenous testosterone will be low (er.) LH can be suppressed by elevated prolactin and assuming your's is a normal range (from memory) it's at the top of the range. Adderrall can increase prolactin to the best of my knowledge. I'd be curious how much your test would rise simply by reducing your prolactin level.

When it comes to the cream 5 days is not enough time to gauge results. I do not advise arbitrarily doubling your dose simply due to erection issues, when you really have no clue what's causing them. It very well could be a little anxiety over what you're going through or so many other things. You're human. You really need to be on a steady dose of your cream for about 4 weeks and then pull BW to see what's going on. Then you make changes to your protocol based on results and how you feel. How you feel is more important than the BW.

When it comes to HCG most of us feel, and research validates it, that it's a great asset to a protocol. In your situation I'd probably wait for your first BW, see how it goes and then initiate HCG. Remember, all this takes time. You did not get in this condition over-night and you won't recover over-night. Patience. Rushing things, doubling dosages, etc., will lead to more problems, imho.

Chrysin is a waste of time, imho:

Chrysin - Scientific Review on Usage, Dosage, Side Effects | Examine.com


I saw you mentioned Diagnos-techs. They have a hormone panel available that tracks your hormone pathways placing results into a flow type chart showing the exact path of your individual hormone cascade. Hormones don't have a direct route and are influenced by many variables. This would reveal exactly how your endogenous hormones are being diverted, and possibly why.

[dizzyiggy]

Thanks for replying, so with that low LH and higher prolactin, is that enough to determine primary or secondary hypogonadism? Someone on Crisler's forum suggested that I /may be a good candidate for hCG mono since my LH and test were both low. Either way I feel like I should be on it (the little bit I know), whether mono or in addition to the test, just cuz I've read of too many guys where it actually hurts when they don't use it, or the shrinkage. And I know that 5 days is not enough to fairly evaluate the cream, but it was just too funny cuz I was telling my gf about it and saying it was gonna be even better and then it was the most pathetic erection i've had in my life, I mean even when i've been wasted. And I just can't possibly believe anxiety could be the factor in my case either because i'm actually really happy/positive now that I'm getting some BW that is explaining my symptoms, plus i just don't get like that. I'll keep the dosage at the 100mg though and ride it out, hopefully adding the hCG on Tuesday when I see the doc. Cheers.

[dizzyiggy]

oh and do you think cabergoline would be appropriate in my case? I'm /guessing that the prolactin's not high enough to warrant it's use.