Normal T, low Free T, High SHBG - TRT or not?
- 02-10-2013, 11:22 PM
Insulin resistance and behind it, leptin resistance, many of us have it. What exactly led you to think IR is a problem for me?
This is another reason why I'm on VLC paleo/keto, the best diet for IR/LR. I read up a lot from Jack Kruse, the expert on this. And yes, increased adipocytes = increased inflammation = hormone imbalance (i.e. estrogen dominance, etc.). But if my a1c and FBG are good as you have seen, my post-prandial BG never goes higher than 130 (unless I eat >50g carbs in one meal), both my fasting insulin and leptin are very low -then why would this still be a problem? BTW, if rHGH increases insulin resistance, that's a problem. I need to increase insulin sensitivity.
Becoming keto-adapted means that I've successfully replaced carbs with fat as my main source of fuel, and fat does not illicit an insulin response which is the key to remaining in ketosis. Perhaps eating too much protein? That will drive up insulin levels via gluconeogenesis.
The diet I previously outlined is about 1350-1400 cals. My RMR is about 1500 give or take. My TDEE is about 2200 according to a calorimetry test I recently had done. That test also said my metabolism is...FAST. Go figure. On some days, my calorie intake will go up to 1800, mostly from fat. That still should be at a deficit. Somewhere along the line, my numbers are OFF and I must be still eating at a SURPLUS.
When you're talking "cellular shutdown" or damage what exactly does that mean? Dysregulated nutrient partitioning? If we look at my not firing on all 8 cylinders, then we're talking about hypometabolism. Throw in chronic inflammation - which slows metabolism - and then that's a problem. My elevated CRP reflects some kind of chronic unknown inflammation we cannot identify, so this has also been an issue. Just read that the overall level of inflammation in the body is determined by the ratio of omega-6 to omega-3 fats in cell membranes. Due to regular fish oil supplementation, I have a surplus of n-3 EFAs (EPA./DHA) over n-6.
But talking strictly about my RMR and macronutrient synthesis, you'd think T3 would come to the rescue, but it didn't do much by way of lipolysis. And when I upped the dose, I got some short and long-term sides, the worst being two blood clots in both legs within the last year which I attribute to too much T3 (and studies will back me up on this since I have zero genetic tendencies for this). IF should definitely help with nutrient partitioning. I think it all comes down to IR and tendency toward metabolic syndrome.
Now, here's something else I should mention. And whether this factors into the equation even though my hormone levels fall within normal ranges is unknown. I was dx'd with ESS when I had an MRI of my brain done a few years back: ncbi.nlm.nih.gov/pubmedhealth/PMH0001389/ (add the www since I am unable to post links still).
All the docs I've talked to says it's not an issue unless the pituitary doesn't function. Mine functions fine, otherwise, I'd be hypogonadal, etc., but who knows.
On a side note, my diet when I was at my leanest in my med-20s was very similar in terms of types of foods, but consisted of a lot more carbs and calories than my current diet + I ate 3 meals then instead of 2 meals I'm doing now. Looks like I partitioned a lot better then than now.
As you can see, I'm doing everything possible to be in a lipolytic state as opposed to a lipogenic state.
Again, the only thing I have not done is consistently make sure my calories are under my RMR nor have I started a cycle of anything to this day. I lied. I tried Genotropin rhGH 10 years ago, but the dose was subpar (0.2mg) and all I recall it doing was cause localized lipolysis at the injection site. That's not even a cycle.
I think the key is this: The more insulin "sensitive" you are, the better nutrients are partitioned in your favor.
And you are right - this has been around a long time as evidenced by the dx of fatty liver (NAFLD) 3 years ago. It's going to take some time to reverse the damage. It is taking a lot longer than I though to purge all those FFAs from the liver than I thought. I'm hoping the T and GH will help escalate things in the right direction, however the insulin issue with GH is of concern.
My body looks as if I ate crap, lots of carbs, and hardly worked out - certainly not the case which is highly discouraging. Again, this wan't the case in my 20s in which my hard work showed.
- 02-11-2013, 07:31 AM
Why i suggested 23andme test. There is an app.which was designed for looking at the 23andme test designed by a doctor and his wife who have an autistic son. I am actually working on their sons case probono. there are excepted to be 1-2 million people.getting the app at 12 bucks a pop. Do the.math..not asking for one.red cent..Once I balance their son which should not be difficult..word spreads quickly. I am.already doing genetic research which will potential save thousands of.life by getting the information out there. This will.make.hrt which is a great advancement.in.medicine look like minuscule. By doing 23andme you will see why you have NASH then corrected at source. By looking at the genetic snps you will also be finding out which supplements will compatible to your body and one causing potential harm. I have done a few hundred of these reports it will not be hard to isolate where the imbalances. You are probably asking who is this smuck? LOL. I have been asked to speak at upcoming conference with the best in the field of methylation in the United States.I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
- 02-11-2013, 10:35 AM
I started to suspect insulin resistance after the t3 chronicle, and after you posted the food break down it confirmed it.
That is correct what you said about being insulin sensitive working in your favor.
I've done extensive research into inflamation and insulin resistance so much so, that I ended up taking a hard look into biochemistry to understand how and why part. WHat happens is that there are some pathways all cels in our body follows under different circumstances. What ppl do is upseting that balance through our diets favoring excessive food intake...especially carbs.
When cells are bombarded with excessive carbohydrates and fructose things get really messy. Protein is ok and so it's fat intake but carbs are the issue. it is hard to explain how the cell works but in a nutshell, cells under the stress of too much glucose instead of making more ATP, it circumvents this process by shuting down insulin receptors and by passing nutrients directly to fats. Fructose, adds fuel to the fire because it doesnt need insulin to be processed! It goes to the liver to be broken down. Too much fructose then the liver dumps the glucose in the blood and stores it around itself(fatty liver). Also, fructose can pass through the cell and if not used for ATP production and it goes straight to fat storage (adipose fat). Once a person is in this state, cells are more concerned avoiding cellular damage rather than normal nutrient partitioning.
Overall, humans are not meant to eat all these carbohydrates, period.
02-11-2013, 12:22 PM
What I cannot understand is how I could have developed fatty liver and IR from eating clean carbs and whole fruits (not fruit juices). That doesn't happen in a healthy person. Research shows a direct link to hypothyroidism and IR as a possible cause.
Another recent finding: Most people are way too high in n-6 FAs. I am too high in n-3 FAs from supplementation. Since you've researched inflammation, I'm assuming it is just as bad to have too much n-3s as n-6s and alone may contribute to inflammation.
02-11-2013, 12:56 PM
02-11-2013, 12:59 PM
02-11-2013, 01:54 PM
I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
02-11-2013, 03:03 PM
02-11-2013, 04:20 PM
Long Readbut Will Make You Think Twice About Fish Oils !!
Then you have polquiin pushing 40 grams of fish oils a day !! WTF ....
Many people ha e very little clue about how.efa metabolism works. Too much fish oil or.metabolic factors from pathogens or.toxicity can.impact a protocol. I have experienced this first hand as I was a patients of Dr Kane her self. I knew the physiology before going into.her. I.just needed the am.results which where what already predicted. Just use this same principle.on a case where an MD contributed.me.to possible saving a life of her patient.which was enigma to every medical Dr. The.information.the fatty acid profile shows has been. game.changer.in my.life as.well as the doctor's patients I have the.opportunity to work along with.
I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
02-12-2013, 02:14 PM
02-12-2013, 04:01 PM
02-14-2013, 12:42 AM
Question: This is good as Yasko's?
Gene & Variation
rsID Alleles Result COMT V158M rs4680 GG -/- COMT H62H rs4633 CC -/- COMT P199P rs769224 GG -/- VDR Bsm rs1544410 CT +/- VDR Taq rs731236 AG +/- VDR Fok-I not found n/a n/a MAO A R297R rs6323 T + ACAT1-02 rs3741049 GG -/- MTHFR C677T rs1801133 AA +/+ MTHFR 03 P39P rs2066470 GG -/- MTHFR A1298C rs1801131 TT -/- MTR A2756G rs1805087 AG +/- MTRR A66G rs1801394 AA -/- MTRR H595Y rs10380 CC -/- MTRR K350A rs162036 AA -/- MTRR R415T rs2287780 CC -/- MTRR S257T not found n/a n/a MTRR A664A rs1802059 AA +/+ BHMT-01 not found n/a n/a BHMT-02 rs567754 CT +/- BHMT-04 rs617219 AC +/- BHMT-08 rs651852 CT +/- AHCY-01 rs819147 TT -/- AHCY-02 rs819134 AA -/- AHCY-19 rs819171 TT -/- CBS C699T rs234706 AG +/- CBS A360A rs1801181 GG -/- CBS N212N rs2298758 GG -/- SUOX S370S not found n/a n/a NOS3 D298E not found n/a n/a SHMT1 C1420T rs1979277 GG -/-
Gene & Variation
rsID Alleles Result
CYP1A1*2C A4889G rs1048943 TT -/- CYP1A1 m3 T3205C rs4986883 TT -/- CYP1A1 C2453A rs1799814 GG -/- CYP1A2 164A>C rs762551 AA -/- CYP1B1 L432V rs1056836 CG +/- CYP1B1 N453S rs1800440 TT -/- CYP1B1 R48G rs10012 GG -/- CYP2A6*2 1799T>A rs1801272 AA -/- CYP2A6*20 rs28399444 II -/- CYP2C9*2 C430T rs1799853 CC -/- CYP2C9*3 A1075C rs1057910 AC +/- CYP2C19*17 rs12248560 CT +/- CYP2D6 S486T rs1135840 CG +/- CYP2D6 100C>T rs1065852 GG -/- CYP2D6 2850C>T rs16947 AG +/- CYP2E1*1B 9896C>G rs2070676 CC -/- CYP2E1*1B 10023G>A rs55897648 GG -/- CYP2E1*4 4768G>A rs6413419 GG -/- CYP3A4*1B rs2740574 TT -/- CYP3A4*2 S222P rs55785340 AA -/- CYP3A4*3 M445T rs4986910 AA -/- CYP3A4*16 T185S rs12721627 GG -/- GSTP1 I105V rs1695 AG +/- GSTP1 A114V rs1138272 CC -/- SOD2 A16V rs4880 AG +/- NAT1 R187Q rs4986782 GG -/- NAT1 R64W rs1805158 CC -/- NAT2 I114T rs1801280 CT +/- NAT2 R197Q rs1799930 GG -/- NAT2 G286E rs1799931 GG -/- NAT2 R64Q rs1801279 GG -/- NAT2 K268R rs1208 AG +/-
02-14-2013, 07:02 AM
I intepret 23andme for.Md.and.psychiatrists. Nutragenomics has been a huge part of my practice. An App coming out will do over 250.genetic snps and will be offered through 23andme. A lot.of.my.research is.incorporated.into.that app along with a few.other.people. I am.actually training doctors.on how.to use these results.in their practice which is having a profound effect on how they are treating their patient to.get a better therapeutic out come. I have conference coming up in.New Orleans and in talks. of.going.to Australia for 3 -4 course to teach medical professionals. It has helped a lot of.younger guys to be able to.come.off trt more.successful. I am currently working with Dr Mullan on some cases which is Amy yasko colleague you is Co writing her book. Amy has done a wonderful job in getting genetic on the forefront. Her test was the first of its kind. Now 23andme has over 900,000 SNPS vs 30- 40 on yasko panel. Each week I am pulling up new information to add to the growing data base of genetic research. When it comes to genetic I am very well respected in the field..
02-14-2013, 11:16 PM
Clean carbs =glucose
THe difference is release rates! THat's it. End result is the same.
I can tell you that I only eat on an high carb day 75g on a low carb day less than 50g.
THat's all I need.
So clean carbs vs dirty carbs is useless in this equation, quantity matters more than anything else.
It will take a while to fix some of the cellular damage but unfortunately you need to avoid complex and simple carbs for a while anyway. Stick with meat, fat and vegetables possible slightly less than maintenance. Anabolics I found to do nothing against this issue of insulin resistance.
Rule of thumb about suplementation is that once in a while is good to stop taking everything for a month or so for issues like this of over supplementation.
Problem I see with the liver is that many times the liver dumps fats into the blood stream for one reason or another,then if the body doesnt use it goes back into the liver again. But at the same time there is more fat to be dumped so at this point it is possible the liver gets overwhelmed and just starts to store it in an attempt to solve this problem.
Also, when the cells have problem using fat to make atp, it is sometimes related to thyroid function or just too much fat in the blood and enough reason to make ATP.
02-15-2013, 01:06 AM
Also, VLC/paleo is known to purge the liver of FFAs, thus the transient increase in LDL. My LDL numbers have actually improved since June of last year after being on VLC/paleo almost a year now.
As far as being at a deficit from maintenance, that is the very one thing I have not been able to determine: just what is "maintenance", as most of the online RMR calculators say I'm at about 1500. That means in order to lose weight AND bf, I have to be at a deficit of that by what, 200-300 cals? Or do I take my deficit from a different number like TDEE which is about 2500.
Or should I just pick a number, eat that much, and measure actual results at the end of a 3 week period? If I lost 3 pounds, then I am eating at a 500 calorie deficit. If I lost 1.5 pounds, I am at a 250 cal deficit, and so on. Despite all my blaming my hypothyroidism for storing bf, it still all comes down to the olde argument of cals in/cal out.
The only caveat: less food intake = body thinks it's in starvation mode = rT3 spikes = slower metabolism = less fat burned.
Protein is key to retaining lean body mass while eating at a deficit so I want to make sure to keep it up. But what should be enough to maintain anabolism and not too much to again get into trouble with an excess that will convert to glucose via gluconeogenesis?
Keto means as much as 75% fat, 20% protein, and 5% carbs, but with such little food intake, that's nowhere near enough protein for those of us that train 3-4x's a week. That means that if I want to be under maintenance my macros should look like this:
60% fat, 35% protein, 5% carbs
There is no way I can bulk even clean at this point and not add unhealthy amounts of bodyfat. Remember, I'm not a big massive guy at 5-7, 175 - with 22% of that weight being fat! I need to recomp to half that bf which mean I should be no more than about 150-155 max. I must do a cut, but not at the expense of LBM - and that's where a anabolic cycle as you had suggested would I believe help - that and keeping protein intake no less than moderate, deriving my energy from healthy fats. Once I get to 10-11% bf, I can then do a clean bulk of say 8-10 lbs, rinse and repeat.
02-15-2013, 11:45 PM
Yes your reasoning is sound. THe fact is that when doing a low carb diet fat intake can be higher if the calorie expanditure requires it BUT protein at that point needs to be around 75g per day. Could be a little more but what happens on a high fat diet protein seems to do more with less. Too much protein and the body will start glucogenesis. So if you active by all means eat more fat.
You will not lose muscle mass if you dont eat x amount of protein, dont worry. You can also take 25 T3 during this cycle.
To be honest im not too concerned about calories that much. Eat 3 meals a day to start consisting of meat/fat/veggies and see what happens. THe important thing is to eat the same everyday so you can make adjustments to the diet if need it. If it's too much food cut down a bit or add another meal if you active that day.
Dont bulk just lose body fat for now.
Isulin resistance is a pain in the butt to fix, it will take time and perseverance.
02-16-2013, 07:56 AM
Correcting gi tract corrects blood sugar metabolism
02-17-2013, 02:39 AM
70% fat, 25% protein, 5% carbs
Again, the only worry is whether the body thinking it's in starvation mode from less calories from carbs will down-regulate its metabolism and burn less fat. Hopefully, the T3 & the fat will offset that possibility.
02-17-2013, 10:38 AM
THe food breakdown is fine. Once on anabolics the more you workout the hungrier you will get that's why is wise to keep your test levels within range or slightly elevated past 1000 and do not workout with very heavy weights.
For the goal you are chasing to lose weight and body fat, 100mg of test a week is more than enough along with 25 T3.
02-17-2013, 01:45 PM
Why not train heavy?
02-17-2013, 09:03 PM
As for the heavy training, I never train heavy while trying to lose weight/fat. It incrases the chances of geting injured and also promotes higher food intake to cope with the recovery. The goal is not to get bigger on this diet but rather the opposite.
02-18-2013, 12:04 AM
On an even more discouraging note, no matter how hard I train and eat clean, etc., I look like I did nothing. I cannot understand what the problem is. Eating very little carbs now for the last year, I started to drop weight and fat, but I seem to have hit a plateau where my body seems to have become "comfortable" and I cannot lose weight/fat. It seems that the only way I'm going to get anywhere is to do T, GH, and whatever else to burn fat and build mass. My 20s was the last decade in which working out, diet and supps made any difference.
02-18-2013, 08:35 AM
Your routine should keep lifting weights the same where you get a good workout but not too heavy where recovery takes more than 7 days.
It doesnt matter how much weight you lift, point is to not push too hard and get hurt.
02-18-2013, 01:26 PM
02-19-2013, 10:05 PM
Higher body fat may be a the cause of poor sleep, but without checking is hard to say but is a good candidate. Poor sleep affect hormones too, so it's like a cascade.
Dont think omega 3 has anything to do with it that I know of
02-19-2013, 10:53 PM
I did a sleep study which showed mild OSA (obstructive sleep apnea) + I am getting sleepy an hour after my first meal even though little or no carbs. Lack of sleep = low GH and T = imbalanced body composition! If it wasn't for my doc urging me to do a sleep study, I would have never known.
GH itself is required to improve endothelial function + it improves blood pressure via NO pathway.
Poor hormone synthesis from sleep dysregulation + IR/LR (insulin/leptin resistance) which is part of metabolic syndrome, and, yep, there's the perfect storm for my body harboring unwanted bf and not enough lean mass! People with OSA have some of the lowest levels of growth hormone measured and this helps partially explain why most of them have body composition issues. Without supplementation, my DHEA-S level is also usually depressed.
But if my IGF-1 level was 203 (which was elevated), that would indicate plenty of GH, wouldn't it? How else to measure GH level? Stimulation test?
Also - same issue with total T vs. free T. Some say ignore free T, it's the total that's tells us more physiologically, whereas other say it's the free T that is the key one because it's what is bioavailable for function such as fat loss, lean mass, etc.
My last TT was 623, but I had less free T than a 90-year old man! In addition, to build muscle, study shows we need a TT to be around 1000. There's no way I'm, going to achieve this unless I'm doing TRT or a cycle.
02-20-2013, 12:15 AM
02-20-2013, 12:19 AM
23andme does not look too bad, but I see a lot of issues which need addressing. I bet you have issues with internalizing stress, might have had some ADDHD growing up. or may be your children may be having these issues ? Very few people know how to decipher these results.
02-20-2013, 01:12 AM
02-20-2013, 01:33 AM
02-20-2013, 06:48 AM
02-20-2013, 08:17 AM
Honestly GH is a small part of the entire process. THere are many more hormones produced in the body while sleeping. Like I've mentioned in other posts Gh doesnt really burn fat contrary to popular belief. If you have sleep problems I'd get a hold of a machine that forces air into your nose while sleeping so you can actually get a good night sleep.Personally I wouldnt go crazy trying to keep measuring GH.
Case and point, when I was heavier my sleep was poor due to poor breathing. I used to always be tired, nap all the time. Upon losing 20 lbs my sleep is great, I dream again, and I wake up rested and feeling great.
I'd say free T is just as important as total T. Both play an important role. Normal total T and low Free T points to problems. Something along the way is robbing your free T from circulation. Usually is SHBG which it seems to point to something wrong with liver inflamation.
In your case I would try very hard to lose weight any way you can even if you have to lower your calories and increase physical activity a bit. I would predict that most of the issues you have will slowly go away and hormones may return to normal upon weight loss. Trying to treat every hormon individually is a long road.
If you want to cycle and push the process along I think in your case is a viable option. You can also do without but it wont be as easy.
02-20-2013, 11:49 AM
BP was worse in a.m. None of my usual concoctions worked (Arginine AKG, mag citrate, hawthorne, etc.).
Then took about 7g potassium citrate which seems to have reduced it nearly 20pts on both systolic and diastolic. This would indicate an electrolyte imbalance. Eating lots of protein also causes my system to become very acidic. Potassium is the only thing to bring it more alkaline. Increased fat (especially SFAs) I read can cause vasoconstriction which would increase BP, but that's part of the Paleo diet.
On a side note, new study shows that lifting heavy does not induce hypertrophy any differently than lifting lighter:
02-20-2013, 10:31 PM
02-20-2013, 10:58 PM
Also, being on Paleo, my diet contains less potassium because I limit fruits.
Compound that with a high protein diet and my acidity doubles. So far, potassium is the only supplement that eliminates that.
02-23-2013, 11:42 PM
02-24-2013, 06:26 AM
02-24-2013, 06:27 AM
02-24-2013, 12:49 PM
02-25-2013, 09:12 AM
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