Is TRT the Best Approach for me?

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    Kasumeat's Avatar
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    Is TRT the Best Approach for me?


    I'm sure you've heard this before, but this forum is awesome, and I'm sorry I hadn't discovered it sooner.

    Here's a brief recap of my history:

    About a year ago, at 21, I had some bloodwork that showed a few problems, including low testosterone and borderline low levels of some other hormones that have since recovered (I'll get back to this). Extensive testing has been done, my testes, pituitary, adrenals (I'll get back to this as well) all tested normal, so my endo concluded that it was hypothalamus dysfunction, which I am quite certain was aggravated to a great extent by undereating/overtraining. Since then, I've been eating better, and everything except for testosterone has recovered, which has stayed low for pretty much a year now.

    Current symptoms that persist include depression, extreme difficulty improving body composition, excessive irritability, fatigue (I sleep 9-10 hrs/day now), low libido, amongst others.

    I saw another endo, who started me on TRT about 3 weeks ago (5g/day Androgel for a couple of weeks, and just recently 100mg/week test enth instead), and since then, I've seen some improvement. His idea was that my low testosterone has got me stuck in a downward spiral, where it's causing depression which is lowering my testosterone which is causing depression and so on. My concerns with my TRT are:

    1. Estradiol. I had this tested after being on Androgel for two weeks, and the result for serum estradiol was about 185 (forgive me, I've forgotten units, and I don't have a copy of the results yet), normal being <205. Is this high that I should be worried? Should this go down now that I'm using the injections? I noticed that when on Androgel, despite feeling better overall, I had severe moodswings, and would feel emotional, vulnerable, and weepy even, which is not normal.

    2. Does this treatment have a chance of restoring normal function to my hypothalamus? Like I said, just about everything on my bloodwork seems to be normal now, and my endo said that he thinks it's more likely than not that I won't be on TRT for life. I'm not so sure. How typical is a case such as mine?

    3. Dose. I noticed the effects of the TRT very, very quickly. Nocturnal erections returned, acne returned, and the previously mentioned changes in mood. Then, towards the end of my two weeks on Androgel, things started to die down again, I had noticible testicular atrophy. Then, just three days ago, I got my first injection, and I felt fantastic, and good as I've felt in months. However, I'm already starting to feel a bit down again, and no morning wood today. Is 100mg/wk likely to be enough?

    4. Adrenal disorder. I have just about every symptom associated with adrenal fatigue and high cortisol imaginable. 9-10 hrs of sleep a day, storing fat on the face and abdomen, I'm easily distracted, I feel on edge all the time, extremely skinny arms and calves (despite weight training) and so on. I'm pretty damn certain that I have some sort of problem related to adrenals. I actually had a fasted ACTH stim test run several months ago, but I don't know how to interpret the results:

    Time / Cortisol (nmol/L)
    0 / 646
    20 min / 612
    30 min / 599
    60 min / 626

    Lab range was 250-850, so my endo said that my initial coristol was on the high side, but it never got over the lab range, so there was nothing wrong. I'm a bit dubious, I would have thought that some sort of cortisol response would be expected from this test! I should note that I was feeling like utter garbage by the time they ran the test: starving, exhausted, and miserable.

    Should I look into treating this further? How?



    Any help with anything at all would be such a relief. If you need more details, I can fill you in as best I can, but I don't have quantitative data for the more recent results.

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    Quote Originally Posted by Kasumeat View Post
    I'm sure you've heard this before, but this forum is awesome, and I'm sorry I hadn't discovered it sooner.

    Here's a brief recap of my history:

    About a year ago, at 21, I had some bloodwork that showed a few problems, including low testosterone and borderline low levels of some other hormones that have since recovered (I'll get back to this). Extensive testing has been done, my testes, pituitary, adrenals (I'll get back to this as well) all tested normal, so my endo concluded that it was hypothalamus dysfunction, which I am quite certain was aggravated to a great extent by undereating/overtraining. Since then, I've been eating better, and everything except for testosterone has recovered, which has stayed low for pretty much a year now.

    Current symptoms that persist include depression, extreme difficulty improving body composition, excessive irritability, fatigue (I sleep 9-10 hrs/day now), low libido, amongst others.

    I saw another endo, who started me on TRT about 3 weeks ago (5g/day Androgel for a couple of weeks, and just recently 100mg/week test enth instead), and since then, I've seen some improvement. His idea was that my low testosterone has got me stuck in a downward spiral, where it's causing depression which is lowering my testosterone which is causing depression and so on. My concerns with my TRT are:

    1. Estradiol. I had this tested after being on Androgel for two weeks, and the result for serum estradiol was about 185 (forgive me, I've forgotten units, and I don't have a copy of the results yet), normal being <205. Is this high that I should be worried? Should this go down now that I'm using the injections? I noticed that when on Androgel, despite feeling better overall, I had severe moodswings, and would feel emotional, vulnerable, and weepy even, which is not normal.

    2. Does this treatment have a chance of restoring normal function to my hypothalamus? Like I said, just about everything on my bloodwork seems to be normal now, and my endo said that he thinks it's more likely than not that I won't be on TRT for life. I'm not so sure. How typical is a case such as mine?

    3. Dose. I noticed the effects of the TRT very, very quickly. Nocturnal erections returned, acne returned, and the previously mentioned changes in mood. Then, towards the end of my two weeks on Androgel, things started to die down again, I had noticible testicular atrophy. Then, just three days ago, I got my first injection, and I felt fantastic, and good as I've felt in months. However, I'm already starting to feel a bit down again, and no morning wood today. Is 100mg/wk likely to be enough?

    4. Adrenal disorder. I have just about every symptom associated with adrenal fatigue and high cortisol imaginable. 9-10 hrs of sleep a day, storing fat on the face and abdomen, I'm easily distracted, I feel on edge all the time, extremely skinny arms and calves (despite weight training) and so on. I'm pretty damn certain that I have some sort of problem related to adrenals. I actually had a fasted ACTH stim test run several months ago, but I don't know how to interpret the results:

    Time / Cortisol (nmol/L)
    0 / 646
    20 min / 612
    30 min / 599
    60 min / 626

    Lab range was 250-850, so my endo said that my initial coristol was on the high side, but it never got over the lab range, so there was nothing wrong. I'm a bit dubious, I would have thought that some sort of cortisol response would be expected from this test! I should note that I was feeling like utter garbage by the time they ran the test: starving, exhausted, and miserable.

    Should I look into treating this further? How?



    Any help with anything at all would be such a relief. If you need more details, I can fill you in as best I can, but I don't have quantitative data for the more recent results.
    Look thru posts on this board.
    You may want to start with sticky posts.
    You may want to read thru my thread.
    Jan's BloodTest April13/2007
    Toward the end there is a list for items to check with blood test.
    It cost about $3500, but I had it paid by insurance.
    With out thorough testing it is hard to figure anybody's problem.
    It you want to give it a try to not be on testosterone supplementation for life then you should not start using testosterone. Instead use HCG to see if your testis are working.
    Every treatment using testosterone should also have HCG included otherwise testis will shrink.
    Using transdermals introduces additional variable that is additionally varying with time and thyroid/adrenals condition.
    Hard to control. One is newer sure of the dose of T that reaches blood stream.
    ============================== ============================== =============================
    Post all the blood tests that you already have.
    Item, value, units, range, laboratory performing testing.
    -----------
    We prefer Quest Diagnostics here, if not possible then LabCorp.
  3. Registered User
    Kasumeat's Avatar
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    I don't have the exact numbers for most of my recent blood work, but please take my word for it when I give these qualitative responses:

    All of these were done before I started TRT, except where noted.
    Lab ranges are in brackets.

    Total Testosterone: 4 (8-28 nmol/L). Since starting TRT, this has gone to 16.
    Bioavailable Testosterone: Very low, ~4 (12-34, I don't recall the units)
    Free Testosterone: 20 (66-142 pmol/L)
    DHT: Don't recall
    Estradiol: 185 (<205, I don't recall the units). This one was taken after starting Androgel. I had this run a few times before starting TRT, and it was always borderline-low.
    FSH: 1.8 (1.4-18.1 IU/L)
    LH: <1.0 (1.5-9.3 IU/L)
    Prolactin: 4.9 (2.1-17.7 ug/L)
    Cortisol: ~650 nmol/L (250-850 nmol/L), fasted, tested at the beginning of an ACTH stim test. It did NOT increase at all.
    Thyroid Panel: Had this one done many times, T3 and T4 are always low or borderline low
    DHEA Sulfate: 12 (< 11.5 umol/L)
    ALT: 64 (< 40 U/L)

    Everything else always tests in a healthy range.

    I've had my testes checked for primary hypogonadism, everything is fine. GnRH test was normal as well, so pituitary is healthy. MRI was negative. Thus, the conclusion that my endo came to was that my hypothalamus was underactive.
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    **I noticed that when on Androgel, despite feeling better overall, I had severe moodswings, and would feel emotional, vulnerable, and weepy even, which is not normal.**

    I had the exact same reaction to Androgel, I was like a chick on her period (according to my wife ). That was 5 days on Androgel. Doc put me on a 10% compounded cream, and those symptoms went away. Maybe 5 days on Androgel wasn't long enough, iow perhaps I would have had the same symptoms on the compounded cream for a few days if that's what I started with.
  5. Registered User
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    Quote Originally Posted by Kasumeat View Post
    I don't have the exact numbers for most of my recent blood work, but please take my word for it when I give these qualitative responses:

    All of these were done before I started TRT, except where noted.
    Lab ranges are in brackets.

    Total Testosterone: 4 (8-28 nmol/L). Since starting TRT, this has gone to 16.
    Bioavailable Testosterone: Very low, ~4 (12-34, I don't recall the units)
    Free Testosterone: 20 (66-142 pmol/L)
    DHT: Don't recall
    Estradiol: 185 (<205, I don't recall the units). This one was taken after starting Androgel. I had this run a few times before starting TRT, and it was always borderline-low.
    FSH: 1.8 (1.4-18.1 IU/L)
    LH: <1.0 (1.5-9.3 IU/L)
    Prolactin: 4.9 (2.1-17.7 ug/L)
    Cortisol: ~650 nmol/L (250-850 nmol/L), fasted, tested at the beginning of an ACTH stim test. It did NOT increase at all.
    Thyroid Panel: Had this one done many times, T3 and T4 are always low or borderline low
    DHEA Sulfate: 12 (< 11.5 umol/L)
    ALT: 64 (< 40 U/L)

    Everything else always tests in a healthy range.

    I've had my testes checked for primary hypogonadism, everything is fine. GnRH test was normal as well, so pituitary is healthy. MRI was negative. Thus, the conclusion that my endo came to was that my hypothalamus was underactive.
    If you want to get help, you have to get more meaningful testing and post it accurately.

    With what you presented;
    Use HCG
    250iu E2D, every other day
    or better
    100iu every day
    re-check your testosterone panel in 3 months.
    ---
    Get Estradiol, ultrasensitive test
    ---
    Get
    FreeT3
    FreeT4
    use enough Armour Thyroid so your FreeT3 is about at the top
    check the Armour dose mostly using your reaction to it and body temperature and pulse. Also blood test every 2 monts until stabilized.
    ---
    ALT: 64 (< 40 U/L) re-check units---
    repeat this test;
    Print Friendly
    ALT (SGPT)
    This test is used to identify liver disease and to distinguish between liver and red blood cell hemolysis as the source of jaundice.

    Reference Ranges: Men: 0–55 IU/L

    Act accordingly.
    ----------------------------------------------------
    Think about getting blood test per my list as described in my previous post.
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