33 years old and just started trt. need some help with lab results please!

[RRtrt]

So here's a little back round on what's going on and what my lab results are.

Last year I decided to change my life around for the better and loose weight and become fit and active. Over the course of the year I lost 90 lbs. and got in shape. I work out 4 to 5 days a week and usually 2 or 3 of those days is crossfit. I am also working with a nutritionist to learn to eat right and also now to gain weight as lean muscle mass. I was 235lbs last year and a few weeks ago I was down to my all time low of 148. Today I weighed in at 154. I am 5'7" and have a bf of about 12 - 15%.

So here's the scoop I feel like complete dog crap. I have withdrawn from all social aspects of life. I now sleep in the spare bedroom away from wife. I have no interest in anything. My short term memory is non existent and most of my days are spent in a fog. I can't even tell you the last time I had an erection let alone sex. I am moody and anxious all the time. The only time I am at ease is when I am alone. I have almost no fat on my upper body, legs and arms but I am still chasing that elusive six pack. I have what appears to be a beer gut But I don't drink alcohol. I also noticed leg hair fading away and blotchy beard as well. The icing on the cake was last week at crossfit I could barely lift. The most I could jerk was 5x5 at 85 lbs. The guys in my class were doing no less than 205lbs and the women were doing about 125lbs. As much as I lift and work out I have actually gain no muscle mass or size despite eating more and gaining weight. I am also cold all the time. I take 2-3 hot showers a day just to warm up and sometimes even soak in the hot tub. My hands remain ice cold and have even became raw and easily crack and break open. There is definitely something adrenal going on.

I am a nurse by profession so I had a doctor friend send me for some blood work to see what was going on and below is what was found. Labs were drawn in a fasted state at 8:15 am on 2/13/2016. the second set was drawn the same time 2 weeks later.

After I had the blood work on the first set I made an appointment with my pcp and went this week. I wanted to have all the work in order that way we could start to treat the problems.

Cortisol 18.5 (5.0-23.0)
HBA1C 5.3 (4.0-6.0)
TT 107 (300-1000)
TSH 1.08 (0.55-4.78)
Cholesterol 152 (100-200)
Tri 57 (30-150)
HDL 57 (35-130)
non-HDL-C 95 (95-160)
LDL 84 (30-100)
Sodium 10 (135-145)
Potassium 4.0 (3.5-5.1)
Chloride 103 (98-108)
CO2 32 (20-31)
Anion Gap 5 (4-16)
Bun 20 (8-20)
Creatinine 0.8 (0.7-1.2)
glucose 74 (65-100)
calcium 9.2 (8.4-10.4)
Total Protein 6.4 (6.4-8.5)
Albumin 4.3 (3.2-4.8)
Globulin 2.1 (2.4-4.8)
total bili 0.6 (0.3-1.2)
AST 43 (7-37)
ALT 47 (10-49)
ALK Phos 59 (30-135)
RBC 4.48 (4.40-6.20)
HGB 14.3 (13.0-18.0)
HCT 42 (40-52)
Platelet count 250 (150-450)

So because my test was so low I started reading about it ant the signs and symptoms of it. Ultimately it lead to me rechecking some lab work and these results were even more alarming!!!

2/26/2016
FSH 1.2 (1.0-15.0) mIU/mL age 20-70 years old
LH 2.4 (2.0-6.0)
TT 95 (300-1000)
SHBG 77.1 (17.3 -65.8)
Free Test 9.7 (48.2 -169.6)
% free test 1.0 (1.3-2.9)
Bioavail test 23 (113-398)

So anyways went to the doc on Monday. He wasn't available so I saw the nurse practioner who I happen to personally know. Anyways after presenting the lab work to her and explaining things we decided I could benefit from TRT. We discussed options and ultimately she wrote for test c. 200mg every 2 weeks, which I started that night. Pins are not an issue as I use them everyday for work.

So what o you guys think? I am trying to get in to the endo as I think there is a lot going on. I know there is some missing lab work but I didn't get it because I was uneducated about TRT before my first blood draw. Knowing what I have learned I suspect I may also have hypothyroidism as well.

 

[ChronosOceanus]

Welcome to 'Ology RR. There are a lot of knowledgeable guys here who can give you good advice during your TRT journey. I've only been on for a few weeks, so wait for a senior member to put in their .02, but would venture to say that you are secondary hypogonadal based on your LH & FSH levels. This means that your pituitary is not sending a "strong enough" signal to your testes to make the proper amount of testosterone.

If you haven't already, please read the Basic TRT Overview sticky: http://www.steroidology.com/forum/testosterone-replacement-therapy/662394-basic-trt-overview.html

Some secondary hypogonadal guys can restart things with an HPTA restart (please see Basic TRT Overview), but your levels seemed pretty low - again, wait for a senior member to chime in.

You should also be getting E2 (estradiol) and hematocrit levels checked regularly, and most men have a better experience and less of a hormone fluctuation with more frequent doses of testosterone (1x or 2x per week split up, rather than 1x every other week).

 

[Megatron28]

RRtrt:

I am sorry to hear that you are not feeling well. But you have come to a great place for help from guys who have gone through what you are experiencing. Here are some thoughts I would like to share:

- Your blood work indicates that you are suffering from Secondary Hypogonadism. You have very low TT along with low/normal LH and FSH. This means your pituitary is not recognizing that your body doesn't have enough testosterone.

- You do not appear to have Hypothyroidism. Your TSH of 1.08 actually looks really good. That is good as guys with Hypogonadism often experience sub-clinical hypothyroidism as well.

- I would like to hear more about your diet and training. You lost a lot of weight very quickly. Are you still in a caloric deficit? If so, how much. The reason I ask is because restricting calories too much can result in suppression of your HTPA. Over-exercising can suppress your HPTA as well. Please give us more details on how big of a caloric deficit you were in and for how long.

---> Here are your choices -- and your response to my third bullet above will help guide you in the decision. 1) Go on TRT for the rest of your life. This will help you feel better. 2) You may want to try an HPTA Restart before committing to TRT. There is a chance you could get your natural testosterone working again. This is typically done by running a combination (in the correct sequence) of hCG and SERM's (e.g. Tamoxifen and/or Clomifene). If the restart doesn't work, then you could go on TRT. For now, I would not inject any testosterone until you make this decision.

As Chronos suggested, please read the Basic TRT Overview thread. It will help us have a more meaningful dialogue.

http://www.steroidology.com/forum/testosterone-replacement-therapy/662394-basic-trt-overview.html


Here is the good news regardless of what you choose. Hypogonadism is very treatable. You should be feeling much better soon.


Finally, the TRT protocol your doctor prescribed is not a good one. But we can cross that bridge later.

Also, for peace of mind, you might want to check your prolactin levels to rule out a possible pituitary tumor. Don't freak out as this is very uncommon.

It is good to have a medical professional here. I am glad you decided to join the forum and post.

 

[RRtrt]

Thanks for the help guys. I did read the basic overview and have a good understanding of what and how treatment works.

I did start test cyp on Monday as I can't take feeling like this much longer. I also have an appointment with the endo in April as that was the soonest I could get in.

So as far as the other questions go. Right now I have worked up just shy or 2500 calories a day. When I was loosing weight I had dropped down to 1900ish which worked out great. I am working with a well respected nutritionist that specializes in sports nutrition and body building. He is also a olympic and powerlifer himself. About six weeks ago we started adding more food and calories as now I'm trying to gain weight but to gain it in lean muscle. Our goal weight is 175. Currently I am 154 and slowly gaining.

As far as training goes I workout 4-5 days a week. If I go to crossfit twice then I lift in the gym three days. If I go to crossfit three days then I lift twice. It's usually a Monday through Friday gig and I take the weekends off to recover. If my schedule at work is crazy or I get called in the sometimes I take an extra day off during the week.

I do have a 3 year old and 1 year old so my sleep schedule is not the greatest. I average about six hours sometimes more sometimes less. My kids are usually up at the crack of dawn usually around 5:45 am so getting to bed early is a challenge.

I have noticed that my legs arm and chest are nice and lean but my midsection and lower back remain fatty.

I would really like to get this straightened out as it feels like hell. I don't mind life long injections or what not I just want to be me again. Pins don't bother me and at this point I'll do whatever it takes.

I do have one fear though. My fear is that when I see the endo. I know it's too soon to see how I will respond with trt but as I now I don't want to start one treatment and then switch it up without giving it a fair chance. When I say I feel like garbage I feel like garbage. This is like hell right now. Definitely the lowest of low.

But anyways I digress. I'm willing to commit to whatever I need to to make sure this doesn't happen again or any longer.

Thanks for your help and insight guys I truely appreciate it.

 

[Megatron28]

Thanks for the help guys. I did read the basic overview and have a good understanding of what and how treatment works.

I did start test cyp on Monday as I can't take feeling like this much longer. I also have an appointment with the endo in April as that was the soonest I could get in.

So as far as the other questions go. Right now I have worked up just shy or 2500 calories a day. When I was loosing weight I had dropped down to 1900ish which worked out great. I am working with a well respected nutritionist that specializes in sports nutrition and body building. He is also a olympic and powerlifer himself. About six weeks ago we started adding more food and calories as now I'm trying to gain weight but to gain it in lean muscle. Our goal weight is 175. Currently I am 154 and slowly gaining.

As far as training goes I workout 4-5 days a week. If I go to crossfit twice then I lift in the gym three days. If I go to crossfit three days then I lift twice. It's usually a Monday through Friday gig and I take the weekends off to recover. If my schedule at work is crazy or I get called in the sometimes I take an extra day off during the week.

I do have a 3 year old and 1 year old so my sleep schedule is not the greatest. I average about six hours sometimes more sometimes less. My kids are usually up at the crack of dawn usually around 5:45 am so getting to bed early is a challenge.

I have noticed that my legs arm and chest are nice and lean but my midsection and lower back remain fatty.

I would really like to get this straightened out as it feels like hell. I don't mind life long injections or what not I just want to be me again. Pins don't bother me and at this point I'll do whatever it takes.

I do have one fear though. My fear is that when I see the endo. I know it's too soon to see how I will respond with trt but as I now I don't want to start one treatment and then switch it up without giving it a fair chance. When I say I feel like garbage I feel like garbage. This is like hell right now. Definitely the lowest of low.

But anyways I digress. I'm willing to commit to whatever I need to to make sure this doesn't happen again or any longer.

Thanks for your help and insight guys I truely appreciate it.

I would recommend increasing calories to a slight surplus and attempting an HPTA restart. If it doesn't work you could hop on injections. You need to hurry and decide -- it is disappointing that your nurse practitioner didn't discuss this with you before you started pinning. Using exogenous testosterone will shut down your HPTA.

Try to get 8 hours of sleep a day too. Melatonin helps a lot for getting back to sleep after your kids wake you up in the middle of the night. Talk to your wife and explain what it going on. Tell her you need her help.

And since you read the Overview, you now know that your nurse practitioner didn't do you any favors by putting you on 200mg of Test to be injected once every two weeks. That is an obsolete protocol. You need to correct this immediately if you are going to stay on injections. It is a simple function of the half life.