TRT for a healthy 25 year old..Need help & advice

[Deez_Nutz]

After being diagnosed with Low T about 6 months ago, I was prescribed Test C from my PCP (100mg/week). After being referred to an endocrinologist, I was taken off of the Test to do further testing to get to the root of my problem. I've listed my stats and blood work results below. My endo is saying that my test levels are "low-normal". WTF is that supposed to mean? I've been working out for about 11 years and I've never taken any AAS prior to being treated for hypogonadism. Also, since my FSH levels are very high, my endo thinks I have Hypothyroidism. She put me on 50mcg of Thyroxine (T4).

Here are my questions for you guys:

• What do you think is the root problem causing my "low-normal" Testosterone with very low FSH and LH levels?
• Is there any other blood tests or any tests that I should be asking for?
• How will taking Thyroxine/T4 affect me?
• I've been thinking about taking my first cycle (TEST ONLY). Would this be advisable at this time??

Current Stats:
Age:25
Height: 5' 5"
Weight: 161 lbs
BF:13-14%
Lifting Experience: 10 years

Current Medications taken:
10mg Remron (Sleep/Antidepressant)
54mg Concerta (ADD)
50mcg Thyroxine (Hypothyroidism) -- Recently diagnosed

I've had 3 blood tests in the past 6 months and my test levels were 150, 274 and 264 ng/dL. My endo took me off the TRT (Test C at 100mg/week) because she said I'm too young to be taking TRT and it would screw me up for the rest of my life.

Recent Blood Work:
SHBG = 26, 26
Testosterone (total) = 150, 274, 264 (
TSH = 3.9, 4.8
T4 (free) = 1
Prolactin = 6.4
FSH = .7, .7
LH = .4, .8

Also, even though my prolactin levels were within the normal range, I just had a pituitary MRI done about a week ago and I'm still waiting for the results.

Notes:

• My Dad has a pituitary tumor and he is currently taking Cabergoline
• Both my Mom and my sister are diagnosed with hypothyroidism and are both taking low dose Synthroid/Thyroxine/T4

I've seen a couple doctors & specialists but I'd like to get some outside opinions from you guys. I would appreciate any thoughts or suggestions on my current situation.

Thanks!

-D

 

[olddawg]

low normal means you are within the normal range for test, but at the low end of normal. I've a bum thyroid too and taking the t4 will increase your metabolism and help you burn fat easier, have more energy. I'm on 150mcg. as for the doing a cycle right now, while they are still testing and adjusting things I wouldn't mess, let them do their thing then go from there my 2 cents

 

[Daniel_IMT_Staff]

Hello,

One of the more important hormones, estrogen should have been included in the labs and full labs from before TRT should have been provided, full labs during TRT, duration of TRT.

Estrogen can decrease thyroid hormones by competitive inhibition at the receptor.

How do you feel the Remron has been working for you?

Increasing seratonin too much can have an inverse effect on dopamine. Be careful when taking drugs that affect neurotransmitters as all nuclear hormones interact.

Discuss with your doctor what hormone is the most skewed and adjust. Seems to me your testosterone is very low. Discuss alternative treatment for anxiety/sleep and/or benefit/sides with current medication. The more medication you are on, the harder it becomes to treat as they are all connected.

Just my two cents!

 

[bigben34]

Hello,

One of the more important hormones, estrogen should have been included in the labs and full labs from before TRT should have been provided, full labs during TRT, duration of TRT.

Estrogen can decrease thyroid hormones by competitive inhibition at the receptor.

How do you feel the Remron has been working for you?

Increasing seratonin too much can have an inverse effect on dopamine. Be careful when taking drugs that affect neurotransmitters as all nuclear hormones interact.

Discuss with your doctor what hormone is the most skewed and adjust. Seems to me your testosterone is very low. Discuss alternative treatment for anxiety/sleep and/or benefit/sides with current medication. The more medication you are on, the harder it becomes to treat as they are all connected.

Just my two cents!

Remeron specifically won't have a negative impact on dopamine as it it an antagonist at certain 5-HT sites (5-HT2A, 5-HT3A). Antagonizing these receptors is thought to disinhibit DA and NA in the nucleus accumbens and possibly other regions of the brain. Aside from that, Remeron at 10mg is mostly an anti-histamine, with a little bit of 5ht/NA action. As you go higher in dose, it becomes the opposite. It's a decent medication thats in a class of it's own but many people cant handle the weight gain associated with it. It's effects on 5-HT2C cause the munchies like no other med can....Aside from pot.

On the flip side of that...Concerta is a dopamine agonist anyways.

 

[Deez_Nutz]

Daniel
The Remron has been working well. I was on Seroquel for a couple of years but it was just too much. I would wake up in the middle of the night and eat everything in sight with no recollection. Remron has a lot less side effects and works well as a sleep aid/anti-depressant (I use it mostly for its sleep effects).

Also, I was on SSRI's for about 7 years (Zoloft 100mg). What effect would that have on my Test levels? I've done some research and it looks like long-term SSRI use can have a negative impact on the HPA axis.

As for the estrogen levels, what specific labs should I request to check my levels?

olddawg
How has the T4 treatment been going for you. Did you start out at a low dose like me (50mcg/day)? Also, would taking T4 (if you need it) be catabolic/muscle-wasting? After having low T with no sex drive, the last thing I want is lose all of the muscle gains I've worked so hard for over the years

 

[olddawg]

yes I ramped up over say maybe a year or so, and yes if you stimulate your thyroid too much you will become catabolic, anious, etc... and lose muscle

 

[Alpin]

Hello,

One of the more important hormones, estrogen should have been included in the labs and full labs from before TRT should have been provided, full labs during TRT, duration of TRT.

Estrogen can decrease thyroid hormones by competitive inhibition at the receptor.

How do you feel the Remron has been working for you?

Increasing seratonin too much can have an inverse effect on dopamine. Be careful when taking drugs that affect neurotransmitters as all nuclear hormones interact.

Discuss with your doctor what hormone is the most skewed and adjust. Seems to me your testosterone is very low. Discuss alternative treatment for anxiety/sleep and/or benefit/sides with current medication. The more medication you are on, the harder it becomes to treat as they are all connected.

Just my two cents!

Daniel,

Would you be so kind to list what tests are required for a FULL thyroid panel (in order of importance)?

 

[Alpin]

Remeron specifically won't have a negative impact on dopamine as it it an antagonist at certain 5-HT sites (5-HT2A, 5-HT3A). Antagonizing these receptors is thought to disinhibit DA and NA in the nucleus accumbens and possibly other regions of the brain. Aside from that, Remeron at 10mg is mostly an anti-histamine, with a little bit of 5ht/NA action. As you go higher in dose, it becomes the opposite. It's a decent medication thats in a class of it's own but many people cant handle the weight gain associated with it. It's effects on 5-HT2C cause the munchies like no other med can....Aside from pot.

On the flip side of that...Concerta is a dopamine agonist anyways.

How bout paxil ?

 

[bigben34]

How bout paxil ?

Paxil is a med you would need to be careful with when it comes to dopamine levels. I would say the same for any SSRI - Zoloft being the least likely to cause a problem. Every SSRI has a secondary action...even if it's minimal. Paxil has a secondary action of norepinepherine reuptake...studies show that it's actually more effective than Effexor (SNRI) at NA reuptake. Obviously, it's main purpose is to prevent the reuptake of serotonin, and without anything effecting dopamine, you begin to create an imbalance...which may or may not cause problems, depending on the individual. I say zoloft would be the least likely to cause problems because it's secondary action is dopamine reuptake...why many people find it to be activating. The only SSRI that is a true SSRI (without any secondary action) is Lexapro...That shit will turn you into a zombie very quickly...although, it is super effective for anxiety.
There is are a couple newer AD's that have been recently released. One of them is called Viibryd. It has some 5-HT1A agonism...which is similar to Buspar, which is also prescribe to augment SSRI's for sexual dysfunction. Anyways, Viibryd is quite dopaminergic compared to standard SSRI's...essentially it's like a combination of Paxil and Buspar in one pill.

When i say "least likely to cause problems" that's completely in theory because these meds effect every person in a completely different way. It ends up being trial and error, but in that trial and error, you have to be aware of what each med is supposedly doing, and how it makes you feel. If one doesn't work, then you find something that hits a different neurotransmitter and go from there. As a word of advice for anyone trying different AD meds...keep a journal on how each one made you feel along with it's basic mechanism of action. It's essentally a puzzle in finding what works best.

 

[Deez_Nutz]

I just got the results back from my MRI and my pituitary is fine. Therefore, I'm back to square one with diagnosing my Low T, FSH and LH. Now my endo thinks the SSRI is the culprit of my low hormone levels.

Is she full of it? Is there any research to back this up? (NOTE: I've been on Zoloft 100mg since 2008)

 

[bigben34]

I just got the results back from my MRI and my pituitary is fine. Therefore, I'm back to square one with diagnosing my Low T, FSH and LH. Now my endo thinks the SSRI is the culprit of my low hormone levels.

Is she full of it? Is there any research to back this up? (NOTE: I've been on Zoloft 100mg since 2008)

I don't think there is any research showing that SSRI usage causes low T. SSRI's have been commonly prescribed for years and there's no link to HPTA shutdown/slowdown or anything, that i know of. Unfortunately, drugs of any kind can cause unique problems in each user and there's nothing that can really prove what impact it might have had on you. I took Accutane once for 11 months and then again for 13 months years later...I like to blame some of my medical issues on the use of accutant but i cant prove anything.

Regardless if it's the cause of it or not, you still definitely have an issue on your hands that needs to be dealt with asap.

When did you discontinue zoloft?

 

[Deez_Nutz]

I just did recently. A couple of weeks ago. I'm going back to get more blood work in a few weeks.

 

[Spunkey71]

I have never heard of a correlation between the use of a SSRI and Low T either, if there is then it would be very interesting as I was on 200mg of Zoloft for almost 20 years.

 

[Daniel_IMT_Staff]

Remeron specifically won't have a negative impact on dopamine as it it an antagonist at certain 5-HT sites (5-HT2A, 5-HT3A). .

I didn't state that it did! I said that too much serotonin will have a negative impact on dopamine!

I don't think there is any research showing that SSRI usage causes low T. SSRI's have been commonly prescribed for years and there's no link to HPTA shutdown/slowdown or anything, that i know of. Unfortunately, drugs of any kind can cause unique problems in each user and there's nothing that can really prove what impact it might have had on you.

There is tons of research that relates to SSRI usage, serotonin and dopamine affecting the HPTA. Do as much reading as you can and try to deviate from mechanism of action until you comprehend the expression and it's reaction to other nuclear hormones. In this guy's case, his prolactin is elevated, estrogen unknown, these two factors can be the cause of his low T. Or his stress may increase ACTH and adrenals get increased stimuli and norepinephrine released.

Estrogen alone can tell so much! Estrogen has been shown to increase prolactin, increase perceived stress, anxiety, compete with thyroid hormones at the receptor leading to a hypothyroid state.

Increasing serotonin may decrease dopamine and too much dopamine will decrease serotonin because of their inverse relationship. Too much dopamine may affect thyroid enzymic conversion response in the liver. Reduction of thyroid hormones will increase your anxiety and irritability. And the cycle and effects of one nuclear hormones goes on and on.

SSRIs can interrupt HPTA and that shouldn't even require a research document to prove as it has always been well known prolactin will decrease testosterone. Dopamine/Serotonin can have an effect on GnRH too and shut down the HPTA at the pituitary. It all goes round and around as I said earlier!

Focus more on effects when reading pharmacokinetic/dynamics and then read further into how this will have an effect on the body.. That will help you get the larger picture and help comprehend the nuclear hormones rather than memorizing names of receptors or enzyme.


Deez_Nutz: Yes, long term SSRI use can have an effect on HPTA and also downregulate receptors that Bigben mentioned. For your current situation, I would ask your doctor to help narrow down the issue, is it your estrogen that is high and having an effect on your hormones? Prolactin reducing the testosterone? Adrenals and previously mentioned hormones affecting your Thyroid? Since you have a history of Thyroid problems it may be the thyroid, but still it is best to narrow down the problem and start eliminating some variables.

For sleep I find that over the counter Unisom and Melatonin works great as a sleep aid! They would be my preference over an SSRI, Trazodone is prescribe quite often as well as a sleep aid but I would opt for the over the counter drugs first.



Apollon: For thyroid problems? Full labs is always best for HRT when trying to diagnose an issue no matter what you think you may have a problem with and most importantly a doctor that knows how to read them and connect the dots. If it is believed to originate from the thyroid I would say get more extensive labs on the thyroid.

 

[bigben34]

I didn't state that it did! I said that too much serotonin will have a negative impact on dopamine!



There is tons of research that relates to SSRI usage, serotonin and dopamine affecting the HPTA. Do as much reading as you can and try to deviate from mechanism of action until you comprehend the expression and it's reaction to other nuclear hormones. In this guy's case, his prolactin is elevated, estrogen unknown, these two factors can be the cause of his low T. Or his stress may increase ACTH and adrenals get increased stimuli and norepinephrine released.

Estrogen alone can tell so much! Estrogen has been shown to increase prolactin, increase perceived stress, anxiety, compete with thyroid hormones at the receptor leading to a hypothyroid state.

Increasing serotonin may decrease dopamine and too much dopamine will increase serotonin because of their inverse relationship. Too much dopamine may affect thyroid enzymic conversion response in the liver. Reduction of thyroid hormones will increase your anxiety and irritability. And the cycle and effects of one nuclear hormones goes on and on.

SSRIs can interrupt HPTA and that shouldn't even require a research document to prove as it has always been well known prolactin will decrease testosterone. Dopamine/Serotonin can have an effect on GnRH too and shut down the HPTA at the pituitary. It all goes round and around as I said earlier!

Focus more on effects when reading pharmacokinetic/dynamics and then read further into how this will have an effect on the body.. That will help you get the larger picture and help comprehend the nuclear hormones rather than memorizing names of receptors or enzyme.


Deez_Nutz: Yes, long term SSRI use can have an effect on HPTA and also downregulate receptors that Bigben mentioned. For your current situation, I would ask your doctor to help narrow down the issue, is it your estrogen that is high and having an effect on your hormones? Prolactin reducing the testosterone? Adrenals and previously mentioned hormones affecting your Thyroid? Since you have a history of Thyroid problems it may be the thyroid, but still it is best to narrow down the problem and start eliminating some variables.

For sleep I find that over the counter Unisom and Melatonin works great as a sleep aid! They would be my preference over an SSRI, Trazodone is prescribe quite often as well as a sleep aid but I would opt for the over the counter drugs first.



Apollon: For thyroid problems? Full labs is always best for HRT when trying to diagnose an issue no matter what you think you may have a problem with and most importantly a doctor that knows how to read them and connect the dots. If it is believed to originate from the thyroid I would say get more extensive labs on the thyroid.

His prolactin isn't elevated or even close to elevated. It's Damn good actually. Most likely due to his concerta use. It's a fact that too much dopamine increases serotonin? Show me something that says that.. Anything.. Then you even mention trazodone? Check it's relationship to dopamine before you do that... You IMT guys are good at hormones.. Stick to that and stay off the psychiatric topics. Clearly you're making things up as you go.. A lot of what you said is based on your opinion only. I have a lot more to say about this but I don't have time right now.. Be back tomorrow.

 

[Daniel_IMT_Staff]

I forgot to check his number on the prolactin after posting, for some reason I "remembered" he had elevated prolactin. However it was his Dad. My mistake! My advice to OP is still to get full labs and narrow down the causation of his current condition.

"It's a fact that too much dopamine increases serotonin?" Show me instead where I said that! Oh, I found it, it's a typo my mistake.

"Increasing serotonin may decrease dopamine and too much dopamine will increase(should read decrease) serotonin because of their inverse relationship. "
They have an inverse relationship meaning if one goes up, the other goes down; clearly a typo meant to write decrease as I am saying they have an inverse relationship they cannot possibly both increase. I have explained this basic fundamental dopamine/serotonin relationship previously.

Trazodone is another drug that is used for sleep that is an SSRI which is why I mentioned it, Trazodone increases prolactin as well which will interrupt HPTA.

I usually don't make statements when providing my opinions, it is usually clear that it is my opinion. IMT knows hormones and nuclear hormones too which is why we can provide the best service because we have a lot of knowledge based of medical literature and experience. Also want to make sure there is a evidence based discussion on certain topics as to not confuse people so they "learn" something which is not true!

I don't have anything to argue with you about, you tried to refute a statement I never made. And then you erroneously stated that SSRI and HPTA has no relationship which is totally the opposite of the fact. I just don't want people to believe it because you were naming off receptors and enzymes which may cause people to believe you know about this field. It seems like you are trying to find something to refute! I am not doubting you have some knowledge with SSRI's, I just don't want to try to play a game where we are trying to refute each other for no known reason!

If you want me to provide proof for any statements made I can!

Pharmacological causes of hyperprolactinemia
Pharmacological causes of hyperprolactinemia

Antidepressant drugs with serotoninergic activity, including selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAO-I) and some tricyclics, can cause hyperprolactinemia. A long list of other compounds may determine an increase in prolactin levels, including prokinetics, opiates, estrogens, anti-androgens, anti-hypertensive drugs, H2-receptor antagonists, anti-convulsivants and cholinomimetics.

 

[Alpin]

I don't think there is any research showing that SSRI usage causes low T. SSRI's have been commonly prescribed for years and there's no link to HPTA shutdown/slowdown or anything, that i know of. Unfortunately, drugs of any kind can cause unique problems in each user and there's nothing that can really prove what impact it might have had on you. I took Accutane once for 11 months and then again for 13 months years later...I like to blame some of my medical issues on the use of accutant but i cant prove anything.

Regardless if it's the cause of it or not, you still definitely have an issue on your hands that needs to be dealt with asap.

When did you discontinue zoloft?

A bunch of guys at Paxil progress are complaining of Low T with their long term use of paxil.
A guy on there says he was in the 600's and got on paxil and his T tanked to 200's...

 

[Alpin]

I appreciate your reply.

Daniel, can you tell me is testing TSH enough or does "Free T3", and "Free T4" need to be added to a thyroid panel ?
I "sensitive TSH" better as well ?

 

[bigben34]

I forgot to check his number on the prolactin after posting, for some reason I "remembered" he had elevated prolactin. However it was his Dad. My mistake! My advice to OP is still to get full labs and narrow down the causation of his current condition.

"It's a fact that too much dopamine increases serotonin?" Show me instead where I said that! Oh, I found it, it's a typo my mistake.

"Increasing serotonin may decrease dopamine and too much dopamine will increase(should read decrease) serotonin because of their inverse relationship. "
They have an inverse relationship meaning if one goes up, the other goes down; clearly a typo meant to write decrease as I am saying they have an inverse relationship they cannot possibly both increase. I have explained this basic fundamental dopamine/serotonin relationship previously.

Trazodone is another drug that is used for sleep that is an SSRI which is why I mentioned it, Trazodone increases prolactin as well which will interrupt HPTA.

I usually don't make statements when providing my opinions, it is usually clear that it is my opinion. IMT knows hormones and nuclear hormones too which is why we can provide the best service because we have a lot of knowledge based of medical literature and experience. Also want to make sure there is a evidence based discussion on certain topics as to not confuse people so they "learn" something which is not true!

I don't have anything to argue with you about, you tried to refute a statement I never made. And then you erroneously stated that SSRI and HPTA has no relationship which is totally the opposite of the fact. I just don't want people to believe it because you were naming off receptors and enzymes which may cause people to believe you know about this field. It seems like you are trying to find something to refute! I am not doubting you have some knowledge with SSRI's, I just don't want to try to play a game where we are trying to refute each other for no known reason!

If you want me to provide proof for any statements made I can!

Pharmacological causes of hyperprolactinemia
Pharmacological causes of hyperprolactinemia

Antidepressant drugs with serotoninergic activity, including selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAO-I) and some tricyclics, can cause hyperprolactinemia. A long list of other compounds may determine an increase in prolactin levels, including prokinetics, opiates, estrogens, anti-androgens, anti-hypertensive drugs, H2-receptor antagonists, anti-convulsivants and cholinomimetics.

Here we go... First off I never said that Ssris don't cause problems with prolactin.. obviously an hpta hormone. If you look back through the thread and previous threads I said that exact thing. So, there's still no link between Ssri use and low t. Because zoloft - an SSRI - has dopaminergic action.. As does viibryd and will most likely not cause problems with prolactin. So.. It wouldn't be accurate to say ssris cause hpta problems.
I originally corrected you on a statement that you were absolutely making.. Clearly remeron is the only drug he's using that has any 5ht action... Why would you randomly say that if you weren't referring to remeron causing problems with dopamine. It's okay to be corrected sometimes.
Trazodone isn't an SSRI.. It's a sari.. And why would you recommend it after trying Melatonin if you know it will cause more problems? Clearly remeron has excellent sleep qualities with minimal effect on DA transmission. So go ahead and switch to trazodone?

You put up one study about prolactin, which I have been saying all along... Where is all of the studies about Ssri causing low t?

Again . it's okay to be incorrect sometimes.. I wouldn't dare correct you when it comes to hormones but I'm telling you that you're out of your league when it comes to psychiatric meds.
But clearly I don't know about this field.. The guys on this site seem pretty appreciative of what I do know about it. You have no idea who I am or what my profession is, so there's no need to make statements like that.. I wouldn't say that you seen to think you know something about hormones..

 

[Alpin]

Is Remeron a sedating anti D ?
anyone know ?