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

[riprockwell]

My 2 cents. I personally hate T4 only medication. It is a stupid old school way to treat the thyroid. Here are some points to note on that...

1. T4 needs to be converted over to the active thyroid hormone. The body is constantly stressing to do that conversion. Over time I have seen so many thyroid patients have to continually up their T4 dosage.

2. A combo med with both T4 and T3 is ideal for thyroid treatment. Additionally before you get to that phase, a look at iodine levels is also crucial. Do some research on this and you will see why.

The big issue with T4 only treatment is that when you have excess T4 in your system and its not being converted over to the active hormone, it becomes what we call reverse T3 and that pools in the blood and blocks the cell receptors and blocking the active T3 from going in your system. It makes sense as you are continually having to up your T4 dose over time. So test TSH, Free T3, Free T4, and Reverse T3. That will give you an idea if your body is doing that conversion and having issues. Read up on the following sites. Don't let the old school "TSH" only reading doctors fool you. There needs to be T3 in the mix. If you are a thyroid tissue resistent patient like myself who has shown to have conversion issues, then T3 only is the option you need to choose. It has gave me my energy back, better metabolism, etc.

If you test all of those, make sure to know the RT3 ratio. Its a ratio between your free or total T3 and your Reverse T3 that indicates if you have too much RT3 pooling in your system. Read the following links. They help a bunch...

Stop the Thyroid Madness? - Hypothyroidism and thyroid mistreatment

Reverse T3 and Thyroid resistance

 

[Daniel_IMT_Staff]

SSRI may cause-> High prolactin
High prolactin will cause -> Low T
High Estrogen/Prolactin will shut down the HPTA really quick.

If a drug increases prolactin it will have an effect on the HPTA and cause low t. The relationship is direct, if you see labs with high e2 and high PRL I would bet a million $ his T is under 300.

I am not even talking about psychiatric meds, I am talking about the HPTA. Certain psychiatric meds will have an effect on the HPTA that's where my interest gets sparked. It's a general because I have no clue on information on individual drugs, just drugs classes and possible interactions.

I didn't recommend Trazadone, I was mentioning another drug that is similar that is often prescribed for sleep that has an effect on prolactin. Melatonin/unisom(diphenhydramine) is what I would recommend for sleep, they work for me!

About the original comment which you found to be false:

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

The reason why I write like this is so that if another person reads that statement it will apply to them as well, often times on forums people will read one thing and think it applies to them as well. This is something that is done too often, applying others advice to themselves. This is why Trazodone was mentioned as well.

Yes, Trazodone is a SARI and technicall remeron is a NaSSA.

de·rail
verb
past tense: derailed; past participle: derailed
1.
cause (a train or trolley car) to leave its tracks accidentally.
"a train was derailed after it collided with a herd of cattle"


Apollon TSH, T3/T4 are all important and it depends on what you are testing for.

 

[bigben34]

Is Remeron a sedating anti D ?
anyone know ?

Yes, it is...it will knock you out like a ton of bricks. Especially at a lower dose, less than 15mg. The higher you go in dosage, the more noradrenergic effects it has. It will also make you eat everything in sight though. There are plenty of reports of people gaining 10+lbs in a week on this stuff...

 

[bigben34]

SSRI may cause-> High prolactin
High prolactin will cause -> Low T
High Estrogen/Prolactin will shut down the HPTA really quick.

If a drug increases prolactin it will have an effect on the HPTA and cause low t. The relationship is direct, if you see labs with high e2 and high PRL I would bet a million $ his T is under 300.

I am not even talking about psychiatric meds, I am talking about the HPTA. Certain psychiatric meds will have an effect on the HPTA that's where my interest gets sparked. It's a general because I have no clue on information on individual drugs, just drugs classes and possible interactions.

I didn't recommend Trazadone, I was mentioning another drug that is similar that is often prescribed for sleep that has an effect on prolactin. Melatonin/unisom(diphenhydramine) is what I would recommend for sleep, they work for me!

About the original comment which you found to be false:

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

The reason why I write like this is so that if another person reads that statement it will apply to them as well, often times on forums people will read one thing and think it applies to them as well. This is something that is done too often, applying others advice to themselves. This is why Trazodone was mentioned as well.

Yes, Trazodone is a SARI and technicall remeron is a NaSSA.

de·rail
verb
past tense: derailed; past participle: derailed
1.
cause (a train or trolley car) to leave its tracks accidentally.
"a train was derailed after it collided with a herd of cattle"


Apollon TSH, T3/T4 are all important and it depends on what you are testing for.

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

I didnt find this to be false...clearly you misunderstood what i said or didnt read what i said. Either way, thats absolutely correct and I've said that in many posts in this thread and in other ones. There was a post last week on here from a guy asking about HRT and SSRI's...I said the same thing to him and then some...Also your point isnt valid because his prolactin is normal...there's no evidence that his former SSRI (zoloft) disrupted his HPTA, since his prolactin was never effected in a negative way...As I said before, Zoloft won't do that.

Either way...I'm done now. I appreciate your responses and what you guys do at IMT. I think you're a good company with some knowledgable people. There may come a day when I need help from you guys...Hopefully I can work directly with you

And on a side note...I wanted to ask you if you knew if the use of nandrolone (in TRT or otherwise) increases the amount of aromatase the body produces? Does that sound accurate?

 

[Deez_Nutz]

Thanks for all the replies guys! Looks like I started quite the debate . I just got my MRI back and my pituitary is all no good. I'm going back to get more blood work in about a month. What blood tests should I ask for??. Here's the blood work I've already had done recently at Quest. Some of the tests I've had done multiple times and I put the average for those (*).

SHBG* = 26 (10-50)
Total Testosterone* = 264 (241-827)
Prolactin = 6.4 (2-18)
TSH = 4.4 (.3 - 3)
T4, free = 1.0 (.8 - 1.8)
Thyroglobulin Antibodies = <20 (<20)
Thyroid Peroxidase AB = 17 (<35)
FSH = <.7 (1.6-8)
LH = .6 (1.5-9.3)
Estradiol = <15 (<or= 39)

What should I tell my endo?

 

[bigben34]

Thanks for all the replies guys! Looks like I started quite the debate . I just got my MRI back and my pituitary is all no good. I'm going back to get more blood work in about a month. What blood tests should I ask for??. Here's the blood work I've already had done recently at Quest. Some of the tests I've had done multiple times and I put the average for those (*).

SHBG* = 26 (10-50)
Total Testosterone* = 264 (241-827)
Prolactin = 6.4 (2-18)
TSH = 4.4 (.3 - 3)
T4, free = 1.0 (.8 - 1.8)
Thyroglobulin Antibodies = <20 (<20)
Thyroid Peroxidase AB = 17 (<35)
FSH = <.7 (1.6-8)
LH = .6 (1.5-9.3)
Estradiol = <15 (<or= 39)

What should I tell my endo?

My opinion on it is that there's no evidence that your past use of Zoloft ever effected your T levels...Since we know that SSRI's can cause issues due to their effect on dopamine and subsequently prolactin; but that never happened with you. Zoloft is not likely to have that effect and your use of concerta (dopaminergic) would help as well. At this point, I don't know if you can pinpoint why your pituitary isn't producing LH/FSH like it should..could be a number of reasons but the key is how you'll treat it. You could try a HPTA restart to see what kind of response you'll get...Otherwise you'll end up on the TRT train...

Overall, if your endo considers you low-normal and doesn't want to do anything about it, then you need to find a new Endo asap..

 

[Daniel_IMT_Staff]

Hello,

Ben in regards to the Nandrolone question, it will aromatase to a certain degree. About 20% aromatase activity of testosterone, just to give you a ballpark figure. Nandrolone has a weird mRNA expression and on the e2 receptor and the effect it has on aldosterone. In TRT there isn't much room for Nandrolone and it is not prescribed by many doctors. If your doctor would be willing to prescribe it, weigh out the benefits/sides first. Especially when using Nandrolone decanoate considering the drug elimination duration would be x5 half life which in literature is explained as anywhere from 6-12 days. I would assume it to be about 10 days so elimination would be 50 days, not counting metabolites. Progesterone receptor interaction will affect your HPTA as well and possible libido. Whatever the reasoning for wanting to include Nandrolone in a HRT protocol, there is probably a more suitable drug to use for that cause!

I agree with your opinion on this young man, however in regards to the Zoloft/SSRI usage. Since his E2 and PRL is normal, and taking in consideration his age. It would make more sense if his HPTA shutdown at the pituitary is caused by some drug interaction or a negative effect from lifestyle(stress, sleep etc) or some serious glandular issue which seems to have been dismissed. Either of the three, or a mix of them.

Assuming Deez_nutz didn't have low T issues and he doesn't rank into the Tanner stages at current age strengthens the thought a drug interaction caused this low t and a restart protocol would be suggested at the discretion of his doctor!

 

[Deez_Nutz]

Hello,

Ben in regards to the Nandrolone question, it will aromatase to a certain degree. About 20% aromatase activity of testosterone, just to give you a ballpark figure. Nandrolone has a weird mRNA expression and on the e2 receptor and the effect it has on aldosterone. In TRT there isn't much room for Nandrolone and it is not prescribed by many doctors. If your doctor would be willing to prescribe it, weigh out the benefits/sides first. Especially when using Nandrolone decanoate considering the drug elimination duration would be x5 half life which in literature is explained as anywhere from 6-12 days. I would assume it to be about 10 days so elimination would be 50 days, not counting metabolites. Progesterone receptor interaction will affect your HPTA as well and possible libido. Whatever the reasoning for wanting to include Nandrolone in a HRT protocol, there is probably a more suitable drug to use for that cause!

I agree with your opinion on this young man, however in regards to the Zoloft/SSRI usage. Since his E2 and PRL is normal, and taking in consideration his age. It would make more sense if his HPTA shutdown at the pituitary is caused by some drug interaction or a negative effect from lifestyle(stress, sleep etc) or some serious glandular issue which seems to have been dismissed. Either of the three, or a mix of them.

Assuming Deez_nutz didn't have low T issues and he doesn't rank into the Tanner stages at current age strengthens the thought a drug interaction caused this low t and a restart protocol would be suggested at the discretion of his doctor!

Daniel,

What do you mean exactly by ranking in the Tanner stages at my current age?

Also, what exactly is a HPTA restart and how should I ask my doctor about beginning a restart protocol?

 

[Alpin]

Daniel,

What do you mean exactly by ranking in the Tanner stages at my current age?

Also, what exactly is a HPTA restart and how should I ask my doctor about beginning a restart protocol?

IMT is the champion of restarts. If your doctor knew what she was doing (which I doubt) she wouldn't have put you on T and then taken you off to find the "root cause" of your problem as you state.
Not all docs are qualified in doing "restarts".

 

[Deez_Nutz]

Apollon,

Thanks for the response. What do you suggest I tell my doctor in regards to "restarts"? Just ask her straight up "do you have experience with HPTA restarts? Can I have one? lol"

I've been doing a lot of research lately and I'm just trying to gain as much knowledge on this area as I can.

 

[Daniel_IMT_Staff]

Daniel,

What do you mean exactly by ranking in the Tanner stages at my current age?

Also, what exactly is a HPTA restart and how should I ask my doctor about beginning a restart protocol?

Tanner stages refers to different stages of sexual development, if you were not fully sexually developed that would lead one to think that you have had the low t and would explain more about your current low t. This doesn't seem to be the problem with you.

I would ask if the doc has any experience with a HPTA restart. If they aren't specialized in TRT they won't have a clue what you are talking about.