My introduction.....

[LW64]

Thank you very much!

I didnt do a thing. You did all the hard work!

 

[idmd]

Just wondering if anyone else sees something different in my original labs? Dr. Jim I'm curious what you see?

4/11/2012 (non-fasting)
Glucose:102mg/dL
TSH Ultrasensitive: 5.07 uIU/mL [0.49-4.67]
AST: 42 U/L [6-60]
ALT: 88 U/L [9-67]
Antithyroglobulin Ab: 54.7 IU/mL [<116]
Thyroperoxidase Ab: 6.8 IU/mL [<34]
Free T4: 1.32 ng/dL [0.71-1.85]
T3 Total: 119.9 ng/dL [84.6-201.8]
Testosterone: 196 ng/dL [240-950]
Free Testosterone: 7.1 ng/dL [9-30]


These were obtained after completing a single 200mg IM injection of test, followed by a single 100mg IM injection of test the following week and then no injection of test for 8 days.

Fasting 12 hours taken 05/18/2012
Glucose: 91mg/dL [65-99]
Glucose random: 83 mg/dL [<140]
Hemoglobin A1C: 5.2
TSH: 4.51 mIU/L [0.40-4.50]
Total T4: 7.3 mcg/dL [4.5-12.0]
Free T4: 1.3 ng/dL [0.8-1.8]
Total T3: 132 ng/dL [76-181]
Thyroglobulin Ab <20 [<20]
SHBG: 16 nmol/L [10-50]
Alpha Subunit: <0.3 [Males 0.6 ng/dL or less; hypothyroid subjects 3.7 ng/dL or less]
C-Peptide: 4.75 ng/mL [0.80-3.0]
FSH: <0.7 mIU/mL [1.6-8.0]
LH: <0.2 mIU/mL [1.5-9.3]
Prolactin: 14.6 ng/mL [2.0-18.0]
Total Testosterone: 399 ng/dL [241-827]
E2: 31 pg/mL [<39]

Lipids:

Total Cholesterol: 194 mg/dL [125-200]
HDL: 47 mg/dL [>40]
Triglycerides: 119 mg/dL [<150]
LDL: 123 mg/dL [<130]
CHOL/HDLC Ratio: 4.1 [<5.0]

 

[idmd]

Here you go noobie123....

BTW I'm not going to argue about lack of education on nutrition.

 

[newbie23]

Here you go noobie123....

BTW I'm not going to argue about lack of education on nutrition.

are your IGF-1 levels decent to high? I mean I don't have time to go through this whole thread but your T is in the tank, basically castrate. your TSH is obviously high and I'm wondering if your cortisol is through the roof. your PRL is in range but its up there, that always makes me sleepy.

My initial guess, and it is a guess, with your BMI being high and T super low, non alcoholic fatly liver disease, or at least developing.

I dont understand the testing so soon after injection, and do not see why your changing your dose and then waiting 8 days.

To me its pretty cut and dry that your T has been low for a while, with the lack of energy and libido in recent years and scoring pretty much nil on the T chart.

I see no reason why you wouldn't supplement, at least temporarily until you get your BMI and diet in check.

On the surface it simply looks diet got you here.

nothing you can't change though.

D3 is more for muscle health, glucosamine is a better supp for joint pain, or Zyflamend to reduce inflammation.


Getting some probiotics would also be beneficial to you.

also as others have pointed out it will be important to know if your primary or secondary.

Hope this helps.

 

[newbie23]

also saw a comment that high E2 may be the cause of your lowT and I don't think so, although it is suppressive, when you score under 200 its hard to have enough T to even make E.

although it is possible.

This is a culmination of multiple factors..... not a singular.

 

[hardasnails1973]

also saw a comment that high E2 may be the cause of your lowT and I don't think so, although it is suppressive, when you score under 200 its hard to have enough T to even make E.

although it is possible.

This is a culmination of multiple factors..... not a singular.

Appears to be major potential for prediabetic state due t elevate c peptide
Even Ha1C is normal does not exclude you from insulin issues.
Looking into what is tweaking your thyroid since you may have problems with cellular thyroid deficiency. Your well is full, but pump is broken (low ferritin and low cortisol) You could have hashimotos but it is just hidden since I see a fluctuation in antibodies which is taken a different intervals. I would run an ANA profile to see if this may show a hidden autoimmune disorder which slips through on people. To catch hashimots a person would have to take blood everyday for a month to accurate find it. I see alot of parameters missing which are crucial vitamin D, ferritin and saliva cortisol are just some of them.

 

[idmd]

also as others have pointed out it will be important to know if your primary or secondary.

But that is the $64000 question that is paramount to my recovery and what everyone else is having trouble determining. I will disagree with the recommendation to start TRT without knowing my diagnosis. Yes what I've done (lost weight and maintained moderate constant exercise) has been more difficult with low T but I felt this was my life on the line and muscled through it.

Here are my labs one more time....what's your guess on primary, secondary or tertiary?

1. This was ordered by my internist. When it came back he decided to not treat thyroid and start IM test. I took two weeks worth of IM test before I wised up and went to an endo.
4/11/2012 (non-fasting)
Glucose:102mg/dL
TSH Ultrasensitive: 5.07 uIU/mL [0.49-4.67]
AST: 42 U/L [6-60]
ALT: 88 U/L [9-67]
Antithyroglobulin Ab: 54.7 IU/mL [<116]
Thyroperoxidase Ab: 6.8 IU/mL [<34]
Free T4: 1.32 ng/dL [0.71-1.85]
T3 Total: 119.9 ng/dL [84.6-201.8]
Testosterone: 196 ng/dL [240-950]
Free Testosterone: 7.1 ng/dL [9-30]

2. Went to an endo knowledgable in TRT. These were taken 8 days after my last IM test injection. He obviously knew LH would be suppressed and it wasn't really a baseline but it still tells us some of the story. He put me on 50mcg/d of Synthroid and wanted to see my LH/test response to a 10 day trial of clomid 100mg/d

Fasting 12 hours taken 05/18/2012
Glucose: 91mg/dL [65-99]
Glucose random: 83 mg/dL [<140]
Hemoglobin A1C: 5.2
TSH: 4.51 mIU/L [0.40-4.50]
Total T4: 7.3 mcg/dL [4.5-12.0]
Free T4: 1.3 ng/dL [0.8-1.8]
Total T3: 132 ng/dL [76-181]
Thyroglobulin Ab <20 [<20]
SHBG: 16 nmol/L [10-50]
Alpha Subunit: <0.3 [Males 0.6 ng/dL or less; hypothyroid subjects 3.7 ng/dL or less]
C-Peptide: 4.75 ng/mL [0.80-3.0]
FSH: <0.7 mIU/mL [1.6-8.0]
LH: <0.2 mIU/mL [1.5-9.3]
Prolactin: 14.6 ng/mL [2.0-18.0]
Total Testosterone: 399 ng/dL [241-827]
E2: 31 pg/mL [<39]

Lipids:

Total Cholesterol: 194 mg/dL [125-200]
HDL: 47 mg/dL [>40]
Triglycerides: 119 mg/dL [<150]
LDL: 123 mg/dL [<130]
CHOL/HDLC Ratio: 4.1 [<5.0]
Non-HDL CHOL: 147 mg/dL


3. So new labs after 10 days 100mg Clomid and 50mcg Synthroid.

TSH = 4.59 [0.40-4.50]
SHBG = 18 [10-50]
FSH = 2.9 [1.6-8.0]
LH = 5.8 [1.5-9.3]

Test Total = 333 [241-827]
E2 = 22 [< 39]
AM Cortisol = 22.8 [4.0-22.0]

He bumped up my Synthroid to 100mcg/d, recommended I lose weight and exercise and started me on arimidex 1mg E3D. It's been almost two months since my last labs and 6 weeks since starting arimidex. I'm due for labs next week. I've lost 35 lbs since my first blood test was taken, I've lost inches around my neck and waist and have changed my body composition through cardio/lifting beyond what the 35 lbs weight loss suggests in itself. My diet is clean and basically the paleo diet. Taking vitamins, D3 and B-complex.

My guess based on how I feel (better mood, morning wood, lifting heavy at the gym, high energy) that my levels are rebounding without TRT - I think everyone would agree this is preferable to TRT IF it works longterm. Had I started TRT it would be a whole lot more work doing the restart after weight loss IMO. I guess we will see next week when my new labs are in......

 

[newbie23]

secondary induced or whatever they want to call it and I still think using testosterone to get your BMI down is not a bad idea but thats me and an opinion.

I hear you saying your diet is good yet as I skimmed some pages last night I think I saw some whoppers in your diet.

Paleo, warrior or smaleo........... thats all hogwash. Count your cals and get your macro's in check.

As you may have seen I when I said earlier most guys in there 30's like yourself would have no problem getting there natural T back, it is just a much longer tougher road.

You got major insulin resistance problems too.

I don't like when people get too caught up in the numbers, I probably would have been able to look at you and see that your insulin resistance and lowT.

Do as I suggested and get the probiotics , this will help you.

You can try the clomid but it only works to stimulate while you use it. it is rare that i see some fully recover with Clomid alone, need HCG and HMG

if your going to try and recover, use Scally's normalization protocol.


Even then its not going to hold until you get your insulin issues back in check.

 

[newbie23]

Probiotics and gut health: A special focus on liver diseases

We suggest that androgen deficiency is associated with IR, T2D, MetS, and with increased deposition of visceral fat, which serves as an endocrine organ, producing inflammatory cytokines and thus promoting endothelial dysfunction and vascular disease.

The Dark Side of Testosterone Deficiency: II. Type 2 Diabetes and Insulin Resistance -- Traish et al. 30 (1): 23 -- Journal of Andrology

In summary, supplementation of a high dose of Te in middle-aged and older men attenuates IGF-I feedback-dependent inhibition of nadir and peak GH secretion. Both effects of Te differ from those reported recently for estradiol in postmenopausal women. Accordingly, we postulate that Te and estrogen modulate IGF-I negative feedback differentially.

http://jcem.endojournals.org/content/90/3/1613.short (Testosterone Blunts Feedback Inhibition of Growth Hormone Secretion by Experimentally Elevated Insulin-Like Growth Factor-I Concentrations)

 

[idmd]

I'm going to guess next week even now my C-peptide will be well within the normal range as will my ALT.

The blood test will tell.

 

[newbie23]

manipulating your insulin temporarily is not going to get you anywhere.

 

[idmd]

manipulating your insulin temporarily is not going to get you anywhere.

Manipulating my insulin?

In 2 months I've lost 35 lbs through diet and exercise AND I've increased my strength and lean body mass too.

I eat a low carb diet with what little carbs I do eat being non-starch vegetables and fruit. My predominate protein source is fish and my predominate fat is olive oil and avocado. The worst thing I eat regularly is a half cup of Greek yogurt with fruit on top instead of ice cream.

I used to drink wine daily now I drink once a week.

I exercise 4-5x per weeks doing both lifting and intense cardio. Last week I did a total of 30 miles over 6 hours on the elliptical and lifted another 3 hours for a total of 8000 calories.

Call it what you want....I call it life style change. I suspect my C-peptide and ALT will be down because I've reduced my visceral fat stores considerably...down 3 pants sizes and need belts for everything now.

Did this all (and I'm continuing to do it) all without a TRT crutch.

 

[newbie23]

Ohhhhhh OK now I see your type. You are the tough guy that does not like to be told that you need testosterone and you think its the easy way out. I have had to deal with many of you as well.

TRT is not a crutch, no more than vitamin B being a crutch for someone who needs it. I am now over this conversation, cause it doesn't matter what we say you will do what you want.

Just so you know I have a guy that is about your stats, he did what your getting into now for 10 years............. he is now on TRT.

Wait a minute.............. you haven't injected testosterone? I thought you did a 200mg and a 100mg shot?

I have already spent too much time on this, I hope you get your issues worked out.

Good Luck

 

[idmd]

Ohhhhhh OK now I see your type. You are the tough guy that does not like to be told that you need testosterone and you think its the easy way out. I have had to deal with many of you as well.

TRT is not a crutch, no more than vitamin B being a crutch for someone who needs it. I am now over this conversation, cause it doesn't matter what we say you will do what you want.

Just so you know I have a guy that is about your stats, he did what your getting into now for 10 years............. he is now on TRT.

Wait a minute.............. you haven't injected testosterone? I thought you did a 200mg and a 100mg shot?

I have already spent too much time on this, I hope you get your issues worked out.

Good Luck

Easy way out....no.....more appropriate for primary hypogonadism and secondary hypogonadism than tertiary....yes.

I'm also not saying I won't end up on TRT....I very well could have a mixed pathophysiology. But as long as I'm willing to try and do the hard work I think giving this a try is preferable to TRT and the need for a restart. There are enough people having a hard time on TRT that people like me should exhaust other possibilities first. To suggest TRT as a first line treatment for someone like me is silly.

If I am tertiary then what I'm doing is treating the underlying pathophysiology....TRT is not. If I also have a primary component then TRT may be the way to go.

Since you with infinite wisdom are unable to give me a definite diagnosis......well......I strongly believe what I'm doing is the appropriate route.

 

[Structure]

also saw a comment that high E2 may be the cause of your lowT and I don't think so, although it is suppressive, when you score under 200 its hard to have enough T to even make E.

although it is possible.

This is a culmination of multiple factors..... not a singular.

Hmmm. There seems to be a problem with your logic here: "...when you score under 200 its hard to have enough T to even make E."

Total T is the amount of testosterone that remains after a portion of it has been converted into E2. Had idmd's problem been due to overconversion of T to E2 (obesity induced hypogonadism), then he could very easily had even less T than this, despite elevated E2; numbers like his are not particularly difficult to achieve from obesity induced hypogonadism.

As far as just throwing T at the problem goes: I think you're off in the weeds here. I also think you're incorrect to blame the patient for being difficult simply because he doesn't see good deductive reasoning in your argument! Seems a bit out of place in this discussion...

 

[idmd]

BTW....are you so pro-TRT that you just tried to make me feel bad about taking responsibility for my condition by calling me a tough guy instead of saying well done?

I would've understood a response questioning my method if you have a patient who flat out says they're not going to diet and exercise but for someone who is willing to try? Really? Your best plan is to try and make them feel bad so they accept your method.

 

[LW64]

Your best plan is to try and make them feel bad so they accept your method.

What method?

 

[idmd]

What method?

My method is Lose weight through diet and exercise unaided by TRT.

His method is to supplement with TRT first.

 

[newbie23]

Hmmm. There seems to be a problem with your logic here: "...when you score under 200 its hard to have enough T to even make E."

Total T is the amount of testosterone that remains after a portion of it has been converted into E2. Had idmd's problem been due to overconversion of T to E2 (obesity induced hypogonadism), then he could very easily had even less T than this, despite elevated E2; numbers like his are not particularly difficult to achieve from obesity induced hypogonadism.

As far as just throwing T at the problem goes: I think you're off in the weeds here. I also think you're incorrect to blame the patient for being difficult simply because he doesn't see good deductive reasoning in your argument! Seems a bit out of place in this discussion...

This would be true if E was only made in the leydig cells. besides, most blood test with rock bottom T that i see, have rock bottom E. at least the 4 I saw today from new guys were that way. Insulin also effects T and GH

every wants to make it as simple as E, but its not

Maybe I am missing something here but when exactly was he E elevated, from what I saw it was 31?

 

[newbie23]

BTW....are you so pro-TRT that you just tried to make me feel bad about taking responsibility for my condition by calling me a tough guy instead of saying well done?

I would've understood a response questioning my method if you have a patient who flat out says they're not going to diet and exercise but for someone who is willing to try? Really? Your best plan is to try and make them feel bad so they accept your method.

Yes when someone has T levels of a 100 year old man I am very pro TRT, the damage done sitting at those levels is far worse than that of supplementation.

I am not trying to make you feel bad, and honestly could care less if you ever get on TRT, the confusing part to me is here you are saying I'm hunky dory i don't use T but I could have swore that you already injected T??? what did I miss?

I am not calling you a tough guy cause you don't want to do TRT, I am calling you an idiot cause you keep asking these questions yet you the know the answer (or at least think you do) already..............[)]

Your logic with thinking that there are tons of people with problems that are on TRT is flawed from this forum, not this one in particular but forums in general. Peopl come to these forums WHEN THEY HAVE PROBLEMS........... Cause they are seeking answers................................for each 1 that has a problem there are 10 that feel fucking fantastic..............like myself :drooling: