MESO-Rx
Anabolic Steroids
My introduction.....
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So I've been wanting to change internists and found one who is also board certified in endo and he does about 50/50 is practice. I have not been back to see Dr. Hulinsky yet but the new guy was able to get my most recent blood work. For comparison albeit from two different labs here are the highlights:
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]
Non-HDL CHOL: 147 mg/dL
New guy says I'm not diabetic, I'm insulin resistant, my testosterone is "normal" even after having not used it for 8 days, he can't make heads or tails of the FSH or LH because I was suppressed by the test IM injections, wouldn't treat thyroid now and his plan of attack:
1. Sleep study
2. Start testosterone injections 200 mg every other week - he said 100mg every week is not better.
3. Metformin for my insulin resistance
4. Keep taking Diovan HCT.
5. Lose weight
6. See you back in 3 months
My assessment of new guy? Doesn't have a clue. Didn't hear the carotid bruit at all but Hulinsky spend about 5 mins having me breath and hold and was certain it was there. Can't make heads or tails of FSH or LH because I'm suppressed? How about retesting in a few weeks before jumping back into 200mg every other week? Thyroid is not an issue? Ok but my mother, brother, grandmother, sister all have Hashimoto's. Keep taking the Diovan? I know for a fact and it's the first thing Dr. Hulinsky said is that if I have renal artery stenosis it's probably not the best choice. Lastly, I'm going to focus on #5 of his plan before going to metformin. Doesn't want to followup on the renal artery stenosis?
Overall assessment was he's by the book and the follows number ranges and doesn't have as much command of the issues as Hulinsky seemed to have.Next week I go back for his opinion. it;s been 2 weeks now with IM test and I'm feeling lethargic again, libido took a dive and fog is coming back.
Comments and opinions welcome.
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]
Non-HDL CHOL: 147 mg/dL
New guy says I'm not diabetic, I'm insulin resistant, my testosterone is "normal" even after having not used it for 8 days, he can't make heads or tails of the FSH or LH because I was suppressed by the test IM injections, wouldn't treat thyroid now and his plan of attack:
1. Sleep study
2. Start testosterone injections 200 mg every other week - he said 100mg every week is not better.
3. Metformin for my insulin resistance
4. Keep taking Diovan HCT.
5. Lose weight
6. See you back in 3 months
My assessment of new guy? Doesn't have a clue. Didn't hear the carotid bruit at all but Hulinsky spend about 5 mins having me breath and hold and was certain it was there. Can't make heads or tails of FSH or LH because I'm suppressed? How about retesting in a few weeks before jumping back into 200mg every other week? Thyroid is not an issue? Ok but my mother, brother, grandmother, sister all have Hashimoto's. Keep taking the Diovan? I know for a fact and it's the first thing Dr. Hulinsky said is that if I have renal artery stenosis it's probably not the best choice. Lastly, I'm going to focus on #5 of his plan before going to metformin. Doesn't want to followup on the renal artery stenosis?
Overall assessment was he's by the book and the follows number ranges and doesn't have as much command of the issues as Hulinsky seemed to have.Next week I go back for his opinion. it;s been 2 weeks now with IM test and I'm feeling lethargic again, libido took a dive and fog is coming back.
Comments and opinions welcome.
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Lousy advice from the second guy but glad to see you caught onto that. You have the best guy on the east coast. I learned that from others first and then my own experience with him. Everything he has said or prescribed for me mirrors exactly what I have learned on these boards from the more knowledgable people. I only wish I had a GP, or for that matter accountant or lawyer, that spent so much time with me for a lousy $25 co-pay. He is THE ONLY Doc that I went to that wanted to test everything, determine if it was primary or secondary and then try other means before accepting a lifetime of TRT replacement. It is rare to find a doc that doesnt want to just write a script and send you on your way so hang onto them when you do.
Yes.
Consider the CRP a warning, and consider yourself fortunate --- not everyone gets such a clear warning. High CRP = high insulin = heart disease is on its way. The most effective way to reduce insulin is to reduce body fat; your plan to do so is a good one, and far better than just taking Metformin.
Unfortunately, your LH and FSH are par for the course. Your testicles will gradually shrink over time (approaching grape size). It comes with the territory; just make sure you need TRT (by investigating the root cause --- sounds like your first doc is doing exactly this).
I was surprised to see that your E2 is as low as it is. However, while your E2 is still in the normal range, it is high compared to your SHBG. I would definitely NOT recommend taking an AI, but would be curious to see how your values will change after weight loss...
Lastly, you probably should be on Synthroid for low thyroid. I imagine your doc will start you off on 50-75 mcg and see how your TSH changes...
the biweekly injection protocol tends to produce the roller coaster effect; you feel Great the first week and like shit the second due to the rapidly increasing t levels post injection as compared to you feeling like youre running on empty as the peak declines. some even do eod injections.
why no Lh/fsh befor the first shot?
Maybe an ultrasound for the renal and carotids?
Paleo will fix the insulin resistance.
why no Lh/fsh befor the first shot?
Maybe an ultrasound for the renal and carotids?
Paleo will fix the insulin resistance.
Sorry --- that's what happens when I don't take the time to preview my posts.
Yes, I meant C-peptide (my concern is with your high insulin):
Type 2 Diabetes is a concern, of course, but in general, you can correct this by just making the appropriate lifestyle changes (diet and exercise). In other words, although the diabetes itself can be avoided (or reversed, once it is established), the damage you are doing to your body from secreting so much insulin is not something so easily reversed. Your high CP result is a warning; even if you never get diabetes, high insulin is causing harm to your body, and is associated with heart disease (among other disease states).
High CP = high insulin = heart disease is on its way...
Absolutely Structure!
All of my health problems are rooted in obesity (assuming other causes of low T are ruled out). I have to get rid of the visceral adipose - it's changing my whole biology.
I find the elevated ALT more telling as ALL of the problems with obesity correlate very well with fatty liver. Obese people with normal livers do not have the same endocrine issues as obese people with fatty liver. Then again, it's all a consequence of the central obesity.
So I know what I need to do!
All of my health problems are rooted in obesity (assuming other causes of low T are ruled out). I have to get rid of the visceral adipose - it's changing my whole biology.
I find the elevated ALT more telling as ALL of the problems with obesity correlate very well with fatty liver. Obese people with normal livers do not have the same endocrine issues as obese people with fatty liver. Then again, it's all a consequence of the central obesity.
So I know what I need to do!
So working on weight loss. I estimate at 310lbs and 6'5" with moderate exercise in need 3500 calories per day to maintain weight. I've set my daily caloric intake to 2800 calories which is surprising easy. Even with a 500 calorie breakfast of eggs/English muffin/coffee and 500 calorie turkey sandwich with seltzer for lunch I find myself going into dinner with 1500 calories left (usually use another 300 calories on a snack) and sometimes it's hard to reach the 2800 calories.
(have to eat more than I want) so I'm comfortably averaging 2400 calories per day. I don't want to under eat and slow my metabolism. No fad diets either - well balanced with fats, carbs and protein. Most just watching portion control, nothing fried or processed or white and trying to eat smaller meals more frequently. I'm down 7 pounds since Tuesday. I've also been exercising daily (plan on 5 days a week) doing 60 mins of cardio (treadmill and elliptical) and 45-60 mins of vigorous lifting.
I'm hoping if my endo decides to treat my thyroid and low T it will just enhance my efforts but I'm not counting on it. This all seems very doable especially since I'm not doing a diet that eliminates one of three macronutrients.
(have to eat more than I want) so I'm comfortably averaging 2400 calories per day. I don't want to under eat and slow my metabolism. No fad diets either - well balanced with fats, carbs and protein. Most just watching portion control, nothing fried or processed or white and trying to eat smaller meals more frequently. I'm down 7 pounds since Tuesday. I've also been exercising daily (plan on 5 days a week) doing 60 mins of cardio (treadmill and elliptical) and 45-60 mins of vigorous lifting.
I'm hoping if my endo decides to treat my thyroid and low T it will just enhance my efforts but I'm not counting on it. This all seems very doable especially since I'm not doing a diet that eliminates one of three macronutrients.
The best way to reverse fatty liver allegedly is to cut carbs and sugars. I have a fatty liver as evidenced on ultrasound, but my bloods are all normal. Bilirubin is high range of normal though.
Restricted calorie diet? If you're tracking daily intake of the three macros, take note of which one you're cutting the most when your weight loss gets going.
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LW64 said:
Carbs always get cut the most especially any simple carbs. I have tried and no longer subscribe to Atkins or South Beach or any other fad diet. I'm not saying they're not successful during weight loss but they always fall short during maintenance. I'm human and very clearly was designed to consume all three macronutrients albeit less off all three than I have in the past. My diet has never been poor - just my portion control. That's where counting calories helps me. To be honest at 2500 calories per day I'm not hungry until just before the next meal time. In the end a calorie of CHO, fat or protein is all the same and as long as my net energy expenditure exceeds my energy intake weight will be lost.
Do CHO, fat, and protein have the same effect on insulin secreted from the pancreas? You know the answer.
What about how they affect the main problem dieters have during maintenance - hunger? You know this answer too.
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