Forty-Three Years Old, Low T Symptoms

[johndoesmith]

I've thought about having a more thorough thyroid panel completed. My family doctor tested my thyroid 9 and 4 years ago. Both times it was in the low to mid 2 range for TSH, but it is now 3.6. T3 and T4 were never tested.

The metabolic syndrome/insulin resistance crossed my mind also because of my lipid panel results and the low SHBG. Was wondering if metformin would be a possibility along with TRT. Again, so many things to balance consider. I want to stay patient though, and start with the TRT to see how that affects everything. Then possibly move onto the thyroid and insulin issues. I'm sure the doctor will properly guide me. I just don't want to throw too many variables into the mix and not be able to clearly see what is helping or hindering symptoms.

The thing is though, that if there are untreated thyroid issues and metabolic issues, they will most likely hinder TRT's benefits.

Plus, without having a baseline, you'll never know if TRT had changed anything.

I can tell you that starting TRT with an SHBG of 6 is going to complicate dialing it in.

 

[1oldsoul]

I had a good consult today with Dr. Calkins from Defy Medical. He was very thorough, professional, knowledgeable and pleasant to consult with. He even fielded a few questions my wife had as she was listening in halfway through the conversation.

Below is the TRT protocol he laid out for me and other suggestions to help with my overall health:

Testosterone Cypionate 40mg EOD due to my low SHBG (6.1)

HCG 400iu every other test cyp injection

Anastrozole 0.125mg taken with every HCG injection.



DHEA 25mg taken every day at night to get me levels up a bit.

Increase my current dosage (500mg) to 4000mg of krill/fish oil or flax seed oil per day to raise good (HDL) cholesterol. Recommended Nordic Naturals brand.

Other Items:
-Look into Paleo or Keto diets.
-Avoid potato products to help lower triglycerides.
-Items to help lower bad (LDL) cholesterol (my current LDL is 301):
1. Stay away from eggs and ground meats.
2. Possibly take a cholesterol lowering statin.
-Have Free T3 tested at 3 month follow-up to see if thyroid treatment is needed.
-Have insulin levels checked at 3 month follow up.
-If desired, have a NMR LipoProfile test done in the future to get a better understanding of my cholesterol levels.

 

[Mad City Dad]

Hello,
With such a high total cholesterol, and low HDL, your ratio is quite alarming. How long do you think you have been walking around with such levels? 25 years ago when I was 30 years old, I insisted on having my cholesterol checked. I had numbers very similar to yours. I have been on lipitor ever since. I am fairly lean, eat a very clean diet, and still could not do it without pharmacological support. What is your weight, BMI and percent body fat.?
Steve

 

[1oldsoul]

Hello,
With such a high total cholesterol, and low HDL, your ratio is quite alarming. How long do you think you have been walking around with such levels? 25 years ago when I was 30 years old, I insisted on having my cholesterol checked. I had numbers very similar to yours. I have been on lipitor ever since. I am fairly lean, eat a very clean diet, and still could not do it without pharmacological support. What is your weight, BMI and percent body fat.?
Steve

Yes, Dr. Calkins expressed his concern about it. The first time I had my cholesterol checked was 10 years ago when I first really noticed lower energy, brain fog and other common symptoms of low T that I currently have. I can't remember the numbers, but they were not good, but not quite as bad as now. After talking with my wife today, I scheduled an appointment with my primary physician next Wednesday to discuss my cholesterol labs and treatment. As with you, I highly doubt that I can get my levels down naturally.

Did you happen to notice any significant side affects from Lipitor?

 

[madman]

Hello,
With such a high total cholesterol, and low HDL, your ratio is quite alarming. How long do you think you have been walking around with such levels? 25 years ago when I was 30 years old, I insisted on having my cholesterol checked. I had numbers very similar to yours. I have been on lipitor ever since. I am fairly lean, eat a very clean diet, and still could not do it without pharmacological support. What is your weight, BMI and percent body fat.?
Steve

More than likely due to your genetics as there are many whom follow healthy lifestyles/eat clean/exercise/maintain healthy body weight and still have cholesterol issues and the human liver produces far more cholesterol internally than the average person consumes through diet daily unless you are eating over 2+ pounds meat/fowl/fish/seafood or 5+ egg yolks a day.

 

[Mad City Dad]

No, I have never had any negative side effects from statin use whatsoever. I respond very well to lipitor 40 mg every day. I also eat well and exercise. There have been times in the past 25 years since being on it that my diet and exercise have been less than optimum, and my total will creep up toward 200, but when I'm plugged in, my total hovers around 160. Untreated I was well over 300, just like you. As you already know, its a huge risk factor for heart disease and sudden death, so get it under control. I asked about your body fat because that has a huge role too. High dose niacin can also help raise your HDL (the good cholesterol), and high fiber (think oatmeal) can lower your LDL. Good luck to you!

 

[1oldsoul]

Body fat can be much better...it hovers around 16%. I strength train 4 times per week (2 days of upper and 2 days of lower), plus I do sprint intervals 2 days per week and another day of low intensity cardio at times.

I am struggling with jumping on board with a statin. I never truly bought into the theory that cholesterol causes heart attacks. My thought process (and I may very well be wrong) has always been that stress, sugars, etc. causes inflammation in the body, so your body increases production of cholesterol to heal itself. Inflammation is the true problem, not cholesterol. Taking a medication that lowers your body's natural way to heal itself seems counterproductive.

I also am not wild about the side affects like muscle/joint aches and increased chance of developing diabetes. Diabetes (type 2) does run in my family.

Again, I may very well be completely wrong, and am open for learning.

 

[1oldsoul]

This is an update on how things have been going so far. I'm on week six of the protocol described above.

During the first week I experienced a minor sore throat and headaches (I very rarely experience headaches) and restless legs at night causing poor sleep. I also developed extremely dry skin on my knuckles/hands and knees that peeled for about 2 weeks. Joint stiffness and pain was bothersome, plus I quickly developed tendonitis in my left elbow that still bothers me today. The joint stiffness has diminished, but still pops up every now and then.

Not related to the TRT treatment, I tore my left pec muscle bench pressing on the very first injection day. Was quite depressed when it happened, but not the end of the world.

On the second week, a few larger skin tags I had for years shrunk/flattened and remain that way today. Over the weeks my reliance on naps completely went away. My energy has improved and seems pretty stable throughout the day, where in the past, I completely crashed around late morning or lunch time. Endurance also improved during workouts, especially my cardio. I didn't lose any weight, but did lose an inch around my waist.

I am a teacher and since school started, I have noticed my tolerance has been much better with the students and a few administrators. My attitude seems much more positive and improving each week.

My drive has also began to return. Besides teaching, I also had another business, but gave it up because of family health problems, and employee issues. I have had no desire in a long time to venture into the entrepreneur arena again, but the itch is starting to return.

Speaking of drive, my libido has increased. Now if only I can get my wife's to also increase.

I by no means feel like Superman, but I do feel like my old self is returning. I am supposed to have a follow up with labs at 12 weeks that includes a more complete thyroid panel and a few other items. I'm anxious to see what the results are and if thyroid treatment is an option and could help even more.

Thank you to all that contribute to this forum! It has changed my life for the better.

 

[ScottM]

Thanks for the thorough update! Very happy to hear this.

This is an update on how things have been going so far. I'm on week six of the protocol described above.

During the first week I experienced a minor sore throat and headaches (I very rarely experience headaches) and restless legs at night causing poor sleep. I also developed extremely dry skin on my knuckles/hands and knees that peeled for about 2 weeks. Joint stiffness and pain was bothersome, plus I quickly developed tendonitis in my left elbow that still bothers me today. The joint stiffness has diminished, but still pops up every now and then.

Not related to the TRT treatment, I tore my left pec muscle bench pressing on the very first injection day. Was quite depressed when it happened, but not the end of the world.

On the second week, a few larger skin tags I had for years shrunk/flattened and remain that way today. Over the weeks my reliance on naps completely went away. My energy has improved and seems pretty stable throughout the day, where in the past, I completely crashed around late morning or lunch time. Endurance also improved during workouts, especially my cardio. I didn't lose any weight, but did lose an inch around my waist.

I am a teacher and since school started, I have noticed my tolerance has been much better with the students and a few administrators. My attitude seems much more positive and improving each week.

My drive has also began to return. Besides teaching, I also had another business, but gave it up because of family health problems, and employee issues. I have had no desire in a long time to venture into the entrepreneur arena again, but the itch is starting to return.

Speaking of drive, my libido has increased. Now if only I can get my wife's to also increase.

I by no means feel like Superman, but I do feel like my old self is returning. I am supposed to have a follow up with labs at 12 weeks that includes a more complete thyroid panel and a few other items. I'm anxious to see what the results are and if thyroid treatment is an option and could help even more.

Thank you to all that contribute to this forum! It has changed my life for the better.

 

[hva]

Speaking of drive, my libido has increased. Now if only I can get my wife's to also increase.

.

My wife is also a Defy patient and usually consults with Dr. Calkins. She's been on testosterone cream for about as long as I've been on TRT and all I can say is...life is good. Girls can have low T too, especially if they are at or near menopause and raising it some can have a dramatic effect on their overall sense of well being and libido. It's worth having her tested if she is willing.

 

[1oldsoul]

My wife is also a Defy patient and usually consults with Dr. Calkins. She's been on testosterone cream for about as long as I've been on TRT and all I can say is...life is good. Girls can have low T too, especially if they are at or near menopause and raising it some can have a dramatic effect on their overall sense of well being and libido. It's worth having her tested if she is willing.

Thanks hva. This has crossed my mind in the past, but my wife is very reluctant about medications and hormones. She had her thyroid removed years ago due to Grave's disease and had some difficult times finding a good balance (and doctors) with her thyroid medication. She also had some very bad reactions to different other meds over the years. She seems to be hypersensitive to anything she takes. I'll just have to live with what "action" I get, and see if I can help convince her over time.

 

[1oldsoul]

UPDATE: Below are updated lab results at 10 weeks into treatment. What do you think? I feel about the same as my last post at 6 weeks. I'm calling to schedule my follow up consult with Defy tomorrow. Thanks.


Hemoglobin 17.4 g/dL 12.6 - 17.7 01
Hematocrit 51.4 High % 37.5 - 51.0 01

Cholesterol, Total 254 High mg/dL 100 - 199 01
Triglycerides 302 High mg/dL 0 - 149 01
HDL Cholesterol 24 Low mg/dL >39 01
VLDL Cholesterol Cal 60 High mg/dL 5 - 40
LDL Cholesterol Calc 170 High mg/dL 0 - 99
T. Chol/HDL Ratio 10.6 High ratio units 0.0 - 5.0

Glucose Fasting and 2hr
Glucose, Plasma 90 mg/dL 65 - 99 01
Glucose, Two-Hour Postprandial 95 mg/dL 65 - 139 01

Testosterone,Free and Total
Testosterone, Serum 700 ng/dL 264 - 916 01
Free Testosterone(Direct) 30.7 High pg/mL 6.8 - 21.5 01

T4,Free(Direct) 0.95 ng/dL 0.82 - 1.77 01
TSH 4.480 uIU/mL 0.450 - 4.500 01
Triiodothyronine,Free,Serum 3.1 pg/mL 2.0 - 4.4 01

DHEA-Sulfate 558.3 High ug/dL 102.6 - 416.3 01

Prostate Specific Ag, Serum 0.7 ng/mL 0.0 - 4.0 01

Estradiol, Sensitive 18.2 pg/mL 8.0 - 35.0 02

Sex Horm Binding Glob, Serum 9.1 Low nmol/L 16.5 - 55.9 01

 

[CoastWatcher]

UPDATE: Below are updated lab results at 10 weeks into treatment. What do you think? I feel about the same as my last post at 6 weeks. I'm calling to schedule my follow up consult with Defy tomorrow. Thanks.


Hemoglobin 17.4 g/dL 12.6 - 17.7 01
Hematocrit 51.4 High % 37.5 - 51.0 01

Cholesterol, Total 254 High mg/dL 100 - 199 01
Triglycerides 302 High mg/dL 0 - 149 01
HDL Cholesterol 24 Low mg/dL >39 01
VLDL Cholesterol Cal 60 High mg/dL 5 - 40
LDL Cholesterol Calc 170 High mg/dL 0 - 99
T. Chol/HDL Ratio 10.6 High ratio units 0.0 - 5.0

Glucose Fasting and 2hr
Glucose, Plasma 90 mg/dL 65 - 99 01
Glucose, Two-Hour Postprandial 95 mg/dL 65 - 139 01

Testosterone,Free and Total
Testosterone, Serum 700 ng/dL 264 - 916 01
Free Testosterone(Direct) 30.7 High pg/mL 6.8 - 21.5 01

T4,Free(Direct) 0.95 ng/dL 0.82 - 1.77 01
TSH 4.480 uIU/mL 0.450 - 4.500 01
Triiodothyronine,Free,Serum 3.1 pg/mL 2.0 - 4.4 01

DHEA-Sulfate 558.3 High ug/dL 102.6 - 416.3 01

Prostate Specific Ag, Serum 0.7 ng/mL 0.0 - 4.0 01

Estradiol, Sensitive 18.2 pg/mL 8.0 - 35.0 02

Sex Horm Binding Glob, Serum 9.1 Low nmol/L 16.5 - 55.9 01

Last update, you said things had improved. You're still happy with things?

Regarding your labs, your hematocrit and hemoglobin need to be addressed. Otherwise, the same challenges that you presented with are present (very low SHBG, e2 at the lower end of things, lipid issues). Many of which will likely remain a challenge.

You *might* be able to see a higher trough on a daily injection protocol. It`s something to discuss. I know it worked for me, low SHBG being a challenge - though not as low as yours.

 

[1oldsoul]

Last update, you said things had improved. You're still happy with things?

Regarding your labs, your hematocrit and hemoglobin need to be addressed. Otherwise, the same challenges that you presented with are present (very low SHBG, e2 at the lower end of things, lipid issues). Many of which will likely remain a challenge.

You *might* be able to see a higher trough on a daily injection protocol. It`s something to discuss. I know it worked for me, low SHBG being a challenge - though not as low as yours.

Yes, I'm still happy overall. I feel even keeled at a decent level, but not quite where I hoped for. Daily naps used to be a normal routine that I needed, but I can't even remember the last nap I took. I'm contemplating stopping or lowering my AI (currently only .125 every 4 days) to see if I feel better overall and can get rid of my stiff/achy joints and elbow tendonitis.

I'm happy with the improvement in my LDL levels as I've dropped from 301 down to 170. Still can't get my HDL high enough, and I'm perplexed as to why my triglycerides went higher (perhaps job stress?). I'm hoping my hematocrit and hemoglobin will stabilize at a lower level in the future, but time will tell.

Thanks for your guidance CoastWatcher.

 

[ScottM]

Happy to see some improvements, especially in that LDL.

The Triglycerides could be a lot of things, how is your diet? How much alcohol do you drink? What's your stress like? Did you fast for this? If you had a fatty meal the night before that could thro.w off the lipid panel (LDL and HDL values won't be affected). How's your blood pressure? etc.

I agree with Coast about his SHBG remarks. Might be worth a shot, pun intended. Thanks for sharing your labs and can't wait to hear what Defy has to say.

Cheers,
Scott
Telthera

UPDATE: Below are updated lab results at 10 weeks into treatment. What do you think? I feel about the same as my last post at 6 weeks. I'm calling to schedule my follow up consult with Defy tomorrow. Thanks.


Hemoglobin 17.4 g/dL 12.6 - 17.7 01
Hematocrit 51.4 High % 37.5 - 51.0 01

Cholesterol, Total 254 High mg/dL 100 - 199 01
Triglycerides 302 High mg/dL 0 - 149 01
HDL Cholesterol 24 Low mg/dL >39 01
VLDL Cholesterol Cal 60 High mg/dL 5 - 40
LDL Cholesterol Calc 170 High mg/dL 0 - 99
T. Chol/HDL Ratio 10.6 High ratio units 0.0 - 5.0

Glucose Fasting and 2hr
Glucose, Plasma 90 mg/dL 65 - 99 01
Glucose, Two-Hour Postprandial 95 mg/dL 65 - 139 01

Testosterone,Free and Total
Testosterone, Serum 700 ng/dL 264 - 916 01
Free Testosterone(Direct) 30.7 High pg/mL 6.8 - 21.5 01

T4,Free(Direct) 0.95 ng/dL 0.82 - 1.77 01
TSH 4.480 uIU/mL 0.450 - 4.500 01
Triiodothyronine,Free,Serum 3.1 pg/mL 2.0 - 4.4 01

DHEA-Sulfate 558.3 High ug/dL 102.6 - 416.3 01

Prostate Specific Ag, Serum 0.7 ng/mL 0.0 - 4.0 01

Estradiol, Sensitive 18.2 pg/mL 8.0 - 35.0 02

Sex Horm Binding Glob, Serum 9.1 Low nmol/L 16.5 - 55.9 01

 

[1oldsoul]

Happy to see some improvements, especially in that LDL.

The Triglycerides could be a lot of things, how is your diet? How much alcohol do you drink? What's your stress like? Did you fast for this? If you had a fatty meal the night before that could thro.w off the lipid panel (LDL and HDL values won't be affected). How's your blood pressure? etc.

I agree with Coast about his SHBG remarks. Might be worth a shot, pun intended. Thanks for sharing your labs and can't wait to hear what Defy has to say.

Cheers,
Scott
Telthera

My diet is average and I very rarely ever drink. Stress is high for me mostly because of my job (teacher). Of course this stress was absent during my initial labs when I was off in the summer. Each year the stress in public schools gets worse for various reasons not worth discussing on this forum.

I don't remember the meal I had the night before, but I did fast for the test. My blood pressure is fine. I'll keep you updated Scott as to if there are any changes in protocol.