Possible PSSD and anhedonia after 10 years of SSRIs. Turning 37 soon - could use some help interpreting bloodwork due to telltale signs of low T.

[ExpatinLatAm]

Hey all, I've had symptoms of T issues and did some bloodwork recently. The results are in Spanish, so I made a quick translated chart instead of posting the raw results. I got a full panel done as well so if anything is missing let me know and I'll add it below.

I'm 5'11" 180lbs. A bit skinnyfat but lift, do martial arts, or something outdoors almost daily. Walk daily 30-60 minutes.

Diet isn't great - my triglycerides are way too high, as is my uric acid (gout). So I know diet can be improved to then improve overall results.

Sleep ~8 hours per night. Do have excess stress in my life.

ED issues, trouble building muscle, skinnyfat, lethargic, low sex drive, hair loss, lacking confidence and drive, some excessive breast tissue.

I also used various SSRIs for many years and recently learned about PSSD. Anhedonia is also common - again, recently learned about this and a light bulb went off.

Take a multivitamin, 2.5 mg cialis, 100 mg allopurinol (for gout), 80 mg aspirin, 30-40 mg zinc daily. Also take about 10-20 mg Viagra before sex.

Last September my total T level was 680. I'm in a country that has various legit TRT options available w/out a prescription, so I'm leaning towards starting a low-dose protocol and testing markers every 3-4 months. Looking for some feedback before I do. I also have an appt with a urologist this week.

Thanks.

[TD='top']
Marker
[/TD]
[TD='top']
Level
[/TD]
[TD='top']
Normal range
[/TD] [TD='top']
TSH
[/TD]
[TD='top']
2.19
[/TD]
[TD='top']
0.27-4.20
[/TD] [TD='top']
T4 Free
[/TD]
[TD='top']
1.35
[/TD]
[TD='top']
.92-1.68
[/TD] [TD='top']
T4 total
[/TD]
[TD='top']
7.41
[/TD]
[TD='top']
4.6-12
[/TD] [TD='top']
T3 free
[/TD]
[TD='top']
3.08
[/TD]
[TD='top']
2-4.4
[/TD] [TD='top']
Free T
[/TD]
[TD='top']
9.65
[/TD]
[TD='top']
5.01-27.78
[/TD] [TD='top']
Estrogen
[/TD]
[TD='top']
14.98
[/TD]
[TD='top']
0-50
[/TD] [TD='top']
Estradiol
[/TD]
[TD='top']
11.99
[/TD]
[TD='top']
7.6-43
[/TD] [TD='top']
FSH
[/TD]
[TD='top']
4.93
[/TD]
[TD='top']
1.5-12.4
[/TD] [TD='top']
LH
[/TD]
[TD='top']
7.07
[/TD]
[TD='top']
1.7-8.6
[/TD] [TD='top']
Progesterone
[/TD]
[TD='top']
.33
[/TD]
[TD='top']
.2-1.4
[/TD] [TD='top']
Prolactin
[/TD]
[TD='top']
5.52
[/TD]
[TD='top']
4.6-21.4
[/TD] [TD='top']
Total T
[/TD]
[TD='top']
483
[/TD]
[TD='top']
250-850
[/TD] [TD='top']
DHEAS
[/TD]
[TD='top']
205.5
[/TD]
[TD='top']
140-484
[/TD] [TD='top']
SHBG
[/TD]
[TD='top']
39.4
[/TD]
[TD='top']
14.4-70.7
[/TD] [TD='top']
Vit D
[/TD]
[TD='top']
70.5
[/TD]
[TD='top']
30-100
[/TD]

 

[Systemlord]

[TD='top']
Estrogen
[/TD]
[TD='top']
14.98
[/TD]
[TD='top']
0-50
[/TD] [TD='top']
Estradiol
[/TD]
[TD='top']
11.99
[/TD]
[TD='top']
7.6-43
[/TD]

There is why you need the Viagra, estrogen is on the low side. I’ve actually seen a couple of members with osteoporosis diagnosis to go along with an estrogen value of 16 pg/mL. Normal adult male, healthy estrogen Is 20>, preferably 25 pm/ml or higher.

[TD='top']
Free T
[/TD]
[TD='top']
9.65
[/TD]
[TD='top']
5.01-27.78
[/TD]

As it is, Free T reference ranges and testosterone deficiency are poorly defined, no standardized hormonal testing methods.

It’s not uncommon to see low estrogen alongside a low Free T value. Many experts, believe Free T at the bottom 25 percentile or low normal to be a sign of hypogonadism.

I strongly believe more testing is needed, at least a ferritin level attained before starting TRT.

 

[Seagal]

There is why you need the Viagra, estrogen is on the low side. I’ve actually seen a couple of members with osteoporosis diagnosis to go along with an estrogen value of 16 pg/mL. Normal adult male, healthy estrogen Is 20>, preferably 25 pm/ml or higher.


As it is, testosterone reference ranges are poorly defined, no standardized hormonal testing methods.

It’s not uncommon to see low estrogen alongside a low Free T value. Many experts, believe Free T at the bottom 25 percentile or low normal to be a sign of hypogonadism.

I strongly believe more testing is needed, at least a ferritin level attained before starting TRT.

I would test DHT level
Didn't know about PSSD. You could try a supplement to increase dopamine.
How do you feel after a one/two week pause of lifting and martial arts? Maybe you need more recovery time?

 

[ExpatinLatAm]

There is why you need the Viagra, estrogen is on the low side. I’ve actually seen a couple of members with osteoporosis diagnosis to go along with an estrogen value of 16 pg/mL. Normal adult male, healthy estrogen Is 20>, preferably 25 pm/ml or higher.


As it is, Free T reference ranges and testosterone deficiency are poorly defined, no standardized hormonal testing methods.

It’s not uncommon to see low estrogen alongside a low Free T value. Many experts, believe Free T at the bottom 25 percentile or low normal to be a sign of hypogonadism.

I strongly believe more testing is needed, at least a ferritin level attained before starting TRT.

So I need to get estrogen and free T up. TRT do both of these IIRC.

 

[ExpatinLatAm]

I would test DHT level
Didn't know about PSSD. You could try a supplement to increase dopamine.
How do you feel after a one/two week pause of lifting and martial arts? Maybe you need more recovery time?

I don't think it's a recovery issue. I've done deload weeks regarding lifting. I've also had some illnesses whereby I've taken five or so days off from lifting. I think additional protein will definitely help and yesterday I picked up some protein powder to integrate into my diet.

 

[Kenp]

Yeah sounds like typical PSSD/PFS

 

[ExpatinLatAm]

Yeah sounds like typical PSSD/PFS

Didn't know what PFS was but just looked it up and accurately explains many of my symptoms too. But I've never used finasteride. Interesting...

 

[sammmy]

Are you taking any supplement or drug that claims to be an Aromatase Inhibitor?

Your free T is low normal, but your estrogen is strangely suppressed.

 

[TLR]

Your HPTA is functional and your T / FT levels are not that bad. Estradiol is lowish but not that bad….Cialis and Zinc are both weak AIs…I would STRONGLY recommend checking other causes for your symptoms and using alternative methods of raising testosterone (Clomid / HCG) before jumping on exogenous T…..its always there if you need it…don’t get in a hurry.

 

[ExpatinLatAm]

Are you taking any supplement or drug that claims to be an Aromatase Inhibitor?

Your free T is low normal, but your estrogen is strangely suppressed.

Nope.

 

[ExpatinLatAm]

Your HPTA is functional and your T / FT levels are not that bad. Estradiol is lowish but not that bad….Cialis and Zinc are both weak AIs…I would STRONGLY recommend checking other causes for your symptoms and using alternative methods of raising testosterone (Clomid / HCG) before jumping on exogenous T…..its always there if you need it…don’t get in a hurry.

Thanks for the ideas. I'll look into both.

I saw a urologist yesterday who's apparently one of the best where I am. He looked at my labs and discussed some of my symptoms. He suggested trying 5 MG cialis instead. He also offered a pellet treatment for increased T levels. Not sure I want to go down this path when I have access to injectable. I was hoping for a script that I can then travel with.

Any ideas for other causes?

 

[sammmy]

Drop the zinc for a few weeks and see how you feel in terms of lethargy. Zinc is one of those overhyped supplements that "cures everything" but there is also zinc toxicity. It should be supplemented only if you are deficient by a blood test.

 

[FunkOdyssey]

Drop the zinc for a few weeks and see how you feel in terms of lethargy. Zinc is one of those overhyped supplements that "cures everything" but there is also zinc toxicity. It should be supplemented only if you are deficient by a blood test.

Yes. Both zinc and multivitamins make me feel like hot garbage. If I took them all the time and wasn't paying attention I would have a lot of annoying symptoms with no explanation.

If you're eating enough nutrient dense animal-based foods you don't need to supplement anything.

 

[ExpatinLatAm]

Yes. Both zinc and multivitamins make me feel like hot garbage. If I took them all the time and wasn't paying attention I would have a lot of annoying symptoms with no explanation.

If you're eating enough nutrient dense animal-based foods you don't need to supplement anything.

This is part of my problem...I'm simply not eating enough quality food. Not cooking enough of my own food too.

 

[Systemlord]

He also offered a pellet treatment for increased T levels.

Sure he did, $$$$! Pellet therapy is far more profitable than any other version of TRT, other than new oral capsules. Urologist make more money doing procedures and surgeries, which are encouraged.

Now you know your urologist is putting his needs, interests ahead what’s best for the patient.

The pellet therapy seems unnecessary, evasive , given much better, uncomplicated delivery methods that will see much more stability in your hormone levels throughout a given time, rather than having to deal with yo-yo therapy, where your hormones are on a roller coaster of highs and lows right after and towards the end before your next insertion.

There’s not many men on pellet therapy, long-term, they usually wake up and want something less evasive and not so yo-yo feeling.

The 5 mg daily Cialis I wholeheartedly agree with, which offers numerous health benefits beyond its intended purpose.

 

[Systemlord]

Any ideas for other causes?

I'm simply not eating enough quality food. Not cooking enough of my own food too.

80 percent of cancer in the US is avoidable,, by eating healthy foods, because the unheathy food causes metabolic disturbances and some new research suggests that cancer is a metabolic disease.