25 years old. Just started TRT. I have a few questions...seeking advice

[dpaul21]

Good Day Gentlemen,

I'll try to keep this as brief as possible. I'm 25years old and I recently started TRT injections. My diagnosis is: Hypopituitarism, Hyposexuality and Hypothyroidism. I've been taking Test Cyp (100mg/week) for the past 4 weeks and I am due to get my next round of blood work in July (3-4 weeks). I've also been taking 0.5 grain (30mg) of Armour Thyroid for the past couple of months. Here are my questions:

1) My endo wrote a lab slip to get the following blood work done as a follow-up to starting my TRT:

T4, Free [fT4]
Cortisol, AM [COAM]
--> What other lab/blood tests should I ask for (if any)?

2) I'm currently not taking any AI, hCG, etc. Do I even need these things? If so, how should I approach talking to the doctor about this subject?

3) Since I am self-injecting at home, would it be more beneficial to split my dose to 50 mg 2x/week instead of 100 mg/week?

Thanks in advance,

Daryl

 

[Tom Larabee]

Hi Daryl,

Glad you are here.

On the first question, look at this post and see the Gold standard tests:


You only need AI if you have blood values of Ultra-senstive Estradiol lab work that point to the need, otherwise stay away from it if at all possible, very strong medicine

HCG is a must and there are papers in the forums about it which you could print out and give to your doc, just do a search on HCG and you will get them.

Split dose injections work better for some, as it evens out the troughs of the half-life of Cypionate, for others it doesn't so you will have to try it to see. I recommend it personally.

Tom

 

[Tom Larabee]

Also when you do get results post them in the Blood work forum if your comfortable and others will let you know thoughts to discuss with your doctor based on those.

One other question how do you feel with what your taking now?

Chris will also most likely provide input on your Thyroid tests which will go beyond that basic set in the thread above.

 

[Vettester Chris]

Daryl, glad you posted, and glad you joined the EM community. 25 is indeed pretty young for having to go through all of this. Regarding the diagnosis your physician provided with the pituitary, did he/she have an MRI performed? Presuming no adenoma or other complications?

On the thyroid, get your Free T4, Free T3, Reverse T3, and TSH. If you haven't had antibodies checked, run the TPO & TgAb. If you get a chance can you also provide your baseline labs prior to going on the Armour? It would be good to compare the baseline against your upcoming follow up labs to see how things look with the NDT medication included. 1/2 grain is usually the starting point to start getting the FT4 & FT3 levels up above 50% of the respective range values.

Lastly, since you're getting the cortisol already, look into upgrading it with a 4x saliva kit. It is very accurate, and it will give you the circadian profile for your cortisol productivity for the entire day (well, about 18 hours of it or so). Since you're on NDT, I highly recommend this, as it will be one area you will be searching if your RT3/FT3 ratio is off.

 

[Gene Devine]

IMO this Physician went to Testosterone therapy WAY TO FAST!

You are only 25 and you need to know the life long consequences and commitment this is for you.

Everything, and I mean everything, should have been tried first with Testosterone being the last therapy of choice if all other things failed.

Correcting your HPTA is probably all it would take to get your Testosterone serum levels back to normal levels.

Clearly something is compromising HTPA because this is not age related decline.

Just correcting Hypothyroidism will correct Hypogonadism and thus your Testosterone serum levels would rebound.

I would seriously reconsider this course of action and have a frank discussion with your Doctor or seek another medical opinion from a Endo trained in HPTA and Hypothyroid management.

I am serious here and only care about your health, long term, dpaul. Being 25 years old and going on TRT is a serious matter and I think you can correct your problems by getting your Thyroid back to normal function.

 

[dpaul21]

@Chris - I had an MRI performed last fall to check for a pituitary adenoma. Results were negative.

Regarding my thyroid, I've had the following levels checked over the past year (Some tested multiple times):

Before Beginning Thyroid Medication:
Free T4: 1.0 (0.8 - 1.8 ng/dL)
TSH: 3.88, 4.79 (.40 - 4.5 mIU/L)
Thyroglobulin Antibodies: <20 (<20 IU/ML)
Thyroid Peroxidase AB: 17 (<35 IU/ML)

After Starting Thyroid Medication:
Free T4:1.13 (0.8 - 1.8 ng/dL)
Free T3: 2.6 (2.0 - 4.4 pg/mL)
TSH: 2.08 (.40 - 4.5mIU/L)

I've never had my Reverse T3 levels checked...this is very frustrating guys

 

[ironman]

Have they ever even done a testosterone test to see where your levels were at?

 

[HarryCat]

Your hypothyroidism is still under-treated. Your FreeT3 and FreeT4 are still low, goal should be to get them near the top of the reference range, or as high as it takes to relieve symptoms, whichever comes first. TSH is still high, you want it down near 1.0.
Do you feel any improvement in symptoms since starting thyroid meds?

 

[dpaul21]

I've had my test levels checked multiple times over the past 6 months.

Date	Total Test (241-827 ng/dL)	Free Test (9.3-26.5 ng/mL)
7/5/2013	186
7/9/2013	159	5.1
11/26/2013	274	5.75
1/7/2014	309
	264
3/25/2014	163
5/9/2014	176	3.3

NOTE: I was prematurely put on TRT by my PCP in Late July 2013. Once I saw my Endocrinologist in early October, I was taken off TRT for further testing to determine the cause of my low levels. I was recently put back on TRT (May 20, 2014) and I have my next endo appt. on 7/2/2014.

 

[dpaul21]

I just emailed my endocrinologist regarding my upcoming lab work. I asked her to add some different things to be tested. I asked for the following to be tested:

Free T
Total T (already included)
Estradiol
LH & FSH
DHEAs
T4, Free (already included)
T3, Free
Reverse T3
TSH (already included)
Cortisol (already included)

She responded with the following:

HI Daryl,
Checking estradiol levels in males with normal levels is unnecessary—especially since the initial check was normal. Free testosterone is unnecessary because adjusting total testosterone for SHBG is more accurate. FSH and LH are suppressed on testosterone supplementation and serve no purpose in regulating levels. DHEAs is also unnecessary to assess since we are not supplementing it. If we are unable to obtain adequate therapy with testosterone administration we may look to adding DHEA but that is unlikely. We could add a FT3, but reverse T3 would provide no useful information in dosage adjustment or evaluation. The other levels are more than adequate. You could do a salivary saliva test. I don't need to order it. You can obtain the kit from a compounding pharmacy or directly online from ZRT.com. I will send out order for FT3.

Is she correct?
How should I respond to this?'
Which lab test should I "demand" as a 2-month follow-up to starting TRT?

I appreciate all the help guys,

Daryl

 

[Gene Devine]

She is not correct in almost her entire response.

You need RT3! Many times all Thyroid labs will look "ok" till you look at RT3 and it tells an entirely different story.

How do you know if you need to supplement DHEA if you don't test for DHEA-S???

What does she mean by estrogen being "normal"??? We all know that the reference range for men's estrogen levels are not "normal" and if she is simply going by reference range than she doesn't understand.

You need to find a Doctor who really understands male hormonal loops.

Where do you live?

 

[dpaul21]

Pittsburgh, PA

 

[Gene Devine]

Pittsburgh, PA

Willing to drive to Lancaster to see the Master himself, Dr. Eugene Shippen?

I'd fly across the Country to see this man if I had the need.

He is without any question one of the worlds best in understanding and treating men's hormonal pathways.

Call his office, he will talk with you over the phone at no cost...he's that kind of guy!

Dr. Eugene Shippen
Address: 9 E Lancaster Ave, Shillington, PA 19607
Phone (610) 777-7896