6 years of progressively worse mental fog/lack of clarity, lack of motivation, low physical energy, tiredness, irritability, feeling of not being in control of emotions, decrease in libido, decrease in erection firmness and sensation, and weight gain. Unexpectedly poor results with strict diet (by a dietitian) and exercise (with a trainer 4x per week for 2 years). The primary complaints are related to mental and physical fatigue and lack of interest/motivation.
Since beginning TRT, I generally feel better. The biggest improvement is with motivation, sex drive, interest in things I enjoy, less irritability, and being less insecure with my body. The persistent problem is simply feeling physically sleepy despite good rest and feeling mentally energized, if that makes sense. The persistent sleepiness feels more like exhaustion for 3 days out of the week.
This part is hard to describe. Though I do feel much better overall, the times when I feel "like myself" are like flickers. Like when there's a word on the tip of your tongue, but you can't quite say it. Or when you recognize an actor, but you just can't quite remember where you saw him. Or deja vu. It's a constant feeling of "almost but not quite." Not sure how to describe this better.
The numbers:
[TD="width: 13%"] | [/TD] | [/TD] | [/TD] | [/TD] | [/TD] |
[TD="width: 13%"] | tT[/TD] | 03/13/17[/TD] | 08:58[/TD] | 354[/TD] | 300-1080 ng/dl[/TD] |
[TD="width: 13%"] | fT[/TD] | 03/13/17[/TD] | 08:58[/TD] | 106[/TD] | 47-244 pg/ml[/TD] |
[TD="width: 13%"] | fT4[/TD] | 03/13/17[/TD] | 08:58[/TD] | 0.97[/TD] | .8-1.8 ng/dl[/TD] |
[TD="width: 13%"] | TSH[/TD] | 03/13/17[/TD] | 08:58[/TD] | 1.204[/TD] | .3-5.0 uIU/ml[/TD] |
[TD="width: 13%"] | ALB[/TD] | 03/13/17[/TD] | 08:58[/TD] | 4.5[/TD] | 4.2-5.2 g/dl[/TD] |
[TD="width: 13%"] | tT[/TD] | 04/04/17[/TD] | 09:02[/TD] | 340[/TD] | 300-1080 ng/dl[/TD] |
[TD="width: 13%"] | fT[/TD] | 04/04/17[/TD] | 09:02[/TD] | 101[/TD] | 47-244 pg/ml[/TD] |
[TD="width: 13%"] | TSH[/TD] | 04/04/17[/TD] | 09:02[/TD] | 1.95[/TD] | .3-5.0 uIU/ml[/TD] |
[TD="width: 13%"] | tT[/TD] | 04/13/17[/TD] | 14:05[/TD] | 108[/TD] | 241-827 ng/dl[/TD] |
[TD="width: 13%"] | FSH[/TD] | 05/09/17[/TD] | 12:16[/TD] | 6.3[/TD] | 1.4-18.1 mIU/ml[/TD] |
[TD="width: 13%"] | LH[/TD] | 05/09/17[/TD] | 12:16[/TD] | 4.6[/TD] | 1.5-9.3 mIU/ml[/TD] |
[TD="width: 13%"] | s E2[/TD] | 05/09/17[/TD] | 12:16[/TD] | 25[/TD] | 10-40 pg/ml[/TD] |
[TD="width: 13%"] | PSA[/TD] | 05/09/17[/TD] | 12:16[/TD] | 0.72[/TD] | 0-4.0 nl/ml[/TD] |
[TD="width: 13%"] | PRO[/TD] | 05/09/17[/TD] | 12:16[/TD] | 6.9[/TD] | 2.1-17.7 nmol/ml[/TD] |
[TD="width: 13%"] | SHBG[/TD] | 05/09/17[/TD] | 12:16[/TD] | 20.1[/TD] | 17.3-65.8 nmol/l[/TD] |
[TD="width: 31%, bgcolor: #808080, colspan: 2"] | 05/09/17[/TD] | Test Cyp 100mg[/TD] | |||
[TD="width: 31%, bgcolor: #808080, colspan: 2"] | 05/16/17[/TD] | Test Cyp 100mg[/TD] | |||
[TD="width: 13%"] | TT[/TD] | 05/23/17[/TD] | 08:45[/TD] | 284[/TD] | 241-827 ng/dl[/TD] |
[TD="width: 31%, bgcolor: #808080, colspan: 2"] | 05/23/17[/TD] | Test Cyp 100mg[/TD] | |||
[TD="width: 31%, bgcolor: #808080, colspan: 2"] | 05/31/17[/TD] | Test Cyp 100mg[/TD] | |||
[TD="width: 13%"] | tT[/TD] | 06/02/17[/TD] | 08:45[/TD] | 466[/TD] | 300-1080 ng/dl[/TD] |
[TD="width: 13%"] | fT[/TD] | 06/02/17[/TD] | 08:45[/TD] | 157[/TD] | 47-244 pg/ml[/TD] |
[TD="width: 13%"] | s E2[/TD] | 06/02/17[/TD] | 08:45[/TD] | 39[/TD] | 10-40 pg/ml[/TD] |
[TD="width: 31%, bgcolor: #808080, colspan: 2"] | 06/07/17[/TD] | Test Cyp 100mg[/TD] | |||
[TD="width: 31%, bgcolor: #808080, colspan: 2"] | 06/14/17[/TD] | Test Cyp 100mg[/TD] |
Relevant demo information:
[TD="width: 33%"] | [/TD] | 32[/TD] |
[TD="width: 33%"] | [/TD] | 5' 11"[/TD] |
[TD="width: 33%"] | [/TD] | 218[/TD] |
[TD="width: 33%"] | [/TD] | 23[/TD] |
[TD="width: 33%"] | [/TD] | Restless Leg Syndrome[/TD] |
[TD="width: 33%"] | [/TD] | Mirapex .25mg daily[/TD] |
[TD="width: 33%"] | [/TD] | B complex[/TD] |
- Baseline morning total T technically WNL (for the average diabetic 85 year-old), and that obliterates my odds of finding a non-skeptic physician or having anything covered by insurance outside of a primary care setting.
- The results for total T, free T, albumin, and SHBG do not check out with one another. If you calculate free T using the total T, SHBG, and albumin values, free T is actually 85.2-89.1 pg/mL. If you use the free T results to solve for SHBG, it puts SHBG at 12.4 nmol/L.
- Afternoon total T falls off a cliff by mid-day. A decline of ~70% is approximately double the typical decline in half the normal time. I believe this would support the possibility of the SHBG test result being incorrectly high. It's also worth noting that I ate lunch immediately AFTER this blood draw.
- LH and FSH results suggest that my body is not recognizing that it has a deficiency, but I don't know why.
- Estradiol looks great, but I don't know enough about T:E ratios to understand this in context.
- Trough of 284 prior to third injection is obviously not good. Subjectively, it's actually still an improvement over pre-TRT if only because it's stable instead of crashing every single day.
I realize 46 hours after a shot is not ideal for finding a peak, but I had a work emergency the day before. All the same...
- Again, the values for total and free do not add up. Assuming albumin at 4.5, that puts SHBG down to 8 nmol/L. Single digits are "crisis" territory, right?
- Estradiol is elevated but staying in proportion with my previous levels relative to total T.
- By this point, I'm seeing side effects like dark, concentrated urine for 2-3 days after injection and more oily skin.
Based on what I've learned up to now, it appears that my primary issue is a combination of high aromatization and metabolic clearance. That could explain the drastic diurnal pattern at baseline. I have seen some research on metabolic clearance correlating with age and SHBG:albumin ratio that would suggest that my clearance rate is high or very high, but I have not been able to find a usable formula to calculate the actual rate or assess whether it's inappropriately high.
If either of those is the case, then more frequent injections would be extremely beneficial.
Honestly, I'm sick to death of researching this, and I just need some help. Then I need to back that up with hard science, otherwise nobody will listen to me. Here are my main questions:
1) Am I on the right track? If I'm totally misreading the results, I need to understand why.
2) What does the LH level mean, and does it matter?
3) Why are free T levels not checking out with the formula? Is a sensitive free T test more or less reliable than SHBG? How do I determine which test result is faulty?
4) Why are my total and free T levels so low just 46 hours after an injection?
5) Does the estradiol increase or level raise any red flags, and does that answer change when SHBG is between 20 and 8?
6) Am I missing anything important? Am I too concerned about things that are not actual problems?
