Learning all I can!

[Chris]

Hey guys,
Some of you already know me, I've been asking a lot of dumb questions on the TRT facebook page. I've finally made it over here. There is a lot of good info! Here is a little about my TRT experience so far:

I've had untreated Low T and hypothyroidism for several years now. At least 3 years that I know of. I actaully came to my doctor thinking something was wrong with my thyroid a few years ago, and we tested and he told me I just need to loose weight. (Although, the reason I though I had a thyroid problem was because I was haveing trouble loosing weight.) After that I thought if my thryoid is okay it must be my testosterone. We checked that and I was around 300 mg/dl, which he told me was normal. Next test I was in the 200's, next test I was in the 100's, still he told me my free T was still in range so nothing to worry about. Not to mention I had gained 50lbs in that time peroid. Finally one day I had a problem being intimate with my georgous girlfriend and I had had it. I picked a different doctor and brought him all the tests I had collected from the first doctor and he was shocked that I had been untreated for so long, and that I had never been checked for testicular cancer which he informed me is a possible cause for a 33 year old male to have such low T. I had an MRI, sleep study, started synthroid, went to an endo and he started me on AndroGel 1.62% (because I insurance damands topical be tried first) after one month on AG I was starting to feel better in several ways but my T was only up to 249 mg/dl so I gave a valid reason to switch off of AG and I got my first injection of depo-testosterone yesterday. I'm taking 50mg every 7 days (per my request) and I'm hoping to feel a lot better soon!

 

[Vettester Chris]

Chris, welcome to EM! Glad you joined!

What you're reporting is an all too common theme with so many physicians these days. It would be good to see ALL the labs related with your diagnosis' and treatments. I'd be really curious to see where your HPTA and gonadotropin levels were at during your physician's briefing about testicular cancer. It sounds like that MRI was negative, but maybe you can confirm the conclusion. Either hypogonadism or hypothyroidism can contribute to the demise of each other, so one could have easily had a helping hand with the decline of the other. What lab results influenced their decision to treat with Synthroid? Again, I'd like to see baseline labs, plus updated labs (comprehensive though, not the TSH and free T3 uptake stuff).

 

[Gene Devine]

I agree with Chris, we really need to see your full set of labs to help you make sense of what's going on.

To have androgen levels so low at your age would suspect that there is some type of pathology causing it.

One common reason for this are small Pituitary Tumors known as Adenoma's. These Adenom's can secrete prolactin so one clear sign of this would be elevated Prolactin levels coupled with low androgen levels.

Most PCP's and Endo's are simply not trained well when it comes to low androgen levels in men and more importantly that in younger men where it's not age related.

I would suggest that you seek out a Physician who specializes in Testosterone Replacement Therapy in men and who is credentialed to do so.

Look for the sticky in our forums on how to find a TRT Physician and get another opinion on what's going on...you're to young to be feeling like you do AND you need to rule out pathology as soon as possible.

 

[Nelson Vergel]

Chris

50 mg per week of testosterone cypionate injections is not enough to bring a man into eugonadal (normal testosterone) blood levels. The usual dose is 100-200 mg per week. Is there any reason why you chose a sub-optimal dose? Fears?

 

[Gene Devine]

Chris

50 mg per week of testosterone cypionate injections is not enough to bring a man into eugonadal (normal testosterone) blood levels. The usual dose is 100-200 mg per week. Is there any reason why you chose a sub-optimal dose? Fears?

Probably his Doctor's prescription; based on his OP I don't think his Physician is well trained in TRT for men.

 

[Chris]

You're right, it's my mistake, I'm taking 0.5cc (100mg) per week.
The MRI did come back negative with slight abnormality but not an Adenom as far as I can tell.
The Endo thinks my problems are cause from 10 years of recreational drug use (from age 14-24) so he's not really looking for anything else.
The decision to treat with synthyroid was based on TSH being high. I think I answered everyone's questions.
I will get my labs up ASAP, Im not sure the best way to go about that, do people scan them in? I have 5 sets of labs sapning back to 2011 all in different formats and testing different things with multiple pages each.

 

[Vettester Chris]

Chris, thanks for clarifying your protocol dosage. Like Gene said, it sounds like your physician isn't quite up to speed in this area of treatment. Did you at least get LH & FSH labs prior to starting your treatment? Also, can you clarify, are you saying the doctor made a thyroid diagnosis solely on TSH? No free T4, free T3, antibodies ?? Were any post labs taken to compare thyroid results?

 

[Chris]

My GP made the decision to treat my thyroid based soley on TSH (as far as I know) and my endocrinologist only spoke to me about TSH when we meet, but, when I went in to get training to give myself shots I asked the nurse about T3 and she went and asked the doctor and reported back to me that he said he doesnt want to treat T3 until my T4 is up, so I assume he just wasn't talking to me about it. But as far as I know, The labs that I got immmediatly prior to starting Synthyroid and TRT (dated 2/17/14) were very limited OR the report they gave me was just a summary. It shows:
Prolactin 5.33
PSAN <1
T total 117
Free T 4.4
Thyroglobulin <0.02
TPO Ab <0.02
TSH3UL 5.97

And that's it. But the lab the endo ordered (dated 4/4/14) that I got after being on Synthyroid (for 6 weeks) and TRT (for 4 weeks) seems to be very comprehinsive. It's 3 pages of numbers and codes that I can't desipher. The only thing I could tell from that set was my Total T was "up" to 249 mg/dl after being on AndroGel for 4 weeks.
Just to be clear I started Depo-Test injections on 4/7/14.

 

[Chris]

I got my results back from Fridays blood test (4/11/14). This was 5 days after my first injection. Total T was 367. That's all they tested.

 

[Vettester Chris]

Chris, your physician's explanation on not wanting to treat the T3 until the T4 is up is confusing. If conversion of T4 to T3 by the deiodinase enzyme is effective, then essentially you will also be treating T3 when administering T4 only medications like Levothyroxine. At a glance, T4 can be viewed as the storage thyroid hormone, T3 can be viewed as the active form of thyroid hormone, which is also approx. 4x more potent than T4. I would try to get your doctor to clarify the objective of taking a solo focus on T4. Maybe he's seeing this at an angle that's being overlooked?