Looking for some assistance for next steps

[Danon]

I would like some perspective on my labs as I try to make some decisions. I recently got some labs back which once again showed some low-T and wonky thyroid. I have had these wonky labs for at least 7 years with little to no treatment (some T4 for a while). My pcp is open to TRT but wants me to get a sleep study first (to rule out sleep apnea). He doesn't see a need to treat thyroid at this point. I have an appointment with a urologist but wondering if that is going to be a waste of time based on what I keep reading. Do these labs suggest primary or secondary hypogonadism? Should I try to get thyroid treated first? Would these numbers suggest trt treatment? I am posting here because I am wanting to educate myself on TRT. I have made several lifestyle changes over the past few years with little difference (lost weight, started lifting, clean diet, eliminate xenoestrogens, consistent 8 hrs of sleep, etc).

 

[madman]

I would like some perspective on my labs as I try to make some decisions. I recently got some labs back which once again showed some low-T and wonky thyroid. I have had these wonky labs for at least 7 years with little to no treatment (some T4 for a while). My pcp is open to TRT but wants me to get a sleep study first (to rule out sleep apnea). He doesn't see a need to treat thyroid at this point. I have an appointment with a urologist but wondering if that is going to be a waste of time based on what I keep reading. Do these labs suggest primary or secondary hypogonadism? Should I try to get thyroid treated first? Would these numbers suggest trt treatment? I am posting here because I am wanting to educate myself on TRT. I have made several lifestyle changes over the past few years with little difference (lost weight, started lifting, clean diet, eliminate xenoestrogens, consistent 8 hrs of sleep, etc).

You are primary as your LH is high and FSH on the top end.

Prolactin is just over the top end.

Would be wise to have estradiol and SHBG tested.

Unfortunately, you had your FT tested using an inaccurate assay the piss poor direct immunoassay!

Keep in mind that although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

The only way to know where your FT truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

Regardless with a TT in the 300s, your FT would be absurdly low.

You definitely would benefit from trt.

The hardest part will be finding a knowledgeable doctor when it comes to up-to-date treatment.

Keep in mind that although having healthy hormones is critical to men's overall health that thyroid/adrenal health will have a significant impact.



4.Why does testosterone deficiency occur?

Testosterone production primarily occurs in the Leydig cells of the testis and is regulated by the hypothalamic-pituitary-gonadal axis (HPG, Figure 1).17 For normal testosterone production, gonadotropin-releasing hormone (GnRH) is released in a pulsatile manner from the hypothalamus. GnRH stimulates the production and release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the anterior pituitary. LH stimulates testosterone production by the Leydig cells in the testis. The HPG axis is regulated by a negative feedback loop whereby high levels of testosterone send a feedback signal (via estradiol and testosterone) to both the pituitary and the hypothalamus to inhibit ongoing testosterone production.17 This pathway is essential for testosterone production and any disruptions can cause downstream effects and inhibit the production of testosterone.

Clinical TD results when the body fails to produce adequate levels of testosterone. If there is an intrinsic failure at the level of the testis to produce testosterone, it is termed primary hypogonadism. By contrast, if there is a hormonal/gonadotropin signaling problem within the brain (hypothalamus or pituitary), it is considered secondary hypogonadism. Primary hypogonadism results in low levels of testosterone but high levels of gonadotropins (LH, FSH). The brain is trying to amplify its signal to the testis to produce testosterone. Secondary hypogonadism is a result of a neural signaling deficiency and clinically manifests with low levels of testosterone and low or normal levels of gonadotropins. A combined pattern of primary and secondary hypogonadism is common. TD or hypogonadism occurs as men age due to several factors including a decrease in Leydig cell size, reduced Leydig cell sensitivity to LH, increases in systemic estrogen levels, and a diminution of GnRH pulsatility.18,19 Multiple medications and medical conditions are also responsible for TD (Table 2).

 

[Danon]

So if primary, then a sleep study is inconsequential, correct? no amount of sleep is going to fix primary hypogonadism?

 

[Vince]

So if primary, then a sleep study is inconsequential, correct? no amount of sleep is going to fix primary hypogonadism?

I definitely would still do the sleep study. If you have sleep apnea, it's going to cause lots of issues. Especially with increase red blood cells, HCT. Your levels will become very high, if you start trt.

 

[Systemlord]

no amount of sleep is going to fix primary hypogonadism?

You have primary hypogonadism that no amount of restful sleep can fix. When your doctor does finally give in to TRT be prepared for a suboptimal treatment protocol because TRT is rarely done correctly in the sick care setting.

If your doctor insists on injections every 2-4 weeks, run don't walk out of the office. There are other options to get better treatment protocols, like private self pay walkin or telemedicine clinics.

 

[Danon]

Thank you guys for the input. I don't think I'm going to address TRT with my doctor but I am exploring all my options and really at the beginning of the TRT journey. I had been hoping the last few years that maybe this was caused by stress, poor nutrition, etc. But that does not seem to be the case. I suppose the next step is to investigate the private lab scene and find out about costs. But based on your experience, looking at the numbers, a clinic like Defy would put me on TRT? Also, I know that improved thyroid function can improve low T, but is the relationship bidirectional? Will improving low T improve the thyroid?

Btw, thanks for chiming in. I've been hesitant to ask questions and just lurking for a while trying to learn but after a brutal winter I am now ready to address this and I appreciate the input. Cheers.

 

[madman]

Thank you guys for the input. I don't think I'm going to address TRT with my doctor but I am exploring all my options and really at the beginning of the TRT journey. I had been hoping the last few years that maybe this was caused by stress, poor nutrition, etc. But that does not seem to be the case. I suppose the next step is to investigate the private lab scene and find out about costs. But based on your experience, looking at the numbers, a clinic like Defy would put me on TRT? Also, I know that improved thyroid function can improve low T, but is the relationship bidirectional? Will improving low T improve the thyroid?

Btw, thanks for chiming in. I've been hesitant to ask questions and just lurking for a while trying to learn but after a brutal winter I am now ready to address this and I appreciate the input. Cheers.

Seek out Defy and they will take care of you.

You can use Nelsons discountedlabs.

Numerous tests/panels to choose from.

Pre Testosterone Replacement Blood Test Panel

Blood Tests Before Starting Testosterone Replacement Therapy TRT

www.discountedlabs.com

 

[Systemlord]

But based on your experience, looking at the numbers, a clinic like Defy would put me on TRT?

Your Total T is inert, the Free T is the active portion of testosterone and is abnormally low. I haven't seen Free T levels this low on these forums in a long time.

Defy is great and use them myself.

Also, I know that improved thyroid function can improve low T, but is the relationship bidirectional? Will improving low T improve the thyroid?

Correcting the low-t will not fix the thyroid, but sometimes fixing thyroid can improve testosterone numbers in some cases.

TRT won't work very well when there are thyroid problems.

 

[Danon]

I started the intake process with defy and just got back the labs they needed in addition to the ones above. I will be scheduling my initial consult soon and would like some thoughts and feedback. I want to get a sense of what this means before meeting with them. Any insight from these labs? Any idea what course of treatment they might recommend?

 

[Danon]

And why is igf-1 being tested? tried looking that up and couldn't find an answer.

 

[Vince]

And why is igf-1 being tested? tried looking that up and couldn't find an answer.

These threads may help.

Optimum IGF-1 Levels

Can't seem to find a prior thread on the optimum IGF-1 levels. My pre-TRT IGF-1 levels were 233 ng/ml (with a range of 75-216 ng/ml). I am about to start enclomiphene (12.5mg/daily) and ibutamoren (12.5mg/daily). The ibutamoren was prescribed after complaining about some nagging gym injuries...

www.excelmale.com

 

[Danon]

Had my initial consult with defy this week. Mike is recommending 200mg per week (broken into 3 doses per week) and an AI as needed. Although my estradiol is ok, he thinks it may spike with TRT. Breaking the injections up to 3x per week may help reduce this. I do not want to take an AI but my head is spinning with too much research these days. Any thoughts appreciated.

 

[madman]

Had my initial consult with defy this week. Mike is recommending 200mg per week (broken into 3 doses per week) and an AI as needed. Although my estradiol is ok, he thinks it may spike with TRT. Breaking the injections up to 3x per week may help reduce this. I do not want to take an AI but my head is spinning with too much research these days. Any thoughts appreciated.

Overkill for a starting dose regardless of where your SHBG sits as of now!

 

[Danon]

Thanks for your input Madman. Not sure what to think about that. I'm trying to find resources to help me understand how frequency of injection influences estradiol. I'm sure that has been discussed on this forum but I can seem to find that info.