New to TRT, lingering concerns

[Tad1979]

[FONT=&quot][FONT=&quot]Hi there,[/FONT][/FONT]
[FONT=&quot][FONT=&quot] I'm 38, chronic back pain and repeated serious respiratory issues for which I have been on prolonged prednisone treatments. I have two adopted kids and a spouse who has been on disability for years. As a former paramedic, I’ve done my best to remain active and fit despite my health issues - after all, who else is going to take car of my family? About a year and a half ago, I started having difficulties in the bedroom, periodic insomnia, fat gain (no matter what I did for exercise or diet), and occasional bouts of depression and anxiety. I did some research, and came to the conclusion that my symptoms could be caused by either low thyroid or low testosterone. I asked my primary doctor to check my levels (I was met with an exasperated "Doctor Google strikes again!") and my TSH came back 2.9 (well within range), and my total testosterone came back 257, free testosterone 37, and SBHG 24, and % free testosterone 1.4 - barely scraping by the low end of normal for the lab my doctor uses. Still, I was reassured I was probably just dealing with the physical effects of stress to to try to slow things down at home.[/FONT][/FONT]
[FONT=&quot][FONT=&quot][/FONT]
[/FONT]
[FONT=&quot][FONT=&quot] Move forward about 2 months ago - I still have not managed to lose any fat weight, despite being in the gym 3-4 times per week (my weight hasn't gone up though), and things are so bad in the bedroom that I hadn't reached orgasm in over a month. I'm experiencing hot flashes, and my family is describing me as "moody", "distant", and "irritable". I was having so much trouble falling asleep, that I was going on about 3-4 hours of sleep per week, and was in a constant fog. Since my doctor hadn't been particularly receptive, my other labs were without question in a healthy range at my last exam, and since I wasn't going to be able to see my primary doctor until September, I decided to stop into a local low T clinic. I figured if my testosterone had even the most remote chance of being the problem, they'd find/exploit it. And I was at a point I just couldn't keep living this way. My testosterone levels came back low across the board - total testosterone was only 128, (I forget the free testosterone number but it was low too. Estrogen was 11.4. My vitamin D was also low at 14.9. The one surprise was my TSH was slightly elevated at 4.9, though my T3 and T4 were well within normal levels.[/FONT][/FONT]
[FONT=&quot][FONT=&quot][/FONT]
[/FONT]
[FONT=&quot][FONT=&quot] I made the decision to start TRT. My thinking was that the year prior my TSH had been normal while my testosterone levels were either low or barely within normal, and some of the reading I’ve done suggested my TSH could settle down some once my testosterone levels back into a better range. Possibly faulty, wishful thinking on my part but we’ll see.[/FONT][/FONT]
[FONT=&quot][FONT=&quot][/FONT]
[/FONT]
[FONT=&quot][FONT=&quot] I’m now two weeks into treatment and the difference has been unexpectedly rapid. I’m sleeping soundly and restfully through the night now, and actually dreaming. I’ve reached orgasm during sex, though I feel silly still thinking of that as an accomplishment. I’m handling the kids so much better - they just aren’t able to push my buttons like before and I’m able to deal with their issues calmly and even with some good humor. It feels like a spark inside me has reignited and every movement no longer feels like it’s sucking out my soul. I feel more like myself than I have in years.[/FONT][/FONT]
[FONT=&quot][FONT=&quot][/FONT]
[/FONT]
[FONT=&quot][FONT=&quot] There are still a few concerns hovering over this.[/FONT][/FONT]

• [FONT=&quot][/FONT][FONT=&quot]my spouse hit the roof over the idea of sleep apnea concerns. I’ve been told I snore since high school, but my sleep has always been restful up until about six months ago, and my symptoms started well before that. I promised I would get a sleep study for the sake of my marriage, but what happens if it is determined I do have sleep apnea? I’ve read that treating sleep apnea can double testosterone levels, but that will still leave me on the low side of things.[/FONT]
• [FONT=&quot][/FONT][FONT=&quot]the slightly elevated TSH. My next labs are on August 20th, and I guess if the TSH comes back elevated again I’ll be talking to my primary doctor.[/FONT]

[FONT=&quot][FONT=&quot][/FONT]
[/FONT]
[FONT=&quot][FONT=&quot] I guess where I stand right now is I feel like the TRT is doing good things for me, and I’m worried either my physician or my spouse is going to try to pressure me to stop the treatment when my inclination is to follow my gut. I mean, the TRT is helping, whereas if I agree to stop to treat sleep apnea or thyroid issues it “might” help but not enough.[/FONT][/FONT]
[FONT=&quot][FONT=&quot][/FONT]
[/FONT]
[FONT=&quot][FONT=&quot] Any thoughts or experiences from others would be welcome.[/FONT][/FONT]

 

[Vince]

I definitely would do the sleep study, I know do many men that use the CPAP and love it. I would also get a complete thyroid panel at least once. TSH, FT4, FT3, reverse T3 and antibodies.

 

[Tad1979]

if either of those results come back abnormal, what should I expect from my healthcare providers?

 

[Vince]

If you need the CPAP, rent them until you find the right one that works for you. After you're sleeping good then get Labs again. When you get thyroid labs post them and then we could answer better. I believe in first treating a thyroid before someone should go on trt. Both can give you the same symptoms.

 

[Vince Carter]

I know looking at lab ranges things can appear slightly elevated or whatever but a TSH of 4.9 is not good at all.

I don't get down with the sleep study and CPAP hysteria such as it is, I'd put that way off in the future and deal with the Thyroid matters.

 

[WrenchHead80]

Fixing a sleep apnea problem will not double your T levels. If you think you have it, by all means get checked out. But getting it fixed will not effect your TRT treatment in a way were you shouldn't be on it. There's members here that have sleep apnea that are on TRT and others that are on TRT while treating their sleep apnea problems with a CPAP as mentioned too. You have low T numbers you needed to do something to address it. Your thyroid also needs looking into. Hopefully you find someone that actually knows how to treat it the right way. Finding a good thyroid Dr is as hard as finding a good TRT Dr.

Wouldn't be a bad idea to share what your TRT protocol is. Most places are clueless. If you did have a bad protocol members here would be able to tell you and suggest a better protocol. My PCP was clueless and the first two clinics I went to were just as bad.

 

[JimGainz]

I agree with all of the above and would recommend you see some other doctors who are more up to date on TRT protocols. All of us going through this can tell you there are plenty of doctors who would be fine keeping your testosterone level around 400 which is ridiculously low for a Trt protocol. Also – regarding your thyroid – it’s a big deal and affects numerous bodily systems. For what it’s worth – I was feeling like crap with my TSH around 4.1 - even after starting TRT. Finally got some good thyroid meds and am good as new.