TRT 2 years . Energy super low

[T0R0]

Hello Guys. Basically my biggest gripe is super low energy and low motivation. Lowish libido also..
So my history on TRT for 2+ years now. Pre TRT testosterone lvl was 182 ng/dL
55 yr male
Great shape
151 lbs

Anyway long story short, it took me almost a year/half to get dialed in and that only happened when I eliminated HCG / ai from the equation back last year. HCG was increasing my aromitization big time. Getting off the ai also was huge.

Current dose is 80-90mg test (200mg)cyp per week split up among 2 pin /wk
(week one = .2cc -2x and week two = .2cc - .25cc ).

Reason for this is that at :
11/16/2022 at 90/wk I was over 1100 ng/dl TT (e=45.8 pg/mL)
so reduce
01/11/2023 80mg/wk I dropped down to 680ng/dl TT (e=26.1 pg/mL)
so slight increase
So I was trying to hit something in the middle ergo, 80 one week, 90 the next.

So my current labs look like this: Took a more comprehensive test because feeling so low energy. Just noting the stuff out of ranges:

08/30/2023
TESTOSTERONE, TOTAL, MS 1090 ng/dL
TESTOSTERONE, FREE 266.0 H
SHBG 31 nmol/L
ESTRADIOL,ULTRASENSITIVE, LC/MS 54 pg/mL
PROLACTIN 10.8
DHT LC/MS/MS = 91 H
DHEA SULFATE 91
RED BLOOD CELL COUNT 6.37 H
HEMATOCRIT 51.2 H
MCV 80.4
MCH 25.9 L
MCHC 32.2

Ferritin 177

I recently also went to GP and thyroid tested about a month ago and could be a contributing factor.
July 11th TSH W Freet4 Reflex 6.970 UIU/ML
July 17th TSH 3Rd Gen 5.130 UIU/ML
August 28th TSH W Freet4 Reflex 5.510 UIU/ML

Am I correct in attributing this to my elevated TT ? My normal is in the 4's

Summary : So for the last 3 month or so, Super unmotivated and have to drag myself to gym. While I see some areas of concern here I was expecting high prolactin levels or anemia or some smoking gun here to explain why I feel the way I do..
I realize my TSH is suspect , my HCT isn't ideal.
Game plan here is slightly reduce dose. I'm thinking to keep 80mg and do 90mg once a month ..
Would appreciate any feedback from the gurus here !
Happy to elaborate on anything.
As an aside, I used discountedlabs for my latest labs, Thank you @Nelson Vergel

 

[Systemlord]

Basically my biggest gripe is super low energy and low motivation.

Get that ferritin up and you’ll start feeling good again.

 

[Systemlord]

MCV 80.4
MCH 25.9 L

Ferritin is low. ^^^. I had the same problem years ago, started TRT, lost the benefits, super fatigued.

A private endocrinologist told me during a consultation that my MCV 80 right at the lower limit, which was indicating low iron. Three months later things went from bad to worse.

My MCH was low, MCHC right at the limit, MCV low, RDW high and ferritin 24 and the size of the red blood cells was not carrying enough oxygen, or more to the point iron.

I fully expect your hemoglobin to be normal, which would point to iron deficiency without anemia.

Patients with true iron deficiency anemia on the basis of negative bone marrow iron staining may have a serum ferritin concentration close to 50 μg/L 7. Patients with the restless leg syndrome should be considered iron deficient when their ferritin concentration is <75 μg/L 8. Furthermore, patients with negative bone marrow iron stores have been shown to present with serum ferritin levels of close to 100 μg/L 9. Iron deficiency in patients with heart failure impairs the quality of life, irrespective of the presence of anemia. There, iron deficiency was defined as a ferritin level <100 μg/L or, at 100–299 μg/L with transferrin saturation <20%

Now that you need iron supplements, this will increase your hematocrit, so TRT dosing may need lowering. Thyroid can’t function optimally with low iron, conversion to free thyroid hormones will be impaired.

Your HCT is perfectly healthy as of right now. Higher HCT is one of the many health benefits of TRT.

My HCT is 51%, none of my doctor are worried. Go to a different lab company with a 52% cutoff and you’re normal. The lab ranges for hematocrit are arbitrarily set.

 

[Systemlord]

Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador.

 

[aneuman]

Reason for this is that at :
11/16/2022 at 90/wk I was over 1100 ng/dl TT (e=45.8 pg/mL)
so reduce

It seems we both respond similarly to the same amount of T Cyp.

01/11/2023 80mg/wk I dropped down to 680ng/dl TT (e=26.1 pg/mL)
so slight increase

Question. How were you feeling on those numbers? It seems you were trying to chase a particular number and that's the reason for your change to 80/90

These numbers look great. If you were feeling good at that range, I'd keep it there. This is what I'm trying right now. I was at 90/week, and had similar results as you did. I was feeling wired and was not having NPT. I changed to 80/week divided in 2x40 SUBQ and NPT has returned

I won't argue with @Systemlord when it comes to ferritin. I know he has some personal experience and you may benefit from his advice. I'd also measure ferritin before doing anything.

 

[t_spacemonkey]

your DHEA is low. i'd start 25mg/day

 

[T0R0]

@Systemlord Thanks for the feedback. Getting ferratin test tommorow morning before I start iron supps just to see where I'm at.. I've always tested low MCH and recall always being told I have anemia. Forgive my ignorance, but a quick search says it could B12 or Iron. I'll update above when I get Ferritin result. Can you suggest supp protocol ?

@aneuman I wasn't so much chasing a TT # but rather more about reducing my E. I actually get that bit of anxiousness also when I'm above 1000. I had to look up what NPT was. I still wake up with erections. My libido did suffer but I think thats because my energy/motivation overall is suffering. Thats why it wasn't my chief complaint above. But overall I think I felt better at lower TT #. (so I guess maybe I am trying to chase that 700-800 range now,, lol )

@t_spacemonkey Thanks for noticing that. Unsure what to do about at the moment (on backburner) until I square away iron issue. I'm just not that familliar with DHEA.. Just thinking out loud, how long do you generally give supps tiimewise to feel a difference ? 1 month ? Is anyone on here on DHEA supp ?

 

[Vince]

Hello Guys. Basically my biggest gripe is super low energy and low motivation. Lowish libido also..
So my history on TRT for 2+ years now. Pre TRT testosterone lvl was 182 ng/dL
55 yr male
Great shape
151 lbs

Anyway long story short, it took me almost a year/half to get dialed in and that only happened when I eliminated HCG / ai from the equation back last year. HCG was increasing my aromitization big time. Getting off the ai also was huge.

Current dose is 80-90mg test (200mg)cyp per week split up among 2 pin /wk
(week one = .2cc -2x and week two = .2cc - .25cc ).

Reason for this is that at :
11/16/2022 at 90/wk I was over 1100 ng/dl TT (e=45.8 pg/mL)
so reduce
01/11/2023 80mg/wk I dropped down to 680ng/dl TT (e=26.1 pg/mL)
so slight increase
So I was trying to hit something in the middle ergo, 80 one week, 90 the next.

So my current labs look like this: Took a more comprehensive test because feeling so low energy. Just noting the stuff out of ranges:

08/30/2023
TESTOSTERONE, TOTAL, MS 1090 ng/dL
TESTOSTERONE, FREE 266.0 H
SHBG 31 nmol/L
ESTRADIOL,ULTRASENSITIVE, LC/MS 54 pg/mL
PROLACTIN 10.8
DHT LC/MS/MS = 91 H
DHEA SULFATE 91
RED BLOOD CELL COUNT 6.37 H
HEMATOCRIT 51.2 H
MCV 80.4
MCH 25.9 L
MCHC 32.2

I recently also went to GP and thyroid tested about a month ago and could be a contributing factor.
July 11th TSH W Freet4 Reflex 6.970 UIU/ML
July 17th TSH 3Rd Gen 5.130 UIU/ML
August 28th TSH W Freet4 Reflex 5.510 UIU/ML

Am I correct in attributing this to my elevated TT ? My normal is in the 4's

Summary : So for the last 3 month or so, Super unmotivated and have to drag myself to gym. While I see some areas of concern here I was expecting high prolactin levels or anemia or some smoking gun here to explain why I feel the way I do..
I realize my TSH is suspect , my HCT isn't ideal.
Game plan here is slightly reduce dose. I'm thinking to keep 80mg and do 90mg once a month ..
Would appreciate any feedback from the gurus here !
Happy to elaborate on anything.
As an aside, I used discountedlabs for my latest labs, Thank you @Nelson Vergel

Before you started TRT you were a great shape. So you must have been motivated before you started TRT. Any reason why you didn't just stop using testosterone?

 

[Nelson Vergel]

July 11th TSH W Freet4 Reflex 6.970 UIU/ML
July 17th TSH 3Rd Gen 5.130 UIU/ML
August 28th TSH W Freet4 Reflex 5.510 UIU/ML

That is very high TSH. Please get your antibodies tested to make sure you don't have Hashimoto's disease.

Hashimoto's Disease Tests and Treatments

Did you know that approximately 5 percent of all people in the US struggle with some form of Hashimoto's disease? This ailment seems to be quite prevalent and it leads to an underperforming thyroid gl

www.discountedlabs.com

Thyroid Antibody Panel

These two tests measure antithyroglobulin antibodies and Anti-TPO antibodies that are commonly present in patients with Hashimoto's thyroiditis, Graves disease and other thyroid-related conditions. Antibodies against the protein thyroglobulin can result i

www.discountedlabs.com

 

[Systemlord]

Low Testosterone Levels and the Risk of Anemia in Older Men and Women - PMC

Anemia is a frequent feature of male hypogonadism and anti-androgenic treatment. We hypothesized that the presence of low testosterone levels in older persons is a risk factor for anemia. Testosterone and hemoglobin levels were measured in a ...

www.ncbi.nlm.nih.gov

Compared with participants with normal hemoglobin levels, men and women with anemia and especially those with “unexplained” anemia had lower total and bioavailable testosterone levels, were more likely to have a stroke history, and had higher IL-6 levels.

 

[T0R0]

@Nelson Vergel "That is very high TSH. Please get your antibodies tested to make sure you don't have Hashimoto's disease"

Yes, already done .. All thyroid antibodies test were neg. Question remains, Which is causing which ? Thyroid causing low iron or low iron causing thyroid..

@Vince Always been in shape my entire life. "Stop using it" ? you mean after I started ? I was in a funk when I started it probably for years. It wasn't a spur of the moment decision. My TT was at 182. Thought about it long and hard. Joined a mail-order clinic, chickened out, then went to local walk-in. Glad I did. I needed the hand holding until I got comfortable with the whole process.

​

 

[DorianGray]

Have you done any genetic tests? There may be some impact due to the HFE gene. Some combo variants can give normal hematocrit, high iron, low ferritin.

 

[Systemlord]

@Nelson Vergel "That is very high TSH. Please get your antibodies tested to make sure you don't have Hashimoto's disease"

Yes, already done .. All thyroid antibodies test were neg. Question remains, Which is causing which ? Thyroid causing low iron or low iron causing thyroid..

Iodine supplements will increase TSH rendering the test useless for diagnostic purposes.

 

[Systemlord]

The standard iron protocol for someone with iron deficiency is elemental iron, 250 mg iron split up three times daily. The goal is to get ferritin 100> and no symptoms present.

If you want an iron type that has no equal, look no further than the Vitamin Shoppe brands 28 mg ferrous fumarate, amino acid chelate. It’s high absorption and it’s available online only.

 

[Gman86]

Iodine supplements will increase TSH rendering the test useless for diagnostic purposes.

Not always. Lugol’s iodine 2% 1 drop per day (2.5mg iodine) eventually dropped my TSH down to 0.02. Prior to that my TSH was unaffected by taking iodine, even at veey high dosages. My TSH always hovers around 0.5-1.2ish. Back in November last year, while on this dose of lugols my TSH was 1.0. Then in may of this year it went down to 0.02, on the same dose. So I stopped taking lugols all together right after these labs, and in august of this year my TSH was still 0.02. I’ll post both sets of labs. The pic where my free T3 was 5.3 was in August, and the pic where free T3 was 5.1 was in May. Oddly enough, all other thyroid numbers were basically identical from when TSH was 1.0 while on lugols 2% 1 drop per day, as they were in may and august where TSH was 0.02

So long story short, intaking extra iodine doesn’t always increase TSH. It absolutely can tho, so ur correct about that. I’ve heard of people in the iodine fb groups seeing their TSH temporarily increasing

 

[t_spacemonkey]

@Systemlord Thanks for the feedback. Getting ferratin test tommorow morning before I start iron supps just to see where I'm at.. I've always tested low MCH and recall always being told I have anemia. Forgive my ignorance, but a quick search says it could B12 or Iron. I'll update above when I get Ferritin result. Can you suggest supp protocol ?

@aneuman I wasn't so much chasing a TT # but rather more about reducing my E. I actually get that bit of anxiousness also when I'm above 1000. I had to look up what NPT was. I still wake up with erections. My libido did suffer but I think thats because my energy/motivation overall is suffering. Thats why it wasn't my chief complaint above. But overall I think I felt better at lower TT #. (so I guess maybe I am trying to chase that 700-800 range now,, lol )

@t_spacemonkey Thanks for noticing that. Unsure what to do about at the moment (on backburner) until I square away iron issue. I'm just not that familliar with DHEA.. Just thinking out loud, how long do you generally give supps tiimewise to feel a difference ? 1 month ? Is anyone on here on DHEA supp ?

I go by what my TRT clinic recommend. 25mg. gets me into 430 range. not sure TBH how long or what difference it would make. but definitely worth a try. its cheap/OTC

 

[Nelson Vergel]

@T0R0

I assume that you read this thread:

Why Do I Feel So Tired on Testosterone ?

Taken from the book: Testosterone: A Man’s Guide by Nelson Vergel If no improvements in fatigue are observed after 6 weeks of testosterone replacement, factors beyond hypogonadism may be present. Thyroid and adrenal function should be checked to ensure that those two glands are working...

www.excelmale.com

Are you taking any meds? How are your sleep and mood?

After 13 years of reading posts on this forum, I am still amazed at how most people here give recommendations without asking questions to elaborate. When you guys walk into a doctor's office, they make you fill out health questionnaires for a reason. Nothing related to fatigue on TRT is a simple answer.

Here are questions I usually ask guys who consult with me: health questionnaire.

 

[T0R0]

Update: @Systemlord (added info to original post) So ferritin came back normal. I really thought this was it. It explained everything I felt. Even hair shedding last few months. Is it worth testing B12 and Folate ? I know I've always had low MCH and MCHC (High RBC) way before TRT

@Nelson Vergel Never been on any meds... I take Vit D3K2 combo, Magnesium, Boron, Zinc, Curcumin and cod liver oil. T3 total and free T4 are all in range.. TSH high. Sleep is 90% great and on those occasions I don't, reason is apparent. As for my mood, well, no energy saps my mood too. They kinda go hand in hand... And no worries, although I welcome all input, I'm not going to follow recommendations haphazardly. Thank you for your concern

At this point, I don't know what else to test. Other than retest TSH end of month.
Thanks all for the input !

 

[Systemlord]

Update: @Systemlord (added info to original post) So ferritin came back normal.

Please be more specific, actual lab value. Normal doesn’t always mean normal.

Your labs don’t lie, your MCH is low and that is due to a lack of oxygen.

I updated my previous post.

 

[Gman86]

Update: @Systemlord (added info to original post) So ferritin came back normal. I really thought this was it. It explained everything I felt. Even hair shedding last few months. Is it worth testing B12 and Folate ? I know I've always had low MCH and MCHC (High RBC) way before TRT

@Nelson Vergel Never been on any meds... I take Vit D3K2 combo, Magnesium, Boron, Zinc, Curcumin and cod liver oil. T3 total and free T4 are all in range.. TSH high. Sleep is 90% great and on those occasions I don't, reason is apparent. As for my mood, well, no energy saps my mood too. They kinda go hand in hand... And no worries, although I welcome all input, I'm not going to follow recommendations haphazardly. Thank you for your concern

At this point, I don't know what else to test. Other than retest TSH end of month.
Thanks all for the input !

A TSH consistently over 2.5 on multiple lab tests is guaranteed hypothyroidism. Unless, like systemlord said, ur taking something that is known to have the potential to specifically skew TSH results. Some doctors say that even a TSH of 2 is getting into hyperthyroid territory. So ur TSH coming back at almost 5.5, and almost 7, means ur extremely hyperthyroid. Even having ur TSH normally come back in the 4’s means u’ve been very hypothyroid for a while now. If I were u, I would focus mostly, if not all, on correcting ur hypothyroidism, first and foremost. Being this hypothyroid is going to cause most people to feel exactly how ur feeling, so it all makes sense

Luckily, if low iron is a contributing factor to ur thyroid issues, the same way to get ur iron levels up is the same way to improve ur overall thyroid function. So u can kill two birds with one stone. The best way to improve both is to simply eat as much ruminant animal meat as possible. Aka red meat basically. This will obv increase ur iron levels, while also giving ur body a source of calories that is giving ur body everything it needs to heal, while decreasing the calories that ur getting from foods that are causing inflammation/ many other negative actions in ur body, and causing ur thyroid to not function properly. We can obv go into all the foods ur consuming that are causing ur hypothyroidism in the first place, but if u want to just keep things simple, for now, and focus on one thing at a time, simply getting as many calories per day from ruminant animal meat will be the #1 thing u can do to improve ur thyroid, and iron levels, if needed, and consequently improve the negative symptoms ur currently experiencing.