Young Male. Need Advice on What Comes Next

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cashcow

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Male, just turned 25 years of age. 5'10” and 143 lbs with 29”/30” waist (as measured by my pants).


I am lean, and any fat is carried in my lower abdomen, but I normally do not carry much fat.


My health has been declining since early high school and became progressively worse with age. I have constant muscle knotting and pain (most severe in my neck and back), brain fog and difficulties concentrating, dietary sensitivities. I have mood swings and fairly consistent irritability with no explanation why. I have constant fatigue and lethargy and have trouble staying asleep.


I've researched, read, and tried a million different things for my health. I've considered thyroid issues, lyme disease/tickborne illnesses, autoimmune issues, leaky gut/crohn's disease/other GI disorders.


I've made dietary changes, tried tons of different supplements, with no real long term improvement.


I've seen a number of doctors and specialists in the last 2.5 years to no avail. Most labwork is good and offers no explanation. Testosterone keeps coming into question, which led me here.


Do you have?


Depression?: Intermittently at low severity. Depression is not a constant problem for me, but it flares up under stress, and lack of sleep.


Anxiety?: Yes. My personality lends itself to anxiety already because I'm very detail oriented and tend to be a perfectionist. My health condition makes my anxiety terrible at times. I worry about how my health, career, and life in general will play out. Also gets worse during stress.


Decreased sexual potency (erection quality)?. If so, is this causing stress in your relationship? Erection are still fine. No real change.


Decreased sex drive? Yes. At my age, my sexual drive should be much higher than it is. I usually only want to have sex a few times per month. This has dropped a lot in 2.5 years time. Sex drive was high during high school and most of my undergraduate college.


how have morning wood and nocturnal erections changed? Rarely wake up with morning wood. Did all the time 3-4 years ago.


Sleep disturbances?: Very commonly. I occasionally have trouble falling asleep, but the bigger issue is that I wake up very easily in early mornings and cannot go back to sleep. If I wake up early, I often feel terrible and still can't fall back asleep. This seems to get worse during times of stress.


Generalized muscle aches and pains?: This is one of my most potent problems. I have pain in my back and neck daily and the severity ranges from moderate to very severe. My muscles hurt and ache all the time. Sometimes I have muscle pain throughout my body but it is usually less severe.


Joint pain?: It is hard to tell if the joints hurt on their own or if it is joint and muscle pain. All I know is that I hurt daily.


Fatigue? - Daily. I never feel fully rested or full of energy. I can't remember the last time I felt vigorous.


Lethargy?- Yes, I suffer from lethargy at least 2x per week. I also have brain fog attributed to feeling lethargic.


Sensitive, lumpy, or swollen nipples? No.


Describe your body/facial hair: Normal body hair on body, not super thick or thin but it hasn't changed in 2.5 years. Fairly normal facial hair growth as well. Few patchy spots without any facial hair, but I can grow a beard. Biggest change here is that I've noticed a decent amount of hair loss on my head and body. If I run my hands through head or body hair, I notice hairs falling out. Sometimes quite a lot.


Are you losing your hair? Yes, my hair falls out when my head or arms are rubbed. I have abnormally thinning hair and a receding hairline. My beard does not seem to lose as much hair as the rest of my body.


Have you ever taken Propecia or Proscar (finasteride) for hair loss or prostate inflammation? No, but I did take one of those acne drugs in high school that eventually got banned by the FDA.


Loss of appetite?: Not really. I enjoy eating and do not have a decreased appetite.


Weight loss or weight gain? Yes, I have lost a significant amount of muscle tone/mass since college. I have probably lost 10 lbs. in the last 3 years.


Do you consider yourself to be in good health? I'm in terrible health, but I try to take exceptional care of myself. I eat really well (avoid processed foods and rarely eat out), don't drink or smoke, and try to at least walk as my energy level will allow.


Average hours of sleep per night?: Attempt to get 8-9 per night but I probably average 8 hours. I do generally feel better when I get 8+ hours.


Do you regularly self examine your testicles? Occasionally.


Do your testacles ache? Sometimes my right testicle aches. In fact, about 4 years ago I had severe pain in my right testicle area. I went to a urologist and he said I had an infection in one of the ducts. I took a few rounds of antibiotics that didn't seem to help. The pain lingered for months. He eventually gave me a few shots into the actual area that hurt like hell. Nothing seemed to help. After a few months, the pain slowly subsided but I wonder if damage was somehow done during the whole process.


Tell us about your diet (The more details, the better): I eat quite a bit of raw and cooked vegetables with high nutrient density, such as 1 salad per day composed of raw organic spinach/kale/dark greens with extra virgin olive oil/raw apple cider vinegar dressing. Cooked onions, broccoli, cauliflower, carrots, regular and sweet potatoes.
Eat an assortment of non-processed meats, including beef, chicken breast, occasional bacon, and wild venison.
Other foods include Black beans, parboiled rice, and a modest amount of fresh fruit. Oils used in cooking are healthy olive, coconut, and peanut.
I eat high probiotic yogurt/kefir. Eat nuts and drink almond milk in sparse amounts. Eat some dark chocolate.
I do not eat most grains, breads, pastas, or normal refined sugars. I have eliminated processed foods from my diet almost entirely and only eat out occasionally.


Do you exercise? If yes, what type and how frequently? I do not exercise frequently these days. I grew up playing sports all the time. I received a scholarship to college for soccer. I was extremely fit and active.
Any more, all I can do is walk. I try to walk as much as possible. I generally do not have enough energy to do a workout and haven't lifted weights in probably 18 months.


Do you feel that you procrastinate a lot and do not have enough mental focus to finish projects? I am an extremely hard worker and do not let my decreased mental capacity affect my work ethic. I often have trouble focusing, but I try to push through. I don't really have a choice because I'm getting a PhD.


Are you experiencing a lot of stress lately? I would say I have moderate stress in my life. I work quite a bit on top of completing a PhD right now. Unless I quit, nothing will change for the next 2.5 years.


--
I've had blood work taken and the full labs are found here (from most recent to oldest 2 years ago): http://imgur.com/a/0u4BX


Some Quick results:
Free Testosterone has ranged from 9.3 to 11.5 ------- UNITS: pg/mL ----- Reference Range: (9.3-26.5)
Total Testosterone has ranged from 291 to 520 with most in low 400s ------- UNITS: ng/dL ------ Reference Range: (348-1197)
Pregnenolone: 60 ------- UNITS: ng/dL ------ Reference Range: (<151)
DHEA-S: 350-375 ------- UNITS: ug/dL ------ Reference Range: (164-531)
Vitamin D, 25-Hydroxy: 30-35 ------- UNITS: ng/ML ------ Reference Range: (30-100)
LH: 3.1 ------- UNITS: mIU/mL ------ Reference Range: (1.7-8.6)
FSH: 1.9 ------- UNITS: mIU/mL ------ Reference Range: (1.5-12.4)


I currently see a doctor who is pretty open minded. He will order lab tests and is open to treating with my input. He just prescribed topical generic testosterone gel. I haven't picked that up because it's in limbo with my insurance. Since seeing him though, I've been reading the forums a lot and I'm not sure that's the best route.


My main questions:


1) Do you think TRT is appropriate right now in my life? I know the dangers and I really don't like the idea of starting at 25. However, I'd do it in a heartbeat for the rest of my life if I could see an improvement in quality of life.


2) Doctor prescribed TRT cream. I've read very mixed opinions on this. Would it be better to go ahead and request Test Cyp now before starting the cream? I think would do injection 2x per week subcutaneously.


3) Doctor is open to HCG as well, but didn't prescribe yet and didn't seem too urgent about it. Do you think I should go back to him and request TRT with HCG right away?


4) Should I request any more labs that might offer insight into my poor health? I'm primarilty concerned about ruling out all other possibilities before TRT. Any suggestions?


Thank you all very much for any help.
 
Last edited:
Defy Medical TRT clinic doctor
Cashcow

Finally! Someone used my health questionnaire! Thanks for doing that. It gives a much better picture than 1 paragraph.

I am sorry that you feel tired at 25 even with 8 hours of sleep. It seems that your mood and anxiety may be also getting to be issues. Gladly, your erections are Ok even without morning wood and low libido.

I am assuming the top three sheets are recent blood work. It seems that you have high Epstein Barr antibodies and antigens plus IgG. Did you have mono?

Your last TT is not horrible at 544 ng/dL but you have a 2012 history of low T and high TSH.

I would check your TSH, free T3, free T 4, reverse T3 and thyroid antibodies just to be sure you are OK with thyroid function. I would also like to see recent TT and FT values along with CMP and CBC if the ones you posted are not at least 3 months old.

Do you sit in front of a computer a lot? Neck and back issues could be related to poor ergonomics.

A T cream (by the way, they are cheap at empowerrxpharmacy.com and apsmeds.com) is not a bad starting point as long as your dose is titrated to bring you up above 600-700 ng/dL of TT while monitoring hematocrit, estradiol and other variables. You can switch to injections and/or bring in HCG at week 6 or 12 after TRT start.


Are you taking any supplements or medications?
 
Cashcow

Finally! Someone used my health questionnaire! Thanks for doing that. It gives a much better picture than 1 paragraph.

I am sorry that you feel tired at 25 even with 8 hours of sleep. It seems that your mood and anxiety may be also getting to be issues. Gladly, your erections are Ok even without morning wood and low libido.

I am assuming the top three sheets are recent blood work. It seems that you have high Epstein Barr antibodies and antigens plus IgG. Did you have mono?

Your last TT is not horrible at 544 ng/dL but you have a 2012 history of low T and high TSH.

I would check your TSH, free T3, free T 4, reverse T3 and thyroid antibodies just to be sure you are OK with thyroid function. I would also like to see recent TT and FT values along with CMP and CBC if the ones you posted are not at least 3 months old.

Do you sit in front of a computer a lot? Neck and back issues could be related to poor ergonomics.

A T cream (by the way, they are cheap at empowerrxpharmacy.com and apsmeds.com) is not a bad starting point as long as your dose is titrated to bring you up above 600-700 ng/dL of TT while monitoring hematocrit, estradiol and other variables. You can switch to injections and/or bring in HCG at week 6 or 12 after TRT start.


Are you taking any supplements or medications?

Thanks for the reply!

Yes, had mono a few years back.

My most recent TT was not 544.

The top lab in the link is from 2 weeks ago with TT, FT, CBC. TT was 432 and free T was 11.7. The labwork 9 months ago shows TT at 520, but FT at just 9.3.

Somedays I do sit in front of a computer a lot, but others not as much. The pain doesn't seem to be highly correlated with that and it's not the primary cause for sure.

I'm currently taking a good organic food based multivitamin for men, vitamin D 5000, a mushroom based adrenal support, magnesium citrate, high potency fish oil, all 3-4 days per week. (Has been every day in the past without any improvement in my symptoms)

I occasionally take 50mg of Zinc, ginger, vitamin C 1000, selenium 200, Lugol's iodine, and probably a few more I'm forgetting.

I have a pantry of supplements that I have tried in the past. Not sure where to go next...
 
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