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Question Can Trt Cause Addison's Disease? Extreme Fatigue?

Discussion in 'Male Health & HRT' started by Creatine, Sep 7, 2018.

  1. Creatine

    Creatine New Member

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    So, I'm on Levothyroxine 100mcg/day + TRT. I did a couple of Testosterone shots 2 months ago, didn't feel good and stopped. I was in India.

    Returned to NYC and asked the US doctor and he gave me a new TRT prescription and protocol:
    * 65mg Test twice a week
    * HCG 250 iu twice a week
    * No Anastrazole for now, only if estrogen goes out of control. Some people don't need it.

    After I got the prescription, I had travel to Colombia and I started my new TRT protocol here 4 weeks ago.

    Every-time I take Testosterone shot (65mg injection), I feel extreme tiredness lasting couple of days. I can barely get out of bed. Just extreme fatigue.

    At first, I thought body was just getting adjusted to it so I decided to keep patient but after 4 shots (2 weeks) of Testosterone injection and same fatigue after every shot, I got worried.

    I spoke to an endocrinologist here in Colombia and seeing her next week. But meanwhile, on the phone, she said: you might have steroid induced Adrenal Suppression Syndrome (aka Addion's Disease). Try Predinosone 50mg (OTC) for 5 days and then we'll discuss more when we meet.

    So, I took Prednisone and within an hour, the fatigue disappeared.

    Can TRT cause this? Or did I already have this (Addison's Disease) and taking Testosterone increased imbalance between Cortisol and Testosterone and hence the onset of extreme fatigue?

    What tests should I get done? She said she'd need to get a comprehensive hormonal panel done including Thyroid related tests, ACTH, Testosterone, Estrogen related tests, DHEA, igf-1, shbg and so on. And Vitamin/Mineral tests like A, B12, D, Iron, Mg, Calcium, Potassium etc. Anything else I should add to it?

    Also, another thing to note: when I took my Testosterone shot in India (250mg Sustanon, every 3 weeks, took only two shots):

    1. I experienced similar fatigue for couple of days. But the fatigue disappeared and I figured it was due to such a high (250mg) dose. But the dose now is only 65mg!

    2. My lipid profile worsened significantly. I went from within normal range to being outside high limit of of cholesterol range after taking first Testosterone (250mg Sustanon) injection. I don't know if that was a co-incidence or if Testosterone causes your cholesterol etc. to worsen
     
  2. BadassBlues

    BadassBlues Super Moderator Staff Member Super Moderator

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    I will answer your post in more detail when time permits, but you can’t compare sustanon with testosterone cypionate. There are four separate esters used in sustanon that are meant to take weeks to metabolize, cypionate is a single ester with a much shorter half life.

    Steroid induced adrenal suppression is related to the use of corticosteroids, I have never heard of it being tied to testosterone.

    Prednisone makes most people feel good, for a while...
     
  3. Creatine

    Creatine New Member

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    Thanks @BadassBlues

    UPDATE:
    Met with the endocrinologist here in Colombia and got a bunch of tests done. While she originally suspected Addison's disease and asked me to take Prednisone 50mg for 5 days, now that we've test results, she doesn't think I've Addison's disease or cortisol deficiency. Rather, she thinks I'm pre-diabetic and that's the root cause of both fatigue (upon TRT shots) and ED (she says diabetes often causes poor blood flow to penis and hence ED).

    She also thinks I've Adrenal Fatigue and bad cholesterol profile.

    She has prescribed
    - Metformin 1000mg for Pre-Diabetes

    - Nothing for Adrenal Fatigue
    - just live a healthy lifestyle (diet, exercise and sleep).

    - She wanted to prescribe statins but I asked her if healthy lifestyle will fix this. So, she decided to wait 3 months to see if cholesterol profile has improved.

    - Also, she asked me to lower Levothyroxine dosage based on TSH. But I was under the impression once you start taking Thyroid medication, you should target to be in middle range for T4 and T3. But according to my test results, my T4 is in lower-half of the range. So, should I really lower my Thyroid dosage? It is currently 100mcg and 125mcg (I take 100mcg one day and 125mcg the next day, to average 112mcg)

    Wonder if anyone here can chime-in from their knowledge? Here are the test results images below: One thing to note: My lipid profile and cholesterol profile was border-line bad pre-TRT. But since I started TRT about 4 weeks ago, it has gotten worse. From my research, it doesn't look like TRT can cause worsening of lipid + cholesterol profile so significantly but I can't help but think that it did.
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    Last edited: Sep 10, 2018
  4. Captain

    Captain Member

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    Your B12 looks like you was already on Metformin. To me looks like you could use more Iron and B12. You should have full labs for Thyroid as everything in the labs you have points to a possible Thyroid problem. You BUN level is low so you may have been over hydrated and these labs would not be accurate if so. Prednisone also may make BUN low. A low protein diet can lower BUN. A low protein diet would effect B12 and Iron. The Prednisone would have caused the Pre-Diabetes and maybe the spike in Cholesterol.
     
    Last edited: Sep 10, 2018
  5. Creatine

    Creatine New Member

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    Thanks, @Captain I took Prednisone for 5 days and then stopped for 8 days before these tests. So, I doubt Prednisone is causing it. Doctor has prescribed me B12 injections as well. BUN - This was fasting test. I hadn't had water or food for 10 hours.

    Overall, do you think I am diabetic or not? Should I start with doctor's prescriptions (Metaformin 1000mg, B12, 100mcg Levothyroxine and TRT protocol of 65mg twice a week, hcg, anstrazole)? And I guess a good multi-vitamin to take care of B, Iron etc.

    Could this (diabetes) really be the root cause of ED and extreme-fatigue on Testosterone injection?
     
  6. Captain

    Captain Member

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    Diabetes I think is a major cause of ED. Diabetes causes problems like low SHBG. Your Cholesterol and Triglycerides levels are like what people with Diabetes look like. Metformin should be good for you. Just reading that pancreatic insufficiency can cause decreased levels of BUN in your body. You don't have proper labs for Thyroid so no one can help you with that.
     
  7. Creatine

    Creatine New Member

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    True on all counts.
    - My SHBG is very low - only 6.78 something (range: 13 to 71). I didn't know pre-diabetes could reduce SHBG.

    So, if I were to start taking Metaformin starting tomorrow, how soon can I expect to see some improvement in ED? I've Google-d this question a lot but haven't found answer to it.

    At this time, I'd be happy if my ED recovers just enough that Cialis 5mg/10mg start to work on me again and work for the whole weekend, like they used to couple of years ago. If I'm unable to get it hard without Cialis, that's fine. But right now, I'm at a point where I've to take 35mg-40mg of Cialis and the effect wears off in few hours.

    Below are Thyroid related results. Do you think I need to DECREASE Thyroid dosage as suggested by doctor?

    T3 Total: 108 ng/dl ( 65 to 204 ng/dl)
    T4 Total: 0.89 ng/dl (0.78 to 2.20 ng/dl)
    TSH: 0.02 mUI/ml (0.47 4.68) <-- this is what doctor wants to bring-up by reducing Thyroid dosage.
     
    Last edited: Sep 11, 2018
  8. Captain

    Captain Member

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    A look at your RT3 would help. What was wrong with your Thyroid when you started treating it? You ever had an MRI of the Pituitary Gland? What was the reason for starting TRT?
     
  9. Creatine

    Creatine New Member

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    Thyroid
    - They don't seem to have RT3 test here in Colombia.

    - I had symptoms of low-thyroid like feeling cold, significant hair loss, loss of facial hair, and very bad sleep. I got a regular check-up done and consulted a doctor with my reports. He noted that my TSH was elevated (5.75) and said you might have subclinical hypothyroidism.

    He got me tested for antibodies and they were negative. So, he said no prescription is required. But after that I did a lot of research online and started self-medicating with 112mcg Levothyroxine myself and within 2 days my sleep got better, felt more energetic and generally less miserable. Hair loss has also slowed down quite a bit and my beard is coming back at normal speed.

    - Pituitary MRI - yes and nothing was found or at-least nothing was flagged.

    TRT:
    Over last 5 years of yearly check-ups, my total T has always been between 200 to 400 range (and when the lab range is 200 to 1100-ish). But no doctor ever flagged it. This year, when I told my doctor that I had been having ED for past 2 years, he looked at my results again and in the latest test, my total T was only 140ish. So, he put me on TRT.

    I was under the impression that within couple weeks of TRT, my ED will be resolved. But instead I started to feel extreme fatigue.

    So, I went to the doctor again (different doctor as I'm now in Colombia) and she said:
    1. Lower thyroid dosage (she assumed my last doctor prescribed Levothyroxine, I didn't tell her I was self-medicating)
    2. Flagged me as pre-diabetic with poor lipid profile. Prescribed: Metaformin 1000mg, B12 shots
    3. Continue TRT protocol of 130mg/week + HCG + Anastrazole as needed
    She told me I've Adrenal Fatigue + Pre-diabetes and both could be the root cause of ED - which is what I seem to care most about day-to-day! lol
     
  10. Captain

    Captain Member

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    There is not many that will test RT3 in the USA either. It takes longer than 2 weeks for TRT benefits. You need labs to see what the TRT is doing and adjust if needed. Give it a minimum of 6 weeks to work.
     
  11. HRMone

    HRMone New Member

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    Some people are sensitive to adrenal stimulation caused by testosterone. Too much test and cortisol goes down = feeling tired. Better to stay small doses, more often. Your morning cortisol is low. You got low ferritin/ iron, so that could make you feel tired. T3/ T4 is low all so.

    I recommend to get iron up, then thyroid meds start working better and you may not need up thyroid meds dosage. No point to take RT3 test now, cause there are so many things to fix first. Probably RT3 is elevated, but it always is, when there are some stressful situation in your body. So T3 meds to lower RT3 is not solution that's going to fix everything for you. RT3 comes down when you get other things to check.

    Continue small doses of test more frequently and take new set of tests after while; testosterone, estradiol, cortisol and thyroid labs. All so maybe some sugar-stress test, cause glucose is so high. No point to take every test available and try fix too many things at once. Put your basics in order first.
     
  12. LeanGuy

    LeanGuy Active Member

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    Also... E2 / prolactin are elevated. You may need an AI, though with low SHBG you may be able to control it by reducing your T dose.
     
  13. NihilTom

    NihilTom New Member

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    I cannot comment on the entire variety of meds you are on but i hope you followed the doctor's advice about lowering your levothyroxine. Your tsh was too low, simply meaning you're slightly overmedicated. I think your doctor made the perfect decision regarding that.

    As far as everything else, you're on so many different meds I wouldn't know where to begin without lab results from before you started TRT. Your cholesterol, triglycerides, glucose are all way off.

    What kind of diet do you have? Do you sleep well? Please give us an update on your health.
     
  14. Creatine

    Creatine New Member

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    Thanks. So, just Iron tablets will be fine or some special kind of iron? Is this one (Iron-C from Pure Encapsulation OK?
    https://www.amazon.com/Pure-Encapsulations-Hypoallergenic-Supplement-Supports/dp/B0017HQDVK )

    Yes.
    Health Update:

    It doesn't look like I've Addison's Disease. Endocrinologist said I just have Adrenal Fatigue and pre-diabetes. Both can be corrected with diet, exercise and sleep.

    1. Post Testosterone injection fatigue has disappeared or significantly reduced already. Now, I take the injection and I feel fine after. No extreme tiredness.

    2. Thyroid - I did not lower the dosage because from what I understood, you should target to be in middle of the range for T4, T3, Ft3, Ft4. Since I'm not above middle range, I did not lower the dosage.

    3. Sleep - Since starting Thyroid, I've been sleeping well. 6.5 hours weeknights, 8 hours weekends. Before Thyroid meds, I had trouble falling asleep and staying asleep.

    4. Diet & Exercise - Until 6 months ago, my diet was very poor. I'd skip most meals (workoholic, don't feel hungry when I'm working) and when I was really hungry, I'd end up eating junk like McDonald's. I was on such poor diet for about 2 years. In last 3 months, I've significantly improved my diet. I eat 3 meals a day. Fruit salad, veggie salad are part of my meals now. I try to eat clean (grilled chicken, rice, brown bread, sushi, civiche) and have significantly reduced junk-food (no more than 2 junk meals a week).

    5. Blood sugar: With above dietary changes and weight-lifting workout routine (3x a week, stronglifts 5x5 routine), my blood sugar is already in control. I got fasting blood sugar tested 3 times in last 3 weeks and each time it came out below 100.

    6. AI / Anastrozole: So with twice a week Test E injections (70 mg twice a week) and no HCG (I've been skipping HCG out of laziness), my T is now in 900s. But my Estrogen/Estradiol E2 went up to 95. So, I've now started taking 0.5mg Anastrozole thrice a week (1.5mg total per week) and it has brought down my Estrogen to 31 in last 2 weeks. Also, DIM supplement (300mg, EOD).

    7. Erectile Dysfunction - When I just started T injection my ED improved. But now it is back to ED. Even with Cialis, I don't seem to get over 80% hardness. When I had just started Testosterone, I was getting 100% erection but now after few weeks, my ED has returned. Cialis helps but I still don't get 100% hardness. I've only been monitoring Testesterone (900s now), E2 (31), Fasting Blood Sugar (<100, normal) and Hematocrit (48.5% now). Should I monitor something else? I also haven't been monitoring lipid profiles because I figured it'd take a few months for diet + exercise changes to improve my lipids.

    Summary of Medications I take:

    1. Levothyroxine 125mcg morning, empty stomach
    2. Testosterone E 70mg twice a week (Tuesday, Saturday)
    3. Anastrozole 0.5mg thrice a week
    4. DIM supplement 300mg EOD
    5. Vitamin D, K, Vitamin B supplements when I remember, 2-3 times a week
      - NOT taking Diabetes medicine (Metaformin) because blood sugar seems to be in control simply with diet & exercise changes
      - NOT taking HCG mainly out of laziness.
      - Doctor gave me Vitamin B shots so it should be normal now. Haven't gotten it tested though.


     
    Last edited: Oct 10, 2018
  15. Nomad

    Nomad New Member

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    I’ve been considering expating in Colombia for a few months at some point, this post has cleared up some of my concerns.
     
  16. Creatine

    Creatine New Member

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    Feel free to ask me anything
     
  17. samwalt

    samwalt New Member

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    Hey there. I've been in a similar spot and have a few opinions.

    I think you got good advice.

    You're going to need more than a multi for the iron. There should be something like a gram of iron in ferritin, and you're missing most of it. You absorb a 1/4, maybe a bit more with the testosterone. So maybe 800 mg/ 25% = 3,200 mg = a month of 100 mg/day. I'd supplement 50 mg twice/day for a few weeks, then retest. Get it to 100 -150.

    testing fasting blood sugar isn't very rigorous. You need to know insulin levels - fasting and post-meal. You could get a glucose tolerance test or at least start testing insulin too. Or try some alpha lipoic acid with some carbs for a month or two. Metformin might be worth it.

    it's strange you're tsh is that low with normal t3 and middling t4. Perhaps your trt dose was too high and slowed down t4 production. Good thing you did the pituitary scan to at least look into that somehow. is your acth okay? It can take a few days for cortisol to come back after 5 days of prednisone at 50 mg/day, so if that test was the day after it might be a bit higher now. 9 is low though. Testosterone lowered mine.

    You lipids might come down now that you're taking some thyroid and you lowered the testosterone dose.
     

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