T Nation

10 Weeks In; Questions; Doctor is Stumped


#1

-26
-5 foot 9 inches
-33 inches
-175lbs
-endomorphic; alopecia areata in beard and scalp for years.
-stomach, hips, waist, butt.
-bipolar/mood swings for years and social anxiety/social phobia. Struggled enormously to ever gain muscle. Binge-eating compulsion. Insomnia for ten years. Symptoms started around onset of puberty (~15 years old).

Take xanax 0.5mg every night to help get to sleep. Sometimes works, sometimes doesn't.

Backstory:

Got full blood draw done from primary care doc after moving to new city. Showed total T at 590~ng/dl and free T at 8.7pg/ml ("low"). Doc gives me RX for 200mg/ test cyp once every two weeks (idiotic) and says "feel better!"

Read internet, realize doc is stupid. Run one week of 100mg test cyp. Go to mens health clinic specializes in TRT. They start me on 140mg test cyp/week.

After first few weeks, some changes:

-more muscle
-way increased libido/erection strength/sexual performance
-increased anxiety including one incident of full-on panic attack. Was sitting on the couch after a night of poor sleep and out of nowhere, felt like I couldn't breathe. Stood up, walked around, panic increased. Thought I was going to die alone in my kitchen floor. Almost called an ambulance, was so convinced of death approaching.

Get labs re-tested after 4 or 5 weeks. Results show total T @ 645ng/dl on day 6 after injection, with the office's estimate being 845ng/dl peak day 4. Estradiol 13.2pg/ml. Physician's assistant (manages the office) increased dosage to 150mg/week. Was supposed to start HCG around this time, but I banked sperm pre-therapy and told them I was feeling good with no personal need for HCG. Didn't mind the testicular shrinkage. So the office concurred and I did not start HCG. No AI, no HCG.

Sometime around now, I noticed bad changes. Libido fell off completely and went away. Currently 10 weeks in and have zero sex drive. Some of the muscle I initially gained seems to have gone away. Food cravings/binge eating has been really hard to control. Sleep is poor and motivation/drive/energy is down.

Got labs tested Monday, 2/2/15 (11 weeks). Results came back today showing total T ~574ng/dl on day 6 (day of draw), and free T at 8.3pg/ml(!). Estradiol at 12.1pg/ml. Both total T and free T are LOWER than BEFORE I started TRT!

I asked the PA to review the results with him. He was first of all confused why free T was even on the blood draw. I told him it was because I specifically asked for it to be. I told him of my symptoms and disappearance of TRT benefits. He said he honestly had no idea why my total T and free T are actually LOWER than they were before starting TRT. He said, "maybe you did better on the lower dose. Maybe it's too high." To which I said, "Well the estradiol is still really low. How can the dose be too high?" He concurred.

He said he was going to research it some more and talk to his boss, an actual doctor. The only thing he said was "it might have something to do with your SHBG. But we've NEVER tested anybody here for that."

I have 4,000iu of HCG in my possession, reconstituted in the fridge. The office's notes are to use 25 units 2 days before T injection, and 25 units the day before T injection. I haven't touched it yet.

Any thoughts on what could be causing this, or what I should do?


#2

whats your SHBG?


#3

Your testosterone injections are fake in my opinion use from other trusted source bro. Hope it helps I have seen this happen to many guys.


#4

[quote]red-devil wrote:
whats your SHBG? [/quote]

I don’t know, they didn’t test for it and the PA said they never do. He said SHBG is correlated with obese people, and I’m 175lbs 13% bodyfat so he was confused.

He thinks starting HCG may help since I’ll be getting T from the shots and T from my own body’s production too, I should start seeing some better results. As of right now, I’m 100% shut down, right?

Also he increased the Test cyp dose from 150mg/wk to 170mg/wk. This combined with starting HCG, I am a little worried E2 will start to rise.


#5

You need to inject more often to get steady levels. Many do twice a week, and many EOD.

Please read these stickies:

  • advice for new guys
    – note the additional info requested
  • protocol for injections

Labs:
TT
FT
E2
prolactin
LH/FSH [ very important, but too late. should always be done before TRT]
TSH
fT3
fT4
DHEA-S
AM cortisol [do labs at 8AM]
fasting cholesterol [could be too low]
CBC

When you get your T levels steady, do labs [always] 1/2 way between injections then increase T dose as required to get to high normal levels. We have some guys here who are hypermetabolisers who need 300mg/week.

There is more going on than T. Your low T is a symptom and you should be finding the cause. Don’t have T tunnel vision. There has not been any effort that I can see to do basic diagnostics. [sadly happens often]

Many here have thyroid problems and many are iodine deficient. Please see the thyroid basics sticky, note references to iodine and iodized salt. Check your body temperatures as suggested.

Sleep: See if you can get as a trial -
150mg trazodone, start with 50mg
5-6mg TIME RELEASE melatonin

You need to not be taking xanax long term. It messes with your brain!

Supplements:
fish oil
5,000iu vit-d3 in tiny oil based gel caps, take 25,000iu for first 5-7 days
Multi-vit with a good spectrum of trace elements including iodine, selenium


#6

[quote]KSman wrote:
You need to inject more often to get steady levels. Many do twice a week, and many EOD.

Please read these stickies:

  • advice for new guys
    – note the additional info requested
  • protocol for injections

Labs:
TT
FT
E2
prolactin
LH/FSH [ very important, but too late. should always be done before TRT]
TSH
fT3
fT4
DHEA-S
AM cortisol [do labs at 8AM]
fasting cholesterol [could be too low]
CBC

When you get your T levels steady, do labs [always] 1/2 way between injections then increase T dose as required to get to high normal levels. We have some guys here who are hypermetabolisers who need 300mg/week.

There is more going on than T. Your low T is a symptom and you should be finding the cause. Don’t have T tunnel vision. There has not been any effort that I can see to do basic diagnostics. [sadly happens often]

Many here have thyroid problems and many are iodine deficient. Please see the thyroid basics sticky, note references to iodine and iodized salt. Check your body temperatures as suggested.

Sleep: See if you can get as a trial -
150mg trazodone, start with 50mg
5-6mg TIME RELEASE melatonin

You need to not be taking xanax long term. It messes with your brain!

Supplements:
fish oil
5,000iu vit-d3 in tiny oil based gel caps, take 25,000iu for first 5-7 days
Multi-vit with a good spectrum of trace elements including iodine, selenium[/quote]

KSman,

Thank you. I was hoping you would read my thread and help.

I read the thyroid basics thread and have my thermometer ready to take temperature readings tomorrow. I found a couple of iodine supplements on Amazon, but haven’t ordered anything yet.

What steps should I take at this point? Start with iodine supplementation, get all that bloodwork done (if so, with who? The TRT clinic is VERY reluctant to do more than total T and a few other things. Should I go to an endocrinologist?), go to a psychiatrist and ask specifically for trazodone? I’m curious to what made you think of that specific drug in my situation. I have tried many SSRI’s and SNRI’s without success.

Reference injecting twice per week, the TRT clinic gives me pre-fills for 1x/week. I know it’s not recommended, but would it be a huge deal if I injected half of the pre-fill on Monday, and the other half on say, Thursday?


#7

[quote]checkmat wrote:

[quote]KSman wrote:
You need to inject more often to get steady levels. Many do twice a week, and many EOD.

Please read these stickies:

  • advice for new guys
    – note the additional info requested
  • protocol for injections

Labs:
TT
FT
E2
prolactin
LH/FSH [ very important, but too late. should always be done before TRT]
TSH
fT3
fT4
DHEA-S
AM cortisol [do labs at 8AM]
fasting cholesterol [could be too low]
CBC

When you get your T levels steady, do labs [always] 1/2 way between injections then increase T dose as required to get to high normal levels. We have some guys here who are hypermetabolisers who need 300mg/week.

There is more going on than T. Your low T is a symptom and you should be finding the cause. Don’t have T tunnel vision. There has not been any effort that I can see to do basic diagnostics. [sadly happens often]

Many here have thyroid problems and many are iodine deficient. Please see the thyroid basics sticky, note references to iodine and iodized salt. Check your body temperatures as suggested.

Sleep: See if you can get as a trial -
150mg trazodone, start with 50mg
5-6mg TIME RELEASE melatonin

You need to not be taking xanax long term. It messes with your brain!

Supplements:
fish oil
5,000iu vit-d3 in tiny oil based gel caps, take 25,000iu for first 5-7 days
Multi-vit with a good spectrum of trace elements including iodine, selenium[/quote]

KSman,

Thank you. I was hoping you would read my thread and help.

I read the thyroid basics thread and have my thermometer ready to take temperature readings tomorrow. I found a couple of iodine supplements on Amazon, but haven’t ordered anything yet.

What steps should I take at this point? Start with iodine supplementation, get all that bloodwork done (if so, with who? The TRT clinic is VERY reluctant to do more than total T and a few other things. Should I go to an endocrinologist?), go to a psychiatrist and ask specifically for trazodone? I’m curious to what made you think of that specific drug in my situation. I have tried many SSRI’s and SNRI’s without success.

Reference injecting twice per week, the TRT clinic gives me pre-fills for 1x/week. I know it’s not recommended, but would it be a huge deal if I injected half of the pre-fill on Monday, and the other half on say, Thursday?[/quote]

before beginning Iodine supplementation, you would need to first establish that your temperatures are consistently low. take temps first thing in the morning before you have done ANYTHING, (eat, drink, talk, etc) and then again in mid afternoon. temps will be lower in morning than mid afternoon. you are looking for the ability to get to ~98.6 mid afternoon. if you’re 96’s in morning and doesn’t climb much past low 97’s- then consider the Iodine Replenishment.

for injecting more than once a week the better option would be to buy your own syringes and split your pre-filled in half- backfilling another syringe. of you can’t purchase syringes where you live, you can inject half, alcohol swab the needle and recap. I’d swab it again before the second injection personally. the real negative to this is actually that by the time the second injection get around, you’ve blunted the needle tip a bit with your first injection- and filling it initially depending on if they backfill or not. not the end of the world, just takes a fraction of a second longer to puncture the skin, which “hurts” more…this pain is negligible.


#8

Many GP’s Rx trazodone for sleep.

In most States, you can order your own labs.

There is a finding a TRT doc sticky.


#9

Ordered Iodoral and Selenium. Daily temps were between 96.4 and 97.7 at the absolute highest, post-workout (figured I’d see if I could break 98.0)

Started HCG 250ui on Friday, then Sunday, injected 170mg test cyp Monday. Mood seemed to come back a little, and libido is rising a little bit too.

But motivation is in the absolute gutter. Usually passionate about Brazilian Jiu-Jitsu, I couldn’t even stand to look at my gi or think about training. Very low energy and unable to stick to diet protocol. Incredible cravings for food.


#10

My first impression is that it’s due to the weekly spikes. When the body sees levels beyond the norm it finds ways to deal with it but then 3 days later you’re tapped out.

You may want to reconsider hCG, not just for testicular atrophy but for the other hormones that will no longer be produced by inhibited testicles. Progesterone plays an important role in your hormone balance and overall well being. Depending on the person, it may also affect libido and erectile function.

I recently had to stop taking it because I ran out and the manufacturer hasn’t had any available for over a month now. I’m way more moody, lower interest in sex, and don’t feel half as good as I did last month. I’ve been on hCG for the past 5 months solid.


#11

Update

Been on HCG 250iu 2x/wk, 170mg test cyp 1x/wk.

Some changes:

Pros
-Libido is BACK! Yes!

Cons
-Gyno side effects. Puffy and sensitive nipples. Tons of water bloat and fat gain. I look “chunky”, as one girlfriend told me.
-Appetite is extremely difficult to control. I’ve been working with a nutritionist for a few weeks and it’s been like banging my head against the wall. In the past I’ve dieted with GREAT success, but these past few weeks I’ve been unable to stick to macros and constantly am binge-eating.
-The only time I’ve had this kind of trouble with diet control was when I was on Abilify for depression in the past. That made my hunger uncontrollable and this is pretty close to that level.

So I’m thinking that starting HCG while simultaneously raising test cyp injections to 170mg/wk, all with ZERO aromitase inhibitor, has led to a huge increase in testosterone and estrogen.

Going in on Monday to ask for blood to be drawn and to complain of my symptoms. It sounds like the protocol you guys recommend on this forum—HCG, Test and Adex–is the way to go. If only my clinic did this from the start instead of all this yo-yo-ing trial-and-error.

Any thoughts on this?


#12

Forgot to add, other symptom is big increase in acne on chest, back and even some on the arms. Big, painful zits.


#13

Yes, you need anastrozole. If you could get Rx first, then do E2 lab work, then you can calculate the dose you need and not need two labs to get there.

Zits can happen as you are going through some of aspects of puberty. Things will settle down. But with 170mg T per week, it may not work out. Why so much T?

Injecting once a week makes things worse, more E2 and more zits. See the protocol for injections sticky and advice for new guys.


#14

Update

Started 1mg anastrazole/wk. Side effects settled down. Acne went away, nipples are looking more normal now.

Got labs done 2 weeks ago and total T was in the mid 600’s on injection day (day 6) so they estimated I was in the mid 800’s peak, during the week. Free T was 12pg/ml. Estradiol was 19pg/ml

PA was not satisfied with total T (and I wasn’t satisfied with Free T, but he doesn’t seem to care). Increased to 180mg/wk. HCG 250iu 2x/week. 1mg anastrazole/wk.

Also I have stopped taking xanax cold turkey. It’s been a little rough. Insomnia the first few days but it’s tapering off. Some bad mood issues.

Testicles are pretty small. New girl the other night asked me if one testicle was smaller than the other. I think she’s right.

This office is tough to work with sometimes. They have their strict protocol. I know KSman recommended I find a different doctor.

Thinking of increasing HCG to 250iu 3x/wk per the stickies.


#15

Ok, so could definitely use some more advice.

Started Trazodone per KSman, and holy shit—It works! I’ve been getting 7-9 hours of sleep every night since I started. Only 50mg, too. Mood and depression are going away as well! I was shocked at how well it’s working.

However, I am at my wits end with appetite control and binge eating. I just got done trolling Target and Chik-fil-A for junk food. Wasn’t even hungry, just felt like I HAD to eat some crappy food. Last night I put down an entire Pizza Hut pizza and other crap by myself.

Currently 180mg Test Cyp 1x/wk, 250iu HCG 2x/wk, 1mg anastrozole 1x/wk

Almost 190lbs. Shit is ridiculous.

I searched the internet for connections to testosterone and binge eating. Everyone seems to agree that it increases appetite, but not in such a negative way.

I want to talk to the PA about bringing Test Cyp down to 140mg/wk. That’s what we started at and I wasn’t having such bad issues back then. I was lean. Now I’m fat!

Testicles are also really small.


#16

I’m not the expert that KSman is (or some of the other guys), but I would definitely look at breaking up your weekly dosage into multiple injections. Are you doing your own injections, or are you going to the clinic weekly? Shouldn’t be too hard to talk them into letting you do your own injections (unless they are charging you an office fee every time you come in).

Another thing you may look into is the pellet implants. I have a couple friends who went that route after the Navy told them 200 and 240 (respectively) wasn’t low enough to warrant replacement - Navy medical policy is 180 before they will prescribe anything. The pellets were pricey, but part of the price was routine checkups including bloods each time. Everyone I’ve known that went that route was very happy with their results. Nice steady release, so you don’t have to deal with the spikes (which may be causing some of your issues).


#17

[quote]boatguy wrote:
I’m not the expert that KSman is (or some of the other guys), but I would definitely look at breaking up your weekly dosage into multiple injections. Are you doing your own injections, or are you going to the clinic weekly? Shouldn’t be too hard to talk them into letting you do your own injections (unless they are charging you an office fee every time you come in).

Another thing you may look into is the pellet implants. I have a couple friends who went that route after the Navy told them 200 and 240 (respectively) wasn’t low enough to warrant replacement - Navy medical policy is 180 before they will prescribe anything. The pellets were pricey, but part of the price was routine checkups including bloods each time. Everyone I’ve known that went that route was very happy with their results. Nice steady release, so you don’t have to deal with the spikes (which may be causing some of your issues).[/quote]

Thanks for replying man.

They give me the option to take home pre-filled syringes. It costs $40 more per month but whatever.

So I have two syringes with me of 180mg each. Going to split them up into 2x/weekly doses. See if it helps.

I’m going to look into the pellets.


#18

Update–

Talked to my doc today. We are going to come off TRT.

Did 180mg test cyp today, will do 140mg test cyp next week, then stopping testosterone completely.

Also going to up HCG to 250iu 3x/week. Besides that, I’m not going to take anything. Unless anyone else has input on this. I’ve seen so many different thoughts on how to come off TRT on the internet. From cold turkey, to clomid/nolvadex/hcg and all kinds of things.

I really appreciate if anyone wants to chime in and add their thoughts.

The reasons I’m coming off TRT are:

-Insane weight/fat/water gain. Despite dieting, can’t lose weight and clothes don’t fit me.
-Insane acne that keeps getting worse.
-Money $$$ I may be getting laid off soon. I cash-pay my TRT treatment and it runs me $240/month. It’s a luxury that I can’t afford even if it was all sunshine and rainbows.
-I want to compete in BJJ and MMA again. Ethically I want to be clean drug-wise.

Thanks in advance guys.


#19

[quote]checkmat wrote:

Testicles are pretty small. New girl the other night asked me if one testicle was smaller than the other. I think she’s right.[/quote]

Pretty much every guy has one larger testicle and one smaller, so this in itself is not abnormal.

Your treatment sounds much more expensive than normal and from the details you mention it doesn’t sound as if the regimen was right for you. Still, your other reasons for quitting are understandable.