T Nation

18 Months on TRT; Want Advice (Update: 2/28)


#1

Age: 27
Height: 5’11
Waist: 31
Weight: 215
Describe body and facial hair: Fast growth on face, chest and genital area. Has darkened since starting TRT in June of 2015
Describe where you carry fat and how changed: Mid section, lower back and chest
Health conditions, symptoms [history]: Social anxiety and depression
Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Bupropion XL 150mg
Lab results with ranges:

11/10 (anti aging clinic):
Total T: 586
E2: 11.2

1/5 (endo):
Total T: 1014 ng/dl
TSH: 4.810 uIU/mL 2nd blood test: 1.590 uIU/mL (.350 - 3.000 uIU/mL)
T4: 1.05 ng/dl (.63 - 1.24 ng/dl)
PSA: .64 ng/mL (0.00 - 4.00 ng/mL)

Describe diet [some create substantial damage with starvation diets]:

~2761 total calories, 259.1g protein 288.6g carbs 63g fat

Chicken, eggs, milk, banana, oats, wheat bread, pasta, whey and casein protein powder, fish oil, emergen-c, vitamin d3 9000iu per day

Describe training [some ruin there hormones by over training]:

Arnold’s intermediate training from his book
Mon/Wed/Fri: Chest, back, deadlifts, squats, hamstrings, calves and abs
Tues/Thurs/Sat: Shoulders, arms, forearms and abs

Testes ache, ever, with a fever?: Never, testes ache a little bit when beginning HCG

How have morning wood and nocturnal erections changed?

Lack of morning wood and nocturnal erections

My story:

In 2015, Mom suggested I go have my T checked. I was actually the leanest I’ve ever been in my life at this point. Probably around 8% bf around 180 or so. In great shape for a kid who had always been muscular but fat

I went to a anti-aging clinic and had my T checked. They said, get this, same day it was around 250. Not having done any research into TRT and testosterone before I naively agreed to a year of pellets. They also started me on HCG at 500iu x 2 weekly subq. Did HCG for most of the 1st year on pellets. Some more tests done during the first year on pellets:

4/27/16: ~950 T
6/2716: 476 T

I never saw any of these results and being a dumbass I didn’t ask to see them. Nor did I ask to see my E2 level

Now we are at mid 2016 and agreed to pay for another year of pellets with insertion on 6/29/16

8/31/16: 977 T
2 or 3 pellet extrusions
11/1/16: 586 T 11.2 E2
Started HCG at 500ui x 2 a week on 11/17/16 which lasted for 30 days.The clinic switched to a quarterly schedule for HCG. Is HCG quarterly a good idea?

Started with a new endo this month out of fear that the anti aging clinic has been lying. My endo thinks I should go off the TRT to find out my baseline T and E2 and go from there. He believes I might’ve never had T in the 250 range or low T in general

I’m leaning towards going off the TRT and checking to see my baseline is before making another move if I even have to. I feel great except for the morning wood issue and if I stay on, I will be doing shots instead of pellets. I see the anti aging clinic on Thursday to try and gather my lab results over the past year and a half and a blood draw

Any advice or input would be appreciated

Thank you


#2

If you do decide to go off, do not quit cold turkey. Definitely coordinate a PCT plan to get your own body producing again. Were you taking an AI along with pellets and HCG?


#3

Good call. I will see if I can coordinate a PCT plan if I do go off. I’m not on a AI and actually haven’t taken one throughout my time on TRT


#4

At your age, low-T is the symptom and not the disease. Clinic probably did not do any diagnostics to find cause of low-T to see if correctable. Can you get those labs?

Pellets are high T for a while, then drop low for a while, hard to get balanced.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc
  • HPTA restart

You should be on hCG always to protect from loss of fertility.
Going off of TRT is expected to lead to low-T just as getting off of TRT without PCT can lead to poor recovery.

Do the reading and come back with informed questions.
Do not ignore the references to thyroid, iodized salt etc.


#5

Hey KSman,

Thank you for the response. I retrieved my labs from the clinic today and 3 months worth of HCG to aid in my recovery. The clinic didn’t do any diagnostic work to figure out why low-t was happening

6/23/15:

Test: 281 ng/dL They used something called a FastPack Testo to same day test this. Time was at 9:47 AM.
Estradiol: 17.1 pg/mL (7.6 - 42.6 pg/mL)
PSA: 0.5 ng/mL (0.0 - 4.0 ng/mL)

First insertion same day, 6/23

8/25/16:

Test: 698 ng/dL (348 - 1197 ng/dL)
Estradiol: 10.6 pg/mL (7.6 - 42.6 pg/mL)
PSA: 0.5 ng/mL (0.0 - 4.0 ng/mL)
MCHC: 31.3 g/dL (31.5 - 35.7 g/dL) Low
Have more info as they ran a CDC with diff/platlet

Pellet insertion around Oct/Nov

12/15/2015:

Test: 885 ng/dL (348 - 1197 ng/dL)
Estradiol: 13.3 pg/mL (7.6 - 42.6 pg/mL)

2/25/2016:

Test: 360 ng/dL (348 - 1197 ng/dL)
Estradiol: 10.4 pg/mL (7.6 - 42.6 pg/mL)

Pellet insertion in early March

4/20/16:

Test: 991 ng/dL (348 - 1197 ng/dL)
Estradiol: 19.1 pg/mL (7.6 - 42.6 pg/mL)
MCH: 26.4 pg (26.6 - 33.0 pg) Low
MCHC: 30.4 g/dL (31.5 - 35.7 g/dL) Low
Have more info as they ran a CDC with diff/platlet

6/28/16:

Test: 476 ng/dL (348 - 1197 ng/dL)
Estradiol: 16.9 pg/mL (7.6 - 42.6 pg/mL)

Pellet insertion on 6/29

8/31/16:

Test: 977 ng/dL (348 - 1197 ng/dL)
Estradiol: 26.6 pg/mL (7.6 - 42.6 pg/mL)

11/1/16:

Test: 587 ng/dL (348 - 1197 ng/dL)
Estradiol: 11.6 pg/mL (7.6 - 42.6 pg/mL)

Pellet insertion on 11/10

281 isn’t considered low but is in on the lower end of my endo’s range


#6

Levels are changing too much. Too long between pellets.

E2 seems too low most of the time. Something is not right.
Almost like you are using anastrozole.
E2=~10 will make most guys feel like crap and ruin libido.
FT may be very low, limiting T–>E2.
What is your quality of life [QOL] on pellets?

Labs:
TT
FT
E2
CBC
hematocrit
SHBG
prolactin - one time
AST/ALT
TSH
fT3
fT4 [not T3, T4 or indexes etc]

Also, see my earlier post.

You read those stickies? I asked that you take note of thyroid related issues and come back with questions.

TSH=4.81 is horrible.
You have a big thyroid problem.
Have you not been using iodized salt [long term]? Needed to make thyroid hormones. The thyroid lab ranges are bogus and doc thinks that you are normal. Eval your overall thyroid function by checking oral body temps as per the thyroid basics sticky.

You are not been well managed. Suggest:
self inject SC/SQ 50mg T cyp/eth twice a week, #29 0.5ml 1/2" insulin syringe
250iu hCG SC EOD, #31 5/16" insulin syringe
May introduce anastrozole later if E2 >> 22pg/ml

My advice is:

  1. Read the stickies
  2. Post oral body temps and requested info re iodized salt
  3. self inject T as above
  4. labs as suggested
  5. may need another doctor and there is a sticky for that.

HPTA restart attempt remains an option.

Endos are often do a very poor job of managing male hormone issues. You got screwed with a poor diagnostic workup and no interest in fixing your root problem, only getting you on reoccurring billing.


#7

QOL: I definitely haven’t been feeling all that great. Decent energy but hardly any libido most likely due to low E2. The pellets are way too much up and down and this is primarily why I’m seeking advice and help.

I read through the stickies and contacted a compounding pharmacy in my area (Seattle) and received a doc’s name who I’ve called today. Dr. John Sherman (if anyone has had experience with him, please let me know)

I checked my temp this afternoon twice and it came out to 98.7 both times. Will continue to check temp in morning and afternoon. My family has a history of being Hypo so will look into buying Iodoral from Amazon.

Yep I think you are right about the Endo and the clinic. Both only cared about billing.

Thank you KSman for being a big help and pointing me in the right direction. I should have looked into this long before I went down this path. Huge lesson learned

Will continue to update


#8

Get started: http://www.tahomaclinic.com/wp-content/uploads/2013/07/New-Patient-Form-2013.pdf


#9

Already did.

Ordered Iodoral and should be here today

Started 25mg 2/4

Morning and afternoon temperature:

2/4 Morning: 96.3 Afternoon: ~97.4
2/5 Morning: 96.6


#10

New update:

Started with a new doc and we went over all the info. He seemed very knowledgeable about trt, thyroid and adrenal issues. I started on compounded cream at 125mg/.5ml once a day. Feeling better only after a few days of application.

I also had a thyroid complete, FSH and LH and Comp Plus 24 hour urine tests done. Still waiting on the Comp Plus 24 hour urine test results to see how my adrenals look.

Here are the thyroid and FSH and LS results:

TSH: 5.94 uIU/mL (.25 - 3.0 uUI/mL)
T4: 7.91 ug/dL (6.09 - 12.23 ug/dL)
T3: 67.21 ng/dL (87 - 178 ng/dL)
rT3: 24.97 ng/dL (6.7 - 21.8 ng/dL)
rT3/T3: 37.15% (4 - 32%)
FT3: 2.88 pg/mL (2.5 - 3.9 pg/mL)
FT4: 0.8ng/dL (.61 - 1.12 ng/dL)

Anti-TPO antibody: 0.4 IU/mL (< 9 IU/mL)
Anti-Thyroglobulin < 0.9 IU/mL (< 4.0 IU/mL)

FSH: <0.7 L (1.6 - 8.0 mIU/mL)
LH: <0.2 L (1.5 - 9.3 mIU/mL)

These results lead me to believe that I’m Hypo and the HCG hasn’t had much of any affect on my FSH and LH.

Any thoughts KSman?


#11

Thyroid is horrible.

Wait, I said that before.

This my new addition to my sticky posts:

  • Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

Please read the thyroid basics sticky again, noting references to stress factors, rT3, adrenal fatigue and Wilson’s Book <-- read it.

You cannot fix adrenal fatigue by simply taking a pill. Taking T4 meds makes it worse as T4–>rT3 increases and most docs do not know this. Fix is time and lifestyle changes with rT3 only medication.

Docs checked your thyroid size and texture and ???

With your thyroid issues I would expect poor transdermal T absorption that is typical. Would be nice if doctors understood that. Sometimes on absorbs briefly or not at all, but E2 increases. You may need to self-inject, which is 100% absorption and least cost.


#12

TSH also up as expected from Iodoral.

I hope that you are taking selenium, very important with larger dose supplemental iodine.