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18Y/O on TRT. Brain Fog, Low Libido, Fatigue. Could Use Some Help

#1

Hello all,

I’m 18 years old. Began weightlifting at 13, played football from 15-18, always been super passionate about fitness by lifting 6-7 days a week and maintaining a clean diet. Take pre-workout, creatine, BCAAs, whey protein, and casein protein regularly. Been lurking on this forum for months now. Have read all the stickies. Unfortunately, I have no prior blood labs. I was a very uneducated user. I apologize for the lack of bloodwork, it is very expensive and this TRT is already draining my small budget as a college undergrad. The next chunk of text is a summary of my steroid abuse.

Some background of why I started TRT: Steroid use started at age 16, just before the ban of the methylated prohormones. Was sold by the idea that it was “now or never” if I was going to cycle prohormones. With no education about steroids whatsoever, I ran my first cycle. I believe the PH was called M1A, ran it for 4 weeks. The PCT was some herbal blend bullshit that the nutrition store sold me. I felt like shit. Now I know that the shitty feeling was a result of complete shutdown. Regardless, I told myself I would never run a prohormone again and allowed myself sometime to recover. I began cycling SARMs, particularly LGD-4033, a very suppressive SARM. I would get a strong sense of well being, as well as a very strong libido and high energy the first 4-5 weeks of each LGD cycle, then this feeling would fade as my testosterone would shut down for the last 4-5 weeks of the cycle. I would run the same herbal PCT for four weeks, then get right back into another LGD cycle. I repeated this on/off SARMs cycling for about a whole year, totaling 4 LGD cycles and 1 RAD-140 cycle. I also would note that Cardarine and MK-677 were included in many of these cycles. Overall, I made great gains and progress in the gym. I’ve kept up my healthy lifestyle of weightlifting regularly and dieting very clean allowing me to keep most of the progress I’ve made over the past few years. I finally realized this year, however, after finishing my most recent LGD cycle, that this was a serious drug problem that I couldn’t keep up with for my whole life. I realized that I had an addiction to that “on” feeling and was jeopardizing my health. I stopped LGD in October 2018, ran the same herbal PCT which I blindly trusted, then remained natty for a month. I tried every aphrodisiac under the sun, but Erectile dysfunction dominated my sex life. I had low drive, low energy, constantly fatigued, brain fogged, and low confidence, no morning wood.

At this point, I realized I needed to become educated on this stuff. I first heard of TRT as a friend of mine’s father had been on it due to his own prior steroid abuse. I researched as much as I could about it, and genuinely feel I have a good, basic understanding of TRT. In late November, I decided I should see a TRT doctor and look into therapy. I knew TRT was a huge commitment, but I felt that bodybuilding has been and will always be a huge passion of mine and setting up a TRT protocol would be the best way to restore my hormone levels to a healthy point while continuing to make progress in the gym. I knew finding a doctor to prescribe testosterone to an 18 year old would be tough, but it was actually very easy. I drove to the next town over for a consultation with a doctor and laid out my entire history of steroids, then listed all of my symptoms. He wrote me a lab request form for Total T and Free T… that was it. “Your lab results came in, Total T = 412 and Free T = 79.4. On the low side for a patient your age. We will call in your prescriptions today.” was the email I received after the blood test. I knew that this was somewhat inadequate evidence for a need for a lifelong testosterone prescription, but was so eager to alleviate these symptoms that I started the therapy right away.

I began this protocol in late November, 2018:
200mg Test Cyp SubQ 1x weekly
1mg Anastrazole 1x weekly (taken on injection day)
250iu HCG SubQ EoD
I also supplement with 12 mg Boron, 450mg Magnesium, 30mg Zinc, 2000iu Vitamin D every morning.

Upon starting this protocol, all symptoms slightly improved. Had some more energy, higher confidence, improved gym performance, but still overall felt pretty shitty. Low libido and ED continued. On this protocol, I noticed I would look very vascular in the gym on the first few days after injection. No morning wood on these days, however, about 4-5 days after injection, I would start getting morning wood (not very strong erections, but definitely something to note).

Week 3, I noticed High Estrogen symptoms (moon face, water retention, emotional), emailed doctor, and upped it to 2mg Anastrazole 1x weekly. This fixed estrogen symptoms right away.

Week 6 got followup blood work, taken on injection day, prior to injection.
Total Testosterone: 561 ng/dl
Free Testosterone: 14.6 pg/mL
Estradiol (sensitive): 25.4 pg/mL
Got a CBC panel, everything was in range. Hematocrit and hemoglobin were on the upper side of the range, so I gave blood. After giving blood, I noticed that my face wouldn’t become so flushed and I wouldn’t get dizzy during workouts.

I told my doctor how my hormones had to be fluctuating between injections since my symptoms (like morning wood) would change based on time between doses. I also said that my Free Testosterone looked low and my symptoms were starting to get worse. I switched to this protocol:

100mg T Cyp Sub Q E3.5D
0.75 mg Anastrazole E3.5D w injection
250 iu HCG EOD
Continued Boron, Magnesium, Zinc supplementation (stopped Vitamin D and began tanning for ~30 min most days). Added 400iu Vitamin E and 5g Ashwagandha Root daily (thought that elevated prolactin could be causing low libido). I also experimented with L-Tyrosine and mucuna pruriens for awhile to see if my issues were dopamine related.

On this protocol, there were some notable changes. After a few weeks on this protocol, I noticed an increase in frequency of morning wood. I noticed my testicles seemed to shrink. I felt better overall on this protocol. Main symptoms that continued persisting are low sex drive, erectile dysfunction, brain fog, and fatigue. On this protocol, I was able to achieve erections and sometimes have sex without losing them. Always took longer than normal to finish, if I were lucky enough to not lose erection. Sex drive was still low.

My guess for low sex drive/erectile dysfunction was a low Free testosterone, and my guess for low Free test was high SHBG. In an effort to see if this was the problem, I bought proviron from a buddy of mine and ordered research-compoud Tadalifil Citrate (cialis). 60mg ED of proviron and 5mg ED of Cialis helped a lot with my energy, confidence, and erectile dysfunction. I decided against the long term use of Proviron, as I was injecting 200 mg Testosterone every week and knew this should already be plenty of testosterone to fix these symptoms. I stayed on Cialis, as it does help slightly with keeping erections, and I love the pump I get in the gym while on it.

I’ve decided to explore my Thyroid function as a cause for my symptoms. I researched Hypothyroidism and noticed many symptoms I have align with it, even those that I haven’t mentioned before. I had noticed the brain fog, fatigue, and low libido. I also get numb hands (often while heavy-squatting or laying in bed trying to sleep), get cold easily, and think I have sparse outer eyebrows. I believe that the LGD messed up my testosterone production, which I’ve since fixed using testosterone injections. I believe using Cardarine, a PPAR receptor agonist that boosts metabolism, may be have messed up my metabolism or thyroid function. I ordered Thyroid labs for TSH, Total T4, Free T4, and Free T3 and hope that these may reveal what is causing my symptoms. I should have results posted from these labs later this week and would greatly appreciate some help from you guys in interpretting the results.

In the meantime, I have some questions that I was hoping you could answer.

  1. I ran Proviron because I assumed my free testosterone was low because my SHBG was high. I’m having second thoughts about my SHBG, however. I’ve read that an SHBG reading can be very helpful in setting up a protocol, however I don’t really have the money to be ordering all different types of labs and unfortunately have to struggle with playing things by ear. Anyway, I recently had the idea that perhaps my SHBG is low, which is why I require so much Anastrazole while on 200 mg Test. Could it be that after injecting the testosterone, so little of it gets bound to SHBG, so it all tries to convert to E2, which is why I need so much AI?

  2. Just based on how I’ve responded to TRT so far, with weekly injections vs. E3.5D injections, is there any way to interpret if I should switch to EOD injections or ED injections based on SHBG?

  3. Are there side effects to using Anastrazole? I’m not talking about side effects from crashing your E2. Is the actual drug itself in anyway toxic or able to cause problems? I can’t seem to find info anywhere on side effects besides those related to an E2 crash.

  4. Besides Thyroid function, should I be looking into any other possible causes for these symptoms? And if my thyroid is the source of the problem, what types of solutions could I expect besides lifelong thyroid medication? I recently started a Thyroid support supplement this week containing 100mcg Iodine, 50 mcg Selenium, 500mcg copper, 500mcg manganese as well as 100mg CoQ10 everyday. I’ve so far noticed hypothyroid symptoms only grow worse (fatigue got worse, brain fog got worse, voice became very hoarse, dry skin especially knuckles) and am stopping this supplementation if they continue to grow worse. I also recently experimented with taking Tongkat Ali, Pine Pollen Extract, Tribulus Terrestris, and black maca to improve libido. These herbs have been shown to affect cortisol in different ways. I’ve stopped these since reading that cortisol can affect thyroid function. My doctor said I could raise T dose to 300mg every week, but I think my symptoms are rooted in thyroid problems or other problems. Oral thermometer is on the way in the mail.

  5. I’ve researched Caffeine supplementation and learned it is generally safe up to 400mg daily in preworkout. I have never really cycled off pre-workout and use it with every workout. Could this be creating some sort of adrenal fatigue that leads to thyroid problems? I train intensely every day of the week, usually (Legs/Pull/Push/Legs/BackBis/ChestTris/ShoulderCore). Could this be straining my body too much, a reason why I’m not benefiting much from TRT and experiencing Hypothyroidism symptoms? I’ve trained like this for years and haven’t really thought of it as a problem, however this could be attributed to the PED use. Ideally, I’d like to not make any changes to my lifestyle and continue training like this.

  6. I am saving so that I can get all my blood tests done at once to see what looks out of range, despite not having baseline tests to refer back to. Is there anywhere you recommend to get the cheapest possible bloodwork done? Currently been using DiscountedLabs.

Lastly, I greatly appreciate it if you took the time to read all this and answer some of my questions, or have any advice to offer. I’m aware I’ve been going through this whole process in a very questionable manner and that my doctor’s lack of testing can even be seen as malpractice. Its a shitty situation, but I’m confident that, in the long term, TRT will pay off as I will get my hormones in balance and feel great and be healthy my entire life. I’ve learned a lot from other’s accounts on this website and figured it was finally time I post my own situation and get feedback. Thanks again.

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Test Cycle at 17, What's The Worst That Could Happen?
#2

You may very well be a hyper excreter and or hyper metabolizer of testosterone do to your low levels on such a massive dosage. If injections every 3.5 days fails to relieve all symptoms I believe you may need injections EOD to keep levels elevated and steady.

It’s a good idea to lose weight so you don’t need the anastrozole, it blocks estrogen and destroys estrogen metabolism. There are things you can do to better control hematocrit and estrogen, smaller more frequent injections, typically EOD and daily injections can see the most dramatic reduction in estrogen and hematocrit when having issues with either.

It’s usually the big infrequent doses that cause estrogen and hematocrit to spike high versus a smaller doses which gives steadier levels. I started out once weekly and twice weekly and notice very little improvements, it wasn’t until I started injecting 20mg EOD that I saw fast improvements in muscle within the first week!

You need thyroid hormones to be able to metabolize testosterone, Free T3 needs to be optimal to see optimal results on TRT, Free T3 should be midrange or preferably high normal. What out for Reverse T3, it can block Free T3 at the receptors stopping you in your tracks.

Test TSH, Free T3, Free T4, Reverse T3 and antibodies if you suspect thyroid problems.

I would test Total T, Free T, SHBG and estrogen (LC/MS/MS) while trying to balance all your levels.

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#3

You found a doctor to prescribe you testosterone at 18yo? Do you live in Mexico?

The only doctor you should be seeing is one who will work to restore you’re testicular function and get you off all that crap. You should run from any doctor willing to do anything else.

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#4

I received my Thyroid labwork test results today.
TSH - 4.460 uIU/mL 0.450-4.500
T4 - 6.6 ug/dL 4.5-12.0
fT4 - 1.21 ng/dL 0.93-1.60
fT3 - 3.4 pg/mL 2.3-5.0
I’ve read that ideal TSH is around/closer to 1, and that fT3 is the only active hormone and should be upper/mid range. With a high TSH like I have, I think this might be hypothyroidism. Does anyone have any advice on how I could achieve better numbers to see if that fixes these symptoms? My symptoms are brain fog (especially forgetfulness), fatigue, low libido/frequent ED, and irritability.

I usually eat out, so I’m not sure my iodized salt intake in the past, however a few weeks ago when I first suspected thyroid problems, I began a daily thyroid support supplement containing Iodine, Selenium, Copper, and manganese. I haven’t noticed any improvements in symptoms, if anything, they may have gotten worse.

#5

I will give ED injections a try. I’m going to start injecting 28mg ED, taken with 0.25mg Anastrazole. This totals 196mg weekly T and 1.75mg weekly AI, which is very close to my current protocol. Hopefully I will feel better on this. How do you suggest I go fixing my TSH in my above post?

#6

That’s an insane dosage (196mg weekly), I predict great suffering! You can’t just pick a number off the top of your head, you need to find out where SHBG sits. You need to start at 10-12mg daily. You don’t fix TSH, if your pituitary gland is happy with your Free T3 levels, TSH will be lower <2.5. Thyroid treatment which will lower TSH and increase Free T3.

You more than likely have hypothyroidism, T4 should be midrange. T4 is the total thyroid hormone produced by the thyroid gland and is low, so Free T3 can’t be optimal is the reservoir (T4) is low.

#7

I think almost all places don’t use iodized salt.

#8

I would start with a low dosage and increase as needed. I would not take an AI.

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#9

I just picked that number because it seemed closest to my current 200 mg weekly, but I guess I will start lower at 12 mg ED. I could get a SHBG check but as I said in OP, bloodwork is difficult money-wise. I understand what SHBG is, but could you explain how an SHBG reading would affect my protocol?

Do you recommend trying any changes in supplementation with iodine maybe or a different solution? I’d rather experiment with that first before I see a doctor about another lifelong medication for hypothyroidism.

#10

I was unaware that was the case. Since moving to college, my diet has significantly changed to contain only foods from the same 4-5 restaurants. Maybe, since making that change, I haven’t gotten enough iodine in my diet. I’ve been supplementing with Iodine for a week or two at 100mcg. I’ve heard of a supplement “Iodoral” around this forum helping guys feel a lot better. I looked it up on amazon and it contains 5mg Iodine and 7.5mg Iodide. Would u recommend increasing Iodine?

When I looked up Iodoral, reviews said not to discontinue use if you feel sick the first few days. The sick feeling is because of some “detoxification”. I think this is why my symptoms have gotten worse since starting the Iodine.

I’m a little hesitant to lower my Testosterone dosage so much. I currently have weak erections and low sex drive and think the cause is my thyroid being out of whack. Do you still suggest lowering my dose? I’ve read online that lowering dosage has helped guys with other symptoms and with feeling good, but I’ve never heard of lowering testosterone improving libido.

#11

Androgens bind to SHBG, if it’s lower you bind less androgens and are pissing it out most of what’s injected.

#12

Glad you got your Thyroid tested. systemlord reccomend Reverse T3 as well to see how much Free T3 is capable of occupying its receptors and I happen to agree based on Thyroid studies I’ve read.

You’re already ahead of me on getting your Thyroid tested. All the tests required to dial in optimal hormone numbers can be very expensive, at least as it pertains to my financial situation right now. you will hear time and time again that you need everything accounted for in your labs and there is good reason for this…for me, it’s just not financially viable.

I have pieces of my bloodwork put together here and there but some numbers I’ve had tested twice (like E2) keep changing significantly. I really need to test Pregnenolone, DHEA, DHT, Progesterone,

It was very clearly stated to me multiple times that my numbers will change a lot when I first begin taking Exogenous Testosterone and it makes perfect sense. Many guys say that they just don’t feel right initially and have some varying symptoms for awhile after beginning, though some guys feel great right off the bat. Scientifically speaking, we are somewhat radically changing our body chemistries functions. I’ll give an example in 2 paragraphs down.
For numbers to get dialed in and level out takes time.

SARMS are much more selective unlike Steroids and Bioidentical Hormones. I have no idea what specific sex hormones are altered by the use of SARMS but am curious. Being newer, SARMS aren’t as tried and tested as old school Steroids so, unfortunately, not as much clinical data is as readily available. Testosterone is only one hormone spun off of the sex hormone tree

Testosterone is only one hormone spun off of the sex hormone tree responsible for many other functions that work in sync with or independently from Testosterone to provide many of the benefits of that we look for Testosterone to provide.
The use of Exogenous Testosterone alone tells the Hypothalamus to reduce or stop the production of GnRH which signals the Pituitary to reduce or stop the production of LH and FSH. As a result of this, the Testicles are not stimulated by LH and FSH so they don’t produce the sex hormones they used to.

There are several places in the body that produce sex hormones to a degree but for men the majority of our sex hormones are for the most part, produced in the Testes.
A good example of one hormone that may suffer from Exogenous Testosterone and therefore Testicular shrinkage is the Parent Sex Hormone “Pregnenolone”. Pregnenolone is mostly produced in the Testes and plays a part in the production and support of all the other sex hormones. Many functions including cognitive thinking, sexual arousal, erectile function, anxiety/depression, etc have to do with the cascade of sex hormones produced by Pregnenolone and Pregnenolone itself.

To give you an idea of what I am saying I have attached a simplified diagram pertaining to the hormones produced from Pregnenolone itself. You can see how far down the chain Testosterone is in this process.

So it stands to reason that when we introduce Testosterone into our bodies Exogenously we may be short changing some of these other hormones from performing their respective functions by limiting their availability from Testicular production.
Remember that each sex hormone has particular functions. Whether our body’s gradually adapt or the stimulation of other hormones is unknown to me but Testosterone is not the only hormone that helps with androgenic/anabolic functioning in men.
For example If our Estrogens are very low or extremely high beyond our threshold we will have sexual problems including ED. Too low in Estrogen = no Erection or penile insensitivity and too high Estrogens = soft erections or losing erections during sex. While Estrogens play only a part of sexual function in men and are produced mostly from Testosterone they are not the only hormonal players in the game. Chemical compounds like Serotonin, Adrenaline, Dopamine are also factors…so it’s quite complex.

My plan is to stick to a Testosterone dose E3.5D’s and wait to let my biological functions catch up. I can’t afford many tests but let me say that Thyroid, SHBG, E2, TT, and FT are some of the more important things for me to get looked at as I go.
…and yes all the tests will help tremendously but I’m going to have to go by how I feel and stick to a dose for a couple months to stop f****** with my body getting used to what I’m doing to it till I can save for other labs. The guys on here are incredibly supportive. I have gotten a great deal of experience from guys who have been doing this for a long time or study Endocrinology or both. I just have to create threads and ask the right questions. I’m still learning and to a greater degree, we all are.
Many lab numbers will go up and down till I stabilize

#13

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#14

I have a rare opportunity to get all my blood labs done at no cost to me. Spoke to my physician today, I’ve just switched to ED injections and AI dosing to get the smoothest protocol I can, as well as adding Iodoral, Vitamin C, and Selenium daily to see if I can detox and raise my fT3. I will continue with this for 4 weeks to allow my levels to stabilize, then get tested for the following values. Remembering that I want to fix my symptoms of brain fog, low libido, ED, fatigue, decreased appetite, and no morning wood, is there any other values I should be getting tested? Currently have a request form for:

SHBG
DHT
Free/Total Testosterone
Cortisol AM/PM
Estradiol (sensitive)
Free T3 + RT3
Thyroid antibodies
DHEA
Pregnenolone
CMP

I weight train intensely every day, maybe one rest day per month if any. Very clean diet, moderate alcohol consumption on weekends, zero recreational drugs. Ideally, I can find a problem within my current values that can be fixed without changing my current lifestyle. Please let me know if you think there is any other value that would be of use to get tested, as I won’t get another opportunity to get this complete of a panel for a long time.

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#15

If this is the case you might be overtrained which would explain many of your symptoms.

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#16

Any literature to back this up? I’m almost certain this isn’t true. SHBG doesn’t and shouldn’t dictate a protocal. If you’re a hyper excreter that’s just bad luck, nothing to do with SHBG. Low SHBG can either be genetic or associated with insulin resistance, NAFLD, thyroid problems (decreased thyroid output), Cushing’s disease and more.

Honestly I’m not sure OP even needs to be on TRT, tis a bit late now, but he could’ve potentially recovered with a HPTA restart given his numbers and absence of endocrine pathology, however I could be wrong

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#17

Dude. Your insight is awesome and in many cases right on. :smiley:

#18

The grandfather of TRT states SHBG is the single most important biomarker for those considering TRT, Dr. John Crisler has been doing TRT longer than most doctors and was an expert on the subject of SHBG.

The comment about this 18 year old not needing TRT, the OP messed around with prohormone/steroids at 16, at time when his HPTA wasn’t fully developed and likely caused permanent damage to his HPTA. Are we treating his age or his symptoms?

A quick Google search is all that was needed, SHBG binds sex hormones and (androgen metabolism) balances testosterone, estrogen, thyroid hormones and even insulin. I’m still learning new things all the time.

https://www.ncbi.nlm.nih.gov/m/pubmed/2080856/

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#19

Mindphaser: I’ve considered my everyday training as a possible cause of symptoms, but have never had problems with it in the past. That being said, the majority of the past year I was on some sort of PED. Do you suggest I try taking a few days off to see if symptoms improve? Again, ideally I’d like to not change my lifestyle and am very dedicated to my passion for training… but not so dedicated that I’d sacrifice my well being and sex life for it.

Regarding SHBG, I’m not exactly sure whether I am a hyper excreter or have low SHBG. Regardless, I’m going to commit to the ED protocol and get blood labs soon. I have noticed, since switching to ED dosing just for one week, I’ve felt much calmer in stressful situations. I didn’t realize how anxious and emotional I was getting before, but now when faced with the same problems in day-to-day life, I have a much calmer attitude. So far, I think switching to ED dosing may be the right call. Ive read that ED dosing will generally lead to lower E2, so perhaps this is a sign that my E2 was higher before, causing the anxiety/emotion.

I’m well aware that being 18 and on TRT is uncommon. The biggest factors in my decision, which I debated for a long, symptom-heavy month, were:

  1. Eradicating symptoms as soon as possible (which hasn’t been the case so far but oh well)
  2. Being able to enjoy optimized hormones for the rest of my life, rather than living with my abused HPTA
  3. Having greater health overall due to optimized hormones
    This process has been really shitty so far, I’ll admit, but I believe that when I come out the other side with a protocol suited for me, it’ll have been worth it.

Are there any other tests someone would recommend I get for the above symptoms, besides those I’m getting already? Thanks everyone for all the responses, BTW.

#20

But the problem is whether he could’ve potentially recovered from simple abstinence of said agents. Puberty (when regarding tanner stages) is typically complete by 16-17, I’m my case more like 13, a male is near his peak T production by then. Given his age, assuming there’s no significant underlying endocrine pathology, it’s very possible simply more time of and attention to optimizing diet and lifestyle would’ve caused him to recover.

That being said, it isn’t a particularly big deal, no one wants to wait that long, and despite the fact that he may be shut down for the rest of his life on TRT, it isn’t as if he’s using meth or something, thus it could be a whole lot worse, if trt helps OP then more power to him. However he hasn’t particularly used gear for a long period of time.

His ED could very well be caused by an imbalance and/or deficiencies/desensitizatiom to certain neurotransmitters, as gear can do this and the long term impacts of SARMS are currently unknown.

Finally, I understand the clinical significance of chronically elevated or depleted SHBG (the one being associated with compensated hypogonadism and the other being associated with either genetics or a wide range of medical pathology), however nowhere does it say SHBG should dictate injection frequency or dosing + ester bound testosterone is released over a period of time, that’s how the ester works. Test is metabolized primarily via conjugation and some other stuff, not particularly important, but not SHBG. These CHANGED inactive metabolites are excreted in urine, has nothing to do with SHBG. Dr Sir @physiolojik would have to clarify this for me though, I could be wrong. I wonder if it annoys him I call him Dr Sir. However with test bound to an ester clearance rate the excretion rate shouldn’t be significantly changed unless one is a genetic freak, you may be an anomaly given you’re medical history. I know I’m fairly sensitive to the SNS stimulating effects of androgens :slight_smile:

Edit: in case someone feels like correcting me I’m aware a tiny teeny portion of test is excreted in urine unchanged

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