T Nation

1st Bloodwork Back, Not Sure What to Do Next

Hey Guys,

I’ve read through the stickies, but as the title said, I’m not really sure what to do for my next step. I’m working with a PCP since I can’t find any reputable TRT docs in NJ area so far, so basically it seems like I’ve been needing to learn about this stuff to teach my doctor what to do.

29/M 5"8"5, 215lb.
Used to be in great shape, and over last 3-4 years I’ve gone from 165lb up to 225lb despite being an ex-fitness junkie and still working out 4-5x/week. Spent last year or 2 going through thyroid tests, sleep apnea tests, and other random bloodwork until recently I was found to be a bit low for Free T. I looked up the symptoms of low T and hit on pretty much all of them; depression, ED, weight gain, strength dropping, loss of muscle mass, sleep issues, constant tiredness and fatigue.

Here was my initial work which is all we tested for:

Overall T on low end of normal LabCorp range:
Testosterone, Serum [= 567] 348-1197(ref range) ng/dL

Free T Low:
Free Testosterone(Direct) [=8.5] 9.3-26.5(ref) pg/mL

Started TRT after that; doc wanted me to do one 200mg shot of Test Cyp a month, but after getting educated here, was able to speak to him and allow me to do 100mg/week. Started that on 6/14. Doc had me do follow up bloodwork on 6/28; my third weekly shot was scheduled for that day, but bloodwork was done BEFORE the injection. I asked him to include E and SHBG this time. These are my results:

Free Testosterone(Direct) =10.7 (Ref Range 9.3-26.5 pg/mL)
Testosterone, Serum =528 (Ref Range 348-1197 ng/dL)
Sex Horm Binding Glob, Serum =31.8 (Ref Range 16.5-55.9 nmol/L)
Estradiol =18.0 (Ref Range 7.6-42.6 pg/mL)

So basically my Free T went up slightly, but my Total T went down slightly; is this normal?

I don’t feel any better at all from my symptoms (note that I’m creating this thread after 4 weeks of injections at this point) so my question is basically what’s next? Do I stay on this protocol longer and see what happens? Do I ask to increase the Test Cyp dosage?
I have not been prescribed HCG or an AI; I’m thinking I should ask him to prescribe me HCG at least for fertility sake, but what about an estrogen blocker? My Estradiol is in normal range, so I doubt he’d be open to prescribing anti-E unless I can convincingly explain to him why it may be important still? I also read that if if my E was normal at this point right before my next inj, it;s possible it could be A LOT higher than that a day or two after my inj?

I’m sorry I just don’t know what to do next even after researching this stuff. I’ve spent the last few years miserable and on the verge of suicidal at times; I finally saw a glimpse of hope when my free T was found to be low and was hoping this would be the light at the end of the tunnel, but after zero improvement from 4 injections I’m getting demoralized again so I don’t want to screw up the next step when I go back to my doctor next week.

Thank you for any advice.

Do not use the term estrogen blocker, it is ambiguous.
You would need an aromatase inhibitor, like in the stickies.

Self inject 50mg T twice a week, subq, with #E29 1/2" 0.5ml insulin syringes.
Do labs always halfway between injections. Random time of office visits not good enough.

Your TT is midrange and FT low. While SHBG is not high, non-bioavailable SHBG+T may be inflating TT because liver clearance of SHBG+T might be low.

You may need higher T dose and as FT increases, FT–>E2 increases and then anastrozole may be needed to get near [optimal for almost all] E2=22pg/ml.

A few guys are T hypermetabolizers who need 300mg T per week to get where others are at 100mg per week.

Mood, energy/vitality, and libido are strongly affected by thyroid and thyroid normal ranges are quite useless. See my last paragraph.

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

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

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.

KSman is simply a regular member on this site. Nothing more other than highly active.

Thanks for the reply. What do you think the next suggested dosage should be for me that I should discuss with my doctor? If I need more than the 100mg/week (I know you said 50mg 2x/week, but frequency aside, I’m just discussing here as weekly amount for simplicity sake)
, what would be the next recommended dosage based on my numbers?.Is 150mg/week the next step to try? 200mg/week? What are your thoughts on the next amount I should ask him for?