T Nation

1st Visit with TRT

So I had my first TRT visit today. From what I can tell it went well. I’ve been doing my research as best I can the last 2 months before I made the appointment, but science is not my thing. So with that said heres my story you guys that know all the science by all means let me know if Im doing bad here…
Im 35 180lb BF 15% 5’9’’
Went to the Low T office in KC nice place pretty girls nice layout. I have good insurance so no issues there. My T tested at 182 Doc said it should be 350… I read the article “your DR your dealer” and did all that stuff to test well It wasnt hard… Also to add to that T seems to be low at end of day he said so if making an appointment shoot for later in the day. Any how Doc said he would shoot me up with Test Cyp every 7 days each shot enough to boost me to 1100 Also he will be shooting me with HCG to keep my nuts right. He said he would be testing every week for first 5 weeks to make sure I didnt need a Estro blocker. He said if I did he would put me on Armidex… He also said he would be testing my blood for thyroid and other stuff before I start. They said I could start today but I said I’d prefer to start in March so I can make sure its right for me. Its only $20 a visit so thats not much & its 15min from my house. Based on what I’ve read this doesnt seem bad… Also he said after 6 weeks he rarely tests… I took that to mean if I bumped the test on the side he wouldnt care or notice… He seemed cool and openminded I know they just want my $$$ so if there is anything else I can squeeze them for let me know… I get the feeling they would do it, if I have a good reason & they get paid for it.

Have you read the stickies?

Yes … and as I understand it 3x per week is optimum for injections so you don’t crash… from what I read from vtballa some guys do ok 1x per week. I think after a month or so after I build repor with the dr I can fanagle self injection…I didn’t want to hijack the protocal sticky so I created my own story 4 general feedback… Do you think how its laid out I will see any gains in mass?

We see many issues with guys other than low T or issues that cause low T. You should not be treating symptoms and looking for a problem that can be fixed. Be open minded to the other pathologies in the advice for new guys sticky and provide more info and lab work results with ranges. If you go to a low T shop, there will be a degree of tunnel vision.

Do not start TRT before you get LH and FSH data!!!

Read the posts of others and see what is going on.

I’ve been reading like crazy I think Im swimming in data…Im trying :slight_smile: You are a great source :slight_smile: I wish I had note pad the doc called me today to go over my test. I was driving with my kids at the time so I got as much as I could info wise. I will explain it as best I can… He said the test for the prostate blood thing was good no reason for concern. He did tell me some numbers but I dont recall them. The test on my thyroid stuff was also good he said. We talked for a minute on side effects becuase my concern was gyno he said the 1st 6 weeks I’ll be tested weekly to dial in the right amount of E blocker.
The numbers I have from my test just show this…182ng/dl & PSA 0.25
Im not really sure what LH and FSH is I’ll keep searching… I agree on the the tunnel vision but based on the protocal I read its Test cyp every 7 days plus, HCG and E blocker…Its not broke up EOD which I understand is optimum so no peeks & valleys on mood. He didnt say exactley how much T but said enough to shoot my level to 1100…However my goal is to speed up surgery recovery, gain mass, & think more fast/clear…Im pretty sure I’ll have TRT for life as Im not surprised its low due to a car accident where I lost a nut at 14. From what I’ve read I think thats enough T to do what I need… Am I wrong?

TT=1100 is a great goal, however, E2 management is mission critical.

T is created in the testes and this function is controlled by the secretion of LH and FSH by the pituitary. LAb work will tell you where the failure is.

I’ll see if I can get the print out Monday on my follow up appointment… Doc said he’d give me Estrogen blockers no problem + HCG shots for my bag… Have you heard anything about T helping to promote healing post injury??? Thats my main reason for going… Doc said it does but I know they want my $$$

Healing is worse when catabolic and better when anabolic.

What is an estrogen blocker? Start using terms where people can know what you are talking about.

He said armidex if E goes up And nolvadox too

Not sure estrogen blocker is the right word… when I asked the doc if he would be giving me anything to keep estrogen in check he said he would test weekly for 6 weeks and if needed add armidex or nolvadex (not sure I spelled those right but that’s what it sounded like) As of now it would just be test cyp and hcg to start… so anabolic is good great I need to heal faster loosing money bad now…

Anastrozole=Arimidex, aromatase inhibitor [AI], reduces E2 levels.

Nolvadex is a SERM and is a Selective Estrogen Receptor Modifier. It blocks the action of estrogens only in selected tissues.

If you modulate E2 levels with an AI there is no need for a SERM.

However, TRT will make your testes shrink with a large risk of infertility. You can prevent that with 250iu hCG SC EOD. Nolvadex can do the same thing by inducing LH and FSH release. However, Nolvadex is not considered safe for life long use. hCG is a natural hormone, SERMs are chemicals.

If you use a SERM without an AI, some tissues will experience high estrogen exposure.

Do not use hCG and a SERM at the same time.

Hey KSMAN here are my labs from today… I dont know what most of it is but heres the print out numbers
BUN 15 Range 65-99
Creatinine Serum 0.90 Range 6-20
E GFR 110 Range 0.76-1.27
Cratinene ratio 17 Range >59
Sodium serum 142 Range 134-144
Potassium Srum 4 range 3.5-5.2
Chloride S 103 range 97-108
Carbon dioxide 26 range 20-32
calcium 9.2 range 8.7-10.2
protin 6.9 range 6-8.5
albumin 4.6 range 3.5-5.6
globulin 2.3 range 1.5-4.5
A/G 2.0 Range 1.1-2.5
Bilirubin .4 range 0-1.2
Alkaline Phospahte 72 Range 25-150
AST SGOT 19 Range 0-40
ALT SGPT 32 Range 0-44
TSH 3.23 Range 0.450-4.500
LH 5.3 Range 1.7-8.6
FSH 5.6 Range 1.5 - 12.4
Prolactin 11.2 Range 4.0-15.2
WBC 6.6 Range 4-10.5
RBC 5.18 4.14-5.80
Hemoglobin 15.5 range 12.6-17.7
Hematocrit 45 Range 37-51
mcv 87 range 79-97
mch 29.9 range 26-33
mchhc 34.4 range 31.5-35.7
rdw 13.5 range 12.3-15.4
platelets 216 range 140-415
neutrophils 62 range 40-74
lympths 23 range 14-46
monocrytes 10 range 4-13
eos 4 range 0-7
basos 1 range 0-3
neutrophils abosulute 4.2 range 1.8-7.8
lympths absolute 1.5 range 0.7-4.5
monocrytes absolute .6 range .1-1.0
eos absolute .2 range 0-0.4
basos absolute 0 range 0-0.2
Sex horm binding glob serum 25 range 16.5-55.9

Total testosterone 182 ng/dl 0.25 PSA

If I start protocal Doc recomends is 100 Test Cyp 1X per week 500 HCG 1x per week then dial in the armidex or nolvadex if needed after 5-6 weeks of blood tests He said Goal would be to get test up to 1100 and let it baseline at 500… He said if need be we could do 2x per week smaller doeses but says for insurance reasons it may be a waste of money… He says if I feel like Im crashing at the end of the week we can talk about it… He says no reason to self inject unless the current protocal doesnt work… What do you guys think ok to start this?

Doc wants to make money injecting you once a week.

I do not know what to think about this: -no experience
BUN 15 Range 65-99
Creatinine Serum 0.90 Range 6-20
E GFR 110 Range 0.76-1.27
Cratinene ratio 17 Range >59

The other indication from your labs is that you have primary hypogonadism.

Ask doc if urine analysis would be useful.

hCG once a week is not appropriate. See the protocol for injections sticky.

If you self inject there are no insurance issues. Why is self injection opposed? Does he do insulin injections in-office for diabetics?

Still no justification for nolvadex unless gyno is serious and that would short term as AI brings things under control. Are you reading what I have posted here?

I posted:
We see many issues with guys other than low T or issues that cause low T. You should not be treating symptoms and looking for a problem that can be fixed. Be open minded to the other pathologies in the advice for new guys sticky and provide more info and lab work results with ranges. If you go to a low T shop, there will be a degree of tunnel vision.

You have:
TSH 3.23 Range 0.450-4.500

So I am calling subclinical hypothyroidism. Subclinical means that your doc will not do anything about it.
What you need to do is read the thyroid basics sticky and start to understand this “other pathology”.

  • get waking and mid afternoon oral body temps and post here
  • describe your history of any iodine in vitamins and/or iodized salt - iodine deficiency
  • do you feel cold easily?
  • dry skin, brittle hair or nails?

I’ll check out the thyroid stuff…probly right on the injection stuff… I can get sublingual hcg can I use that safely ?if so how many drops per day? To answer your question…I don’t have any issues with salt that I know of I’m not a big salt eater… no problems being cold…no problems with skin or hair. You just mean a reuglar thermometer right?

Get a better quality fever thermometer.

“sublingual hcg” is a fraud, peptides do not cross skin.

The issue is not salt, but the iodine that you need from iodized salt.

BUN 15 Range 65-99
Creatinine Serum 0.90 Range 6-20
E GFR 110 Range 0.76-1.27
Cratinene ratio 17 Range >59

This ranges do not look correct. Was this a typo? The GFR range is wrong.

I concur with KS it seems you’re primary with sub clinical hypothyroid. This is up to you, but to be on the safe side I always recommend people who’s thyroid looks iffy to get a full study.

That means FT3 FT4 TgAB TPO and sometimes ultrasound. It wouldn’t hurt to check your adrenals as well cortisol and dheas.

For now you can start avoiding soy containing foods, start reading labels, while your at that you will see a bunch of other stuff in foods that should be avoided. Use iodized salt for cooking.

Heres my temps

Morning 97.3

Noon 98.7

Night 97.1

Is that ok or bad? I feel fine… Sure I can start putting idionized salt on my food…I quess my big question is…Is it safe to inject 100mg test cyp & 500 iu of HCG weekly if my main goal is 1) Speed up healing from surgery 2) aid in growing muscle mass / cutting fat… Im sure I can find away to follow the protocal listed if this doesnt work but for $20 a week I can do the above weekly… I’ve read some find no big deal with weekly… I can get test cyp or eth pretty easy but the HCG is tough

I think that you need to take the long view of TRT health benefits and not worry about your surgical recovery. If you optimize your hormones, everything will work better and accelerated aging will be avoided.

AM [waking?] is low. [General: You cannot be eating, drinking, exercising etc for a good while before hand. Also, check that you can get normal temps with another person.]

Noon temp is normal, good to see

Have you read the thyroid basics sticky? Note the comments that you cannot replenish iodine with dietary doses.

I will re-read I must have missed that… I agree it seems like TRT is great long term no doubt about it. As I am done having kids the only drawback to me with it is potential gyno, but if I keep things in check with the right meds it shouldnt be an issue…
For me TRT is something that would save me 1000’s I own a small biz where I flip houses & I manage several rental homes. When Im down due to injury Im loosing money bad. As I’ve gotten older sprains, strains, take longer to heal…I support a family of 5 so TRT could help me get back to when I was in my 20’s where I was virtually unbreakable… Im in good shape it just seems as I’ve got older recovery is slower & energy dips. With TRT I could have my wisdom from the years plus my strength and endurance back… This could help me be massively more productive long term which is good business :slight_smile: If I go down the road of TRT its for the long hual not just a few weeks… Im not looking at this as a juice cycle…Not that there is anything wrong with that for those that do

With that in mind, a reminder that many of the symptoms of hypothyroidism are the same as hypogonadism. Do not tunnel vision on testosterone!