T Nation

23 Yrs Old, About to Start TRT. Bloodwork Listed

Jan 19 - 5’9 M 170lb

Blood Work -

LH - 2.4 (1.5 - 9.3 miu/ml)
FSH - 3.4 (1.6 - 8.0 miu/ml)
Prolactin - 10.0 (2 - 18 ng/ml)
Total Testosterone - 236 (250 - 1100 ng/dl)
Bio Testosterone - 75.6 (110 - 575 ng/dl)
Free Testosterone - 34.6 (46 - 224 pg/ml)
Estradiol - 17 ( < OR = 39 pg/ml)
Cortisol - 2.2 msg/dl
SHBD - 26 (10-50 nmol/L)

Can give more information if needed.

Personal Background
Live a pretty sedentary lifestyle besides hitting the gym about 5 times a week. Have been experiencing low energy levels, low libido, irritability and found it difficult to put on muscle mass ( Have been lifting for a couple years at this point never had great gains ). Went to my primary about 8 months ago with these symptoms and found my total test at 290 (low Fsh and Lh as well). Was referred to an Endo and he prescribed me Chlomophene 25mg EOD. My symptoms never greatly improved and after a month or two i began to experience symptoms of gyno, this made me jump of the medication right away. My Endo then prescribed me .25 of Anistrozle to be taken twice weekly. However, after a couple months the gyno symptoms flared up again and i got off the medication (I remember my test being around 800 at that point but my E2 was up to 46). From what I’ve read that was do to the conversion of T>E2 in the testes which an AI cannot take care of thus leading me to not feel the full effects of the testosterone(feel free to correct me if I’m misunderstood). The labs above are from roughly 6 weeks after stopping the chlomophene. Now, I’ve decided to dive fully in and get the shots ( i start on Monday). My Endo insists I start on 200mg of Cypionate Once a week,(convinced him to let me do 100mg twice a week to avoid the rollercoaster effect). He is willing to prescribe me an AI along with the shots (Thank god) and recommended i take .5mg of Anastrozole on Injection days. Is this enough to ensure i don’t get gyno? Also curious to what you guys think of my treatment plan Overall having gone through this yourselves. Cheers.

I suggest that you First get the book tot revolution made. That is where I started and you will educate yourself. After that I’m sure you’ll have more questions.

I went backwards a month ago and recently got the book … it is through and you’ll learn so much.

A good starting protocol is 100 total a week. Some divide into 2 injections a week. No ai. Most do not need an AI on a trt dose. Especially if you start low. Some even get great levels on 80 MG a week divided in 2 injections.

Start with less. 200 a week is likely a high dose.

Labs after 8 weeks. You will experience ups and downs during this time but stay strong and wait 8 weeks. Things take time to even out.

BTW you can get the 200 MG testosterone but inject only 100. You can save the rest incase you need to go higher.

Good to get testicular ultrasound and pituitary mri.

And read…keep reading.

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Could be way off base, but could it be depression also? I suffer from it. The test gel I take counteracts the lack of sex drive I get from my other meds.

Appreciate the advice, got an mri done so I know it’s not pituitary related. Will definitely be giving those a read, thanks for the links.

Don’t believe it’s depression based considering my mood, if I had to guess it would be the sedentary lifestyle

I wouldn’t classify yourself as sedentary. You go to the gym a lot. It is more then most people do. I have a lot of experience with depression. Ever since college. I’m in my late forties now. It took seeing a psychiatrist to properly diagnose my condition. My family doctors would just keep changing my antidepressants, over and over. I finally found out I was bipolar 2. Depression and mania. The manic part made me excellent at work. The depression made me suicidal. I admit it freely, since I’m older and not ashamed. Be very careful when a regular dr. prescribes antidepressants. They can make you feel great for a few months, then the crash. Certain ones make specific conditions worse. Depression manifests itself as other things also. Not just feeling down. Such as being irratable and having a lack of energy. So if your regular dr. wants to prescribe them, think long and hard. They only get a short class in med school on the subject. The other guys on here know a hell of alot more then me about hormones etc. But I KNOW depression…lol

I appreciate your concern as well as you sharing you own experience, however I really don’t believe it’s depression based. My only activity was at the gym aka 45 minutes of lifting other than that my job and hobbies were 100% sedentary very little activity besides that brief period of time

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Good point. It’s impossible to know someone’s situation from just a few sentences. How they truly feel or who they are. And it’s easy for one to project their own issues onto others(me to you). People are multifaceted, hard to convey on the internet.

There aren’t a lot of men who can tolerate 100mg twice weekly, 98% would be forced to reduce the dosage closer to 100mg total weekly dosage do to out of control HCT, RBC and HGB. I’m on 84mg weekly or 21mg every 2 days and Free T is just above the top of the ranges with Total T hovering at or above 500.

SHBG plays a big roll in Free T levels and the higher the SHBG, the more Total T you will need to have healthy Free T levels, healthy Free T levels is 20-25 pg/mL. The majority of men will not need an AI, simply increasing injection frequencies and smaller doses will lower estrogen without the need for AI which destroy estrogen metabolism.

AI’s can weaken bones, joints and decrease bone mineral density.

Thanks for the reply, with my SHBG being at 26, will I likely need a higher Total Test lvl?

I am curious how does one communicate with their doctor if they aren’t taking the right dosage. For instance let’s say I’m prescribed 200, and I take 100. Then doc sees lab work … and not high enough.

I said that cause some of us get the testosterone and we inject with a modern protocol which some Dr’s have trouble understanding.

You can tell the Dr your plan and he may cut the dose or still give you the 200 MG / ml vial per week.

Even if Dr cuts the dose at least you know he is willing to prescribe more.

Let’s say the 100 gets you midrange and Dr says that’s fine. But maybe you need to be higher than midrange…

Makes sense … I had very high levels so mine lowered mine but I’m still having extra as you said. Good idea.

@KSman Read your responses on several posts regarding trt, would love to get your opinion if you find the time. Thanks!

Just tell your doctor you want to increase dosages towards 200mg gradually, that way you don’t have to lie about it. Only you can determine what levels is best for you.