@systemlord So do you think my I should get shbg and free test checked before I begin trt? I can then discuss those results with my doctor in a couple weeks at my appt? Would it be unwise to begin without having those checked?
Yes you need SHBG tested otherwise you have no idea what protocol you require.
had appt , doc wants me starting 1x a week 100 mg . check my levles in 4 weeksā¦ at that time i can check my SHBG. said in younger guys like myself its normally not an issue. not sure what to do and if i should start his protocol? most of the things on the webstie here also mention splitting doses and i mentioned that to him but he said the half life of this is long enough so it shouldnt matter
what have you done in your current situation? my doc says I am all good to go and to start my first shot this fridayā¦
Iām still just living with it currently. Iām still unsure about starting at my age. Iām looking into getting an about with a urologist and seeing if I have varicoceles.
Your E2 was too high, target is 22pg/ml - 80 pmol/L
You did not describe clomid dose [that I saw].
Clomid increases LH/FSH but if too much, Tā>E2 inside the testes can become high and serum E2 gets too high.
your 39.9 and 38.4 are what?
We need labs clearly posted with lab ranges.
You posted free T?
Your T levels were near or below expected TRT levels, so you numbers strongly suggest that anastrozole will be needed. Your doc is not preemptively going after E2 management.
With TRT T+hCG, you are getting T from injections and a smaller amount of hCG should be used to preserve testes and ferility. 1200iu/week is expensive and may create high Tā>E2 inside the testes, that anastrozole cannot correct.
Your E2 levels were high enough to spoil the game.
Suggest:
- self inject 50mg T twice a week, subq, not IM, with #29 1/2" 0.5ml insulin syringes
- 0.5mg anastrozole at time of T injections
- 250iu hCG subq EOD
A few are anastrozole over-responders who will crash E2 on typical dosing, they need 1/4th the expected dose and should stop for 5-6 days then resume at the lower dose if suspected.
TSH should be near 1.0, 3.15 is way too high, the ranges are stupid. fT4 is a bit shy of mid-range. fT3 should be near or a bit about mid-range. fT3=5.2 is insane. I suspect that elevated rT3, reverse T3 is blocking fT3. I really need you to check your oral body temperatures as per below. If low that strongly suggests elevate rT3 can can be a result of stress or training with low-T and low thyroid function where young men replace that lost natural energy with adrenaline. Please see the thyroid basics stick for references to rT3, stress, illnesses, accidents, surgeries, over-training, adrenal fatigue, AM cortisol and Wilsonās book āadrenal fatigueā.
Please read the stickies found here: About the T Replacement Category - #2 by KSman
- 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 bodyās 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.
I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I canāt follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.
The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.
THanks for your feedback, I accidentally edited that part out but I added it back in.
These were the first labs I got done by the first endo I saw who prescribed clomid
labs:
my lab ranges from may 2016 were for FREE test
reference range ; 196 to 636
my results were 191 p/mol
total test reference ranges 7.6 ā 31.4
may 2016 ā 8.5 ā this is pre clomid!
started clomid at 25 mg M W F and endo tested t again
august 2016 ā 39.9 (endo said I was now in high range) but i didnt feel much different
dec 2016 ā 38.4
(still didnāt feel that different)
took clomid up until october of 2017 once the drug became no longer available here
I mentioned me e2 levels yesterday at the appt and he said it was in range and will follow up with labs in 4 weeksā¦ if its elevated then he will manage it thenā¦ he did not prescribe me anything as he said there was no need to yet although I understood it was HIGH from what I have been reading!!
my first endo who prescribed clomid NEVEr tested e2 levels ever!!! he just said oh yeah test levels are high so i should be good. but i felt like shit!!
I am a full time student and have been stressed to the max with my studies and I still try to push myself in the gym so i suspect this has been a contributing factorā¦ I will start checkin oral temps but overall im never cold, i started using iodized salt a week ago.
Am I okay to continue my protocol without the AI at this time and see what my labs say in 4 weeks ? its not like i can get a script form my doc as he said no already and takes months to get appt.
are you suggesting high ft3 and high tsh contribute to hypothyroidism? I definitely dont have a fast metabolism and put on fat easilyā¦ but I thought the high value meant that I am fineā¦
I will continue to research but I am eager to start my protocol because I feel like crap.
your help is appreciated!
This is a problem. In range allows for E2 levels that have major negative effects. You need a doctor who is open to understanding that hormone care involves seeking optimal results. This is not disease management. Pay attention to thyroid/iodine issues, these are not trivial issues. With thyroid problems, TRT can make some feel worse as the restored metabolic demands of TRT can exceed what the body can manage if thyroid or adrenals are not up to the job. T-tunnel vision can be a problem.
The endo I am seeing is the best option I have here and runs many mens health clinics and is active in researchā¦
that is very concerning to me .
This is brutalā¦ he just said yea E2 its <158 (the limit shown on test) so its nothing to worry about and will see if it changes in 4 weeks. also said thyroid is fine.
this is incredibly frustrating and I am not sure what to do because my GP was no help and I had to fight to get referred out.
Thyroid in range. God help us allā¦
Check your body temperatures and study everything that I wrote re thyoid and adrenal issues.
Doctors are the single biggest problem in male hormone care. The medical community should be embarrassed.
Iāve had to take things into my own hands since my endo is uncaring, unconcerned with optimising my protocol. Never once has she asked how I feel, in the beginning I had a trough of 452 ng/dL and stated I right where I should be without asking me how I feel.
All she cared was that I was now in range, without a regard how I feel.
I just realized Both of the docs I have seen are urologists. I was going to ask if I should get refferred to and endo but it seems they may just say the same thingā¦
the urologist I am seeing now who runs the mens clinics atleast says he will be treating my symtpoms and will alter my protocol based on how i feelā¦
ON the other hand he seems to be missing all of these other issues and says things are fine when they may not be. I also dont like that he isnāt too concerned about my E2 levelsā¦
It seems you canāt win whatever you do. I want to take things into my own hands but I also am hesitant to and make things worseā¦
I want to trust the doctor as this is his field of expertise but the more I read, the more I am realizing he is missing other thingsā¦
anyway, do you think an endo would be of much help vs the urologist? I am supposed to start my first TRT shot Tmā¦ I am not sure what to do
what did you do in your situation? change your protocol on your own? how did you know it was a test issue and not thyroid issue, i have no clue if its related to my thyroid or my test levelsā¦
In this day and age itās normal to go through several doctors before you find one knowledgeable. I think itās insane you donāt have an AI prescribed. If you really want to cut through the BS give Defy Medical a call, they know exactly how to manage men on TRT.
How much worse can my e2 get in 4 weeks ? thast when itll be tested againā¦
When I started injecting 25mg EOD within the first week I had E2 problems, my pre-TRT labs show low E2 and yours show near the top of the range already.
Do you use them? Whatās the yearly cost?
If only T-Cyp and AI $1300 yearly including labs, medicine and doctor consult. More if HCG and thyroid treatment. Iām considering using Defy even though my insurance covers everything, I just canāt get my endo to care about balancing me. Iām not sure if 500-600 ng/dL is going to sustain my long term goals.
Thanks. I have an endo appt in 3 weeks but need to be prepared for the worst case, well the USUAL case.
I find it utterly insane that so many guys have this ridiculous experience with their doctors. I must have just been lucky that I found a great one on the first try. I got my results after my first 20 weeks, told the doc that I thought my e2 looked high, explained how I was feeling, and he said āyep, we need to increase your AIā. I hate to see other guys not getting that level of care and attention from their doctor. We are trusting these people to do the best things for us and itās dispiriting to hear that so many are not getting that. Anyway, sorry for the rant.