Clomid was the first SERM and it was used to examine how the HPTA responded. With other SERMs the researchers did not see any need to repeat that. But narrow minded docs do not see the bigger and obvious picture.
The real issue is trying to treat primary with more LH receptor stimulation.
Not only that, he also didn’t order LH/FSH with my labs for the next twelve weeks. The complete incompetence is a joke to me at this point - see below.
Last week I faxed him stating that I am not comfortable using clomiphene long term and I would prefer bio-identical hormones even if it is more expensive. This is not the protocol I would actually do but I proposed the following protocol for simplicity because of the reference:
He got back to me this morning suggesting 3,000IU hCG per week, Lol.
I am trying to figure out how I can best botch the labs, but my fear is that he will then want to up the hCG even higher.
I also have some new lab results and more that will be coming in soon. I got these done mainly to have a comprehensive look at everything before I start TRT because there are some pretty clear hormonal problems on both sides of my family.
5/1/17
TESTOSTERONE, TOTAL 343 250-1100 ng/dL
CORTISOL, FREE, SALIVA:
8:00 AM - 0.316 0.094-1.551 ug/dL
12:00 PM - 0.208 0.094-1.551 ug/dL
4:00 PM - 0.062 0.010-0.359 ug/dL
8:00 PM - 0.050 0.010-0.359 ug/dL
The testosterone was done at 11:00AM because that was latest the doctor said I could do it and I wanted it to be low, Lol. All values here should be near midrange for free cortisol. My numbers are on the low side of the range and have a nearly linear decay from 8AM-4PM. It appears that my ACTH is in rhythm.
I have a handle on nearly all of my adrenal fatigue symptoms but I can’t get rid a sensation that I get in my hands and feet sometimes. It has not gotten worse at any point but I can “feel” my hands and feet sometimes, especially when I wake up in the morning. I believe it is related to eating frequency, which is most prevalent in the morning when I am fasting. I am thinking that it is cortisol and blood sugar related. I am going to try to eat more snacks because I have been lazy with that. I also need to fix my sleep schedule once and for all because I love to stay up late but obviously can’t handle it.
5/2/17
GLUCOSE, SERUM 88 65-99 mg/dL
URIC ACID, SERUM 5.3 3.7-8.6 mg/dL
BUN 17 6-20 mg/dL
CREATININE, SERUM 0.87 0.76-1.27 mg/dL
eGFR (NON AFRICAN AMERICAN) 120 >59 mL/min/1.73
eGFR (AFRICAN AMERICAN) 139 >59 mL/min/1.73
BUN/CREATININE RATIO 20 9-20
SODIUM, SERUM 142 134-144 mmol/L
POTASSIUM, SERUM 4.7 3.5-5.2 mmol/L
CHLORIDE, SERUM 97 96-106 mmol/L
CARBON DIOXIDE, TOTAL 27 18-29 mmol/L
CALCIUM, SERUM 9.9 8.7-10.2 mg/dL
PHOSPHORUS, SERUM 4.1 2.5-4.5 mg/dL
PROTEIN, TOTAL, SERUM 7.4 6.0-8.5 g/dL
ALBUMIN, SERUM 4.9 3.5-5.5 g/dL
GLOBULIN, TOTAL 2.5 1.5-4.5 g/dL
A/G RATIO 2.0 1.2-2.2
BILIRUBIN, TOTAL 0.6 0.0-1.2 mg/dL
ALKALINE PHOSPHOTASE, S 64 39-117 IU/L
LDH 141 121-224 IU/L
AST (SGOT) 23 0-40 IU/L
ALT (SGPT) 24 0-44 IU/L
IRON, SERUM 132 38-169 ug/dL
CHOLESTEROL, TOTAL 187 100-199 mg/dL
TRIGLYCERIDES 35 0-149
HDL CHOLESTEROL 84 >39 mg/dL
VLDL CHOLESTEROL CALC 7 5-40 mg/dL
LDL CHOLESTEROL CALC 96 0-99
T. CHOL/HDL RATIO 2.2 0.0-5.0
ESTIMATED CHD RISK <0.5 0.0-1.0
WBC 4.6 3.4-10.8 x10E3/uL
RBC 4.66 4.14-5.80 x10E6/uL
HEMOGLOBIN 14.7 12.6-17.7 g/dL
HEMATOCRIT 43.4 37.5-51.0 %
MCV 93 79-97 fL
MCH 31.5 26.6-33.0 pg
MCHC 33.9 31.5-35.7 g/dL
RDW 12.9 12.3-15.4 %
PLATELETS 204 150-379 x10E3/uL
NEUTROPHILS 39 %
LYMPHS 50 %
MONOCYTES 8 %
EOS 3 %
BASOS 0 %
NEUTROPHILS ABSOLUTE 1.8 1.4-7.0 x10E3/uL
LYMPHS ABSOLUTE 2.3 0.7-3.1 x10E3/uL
MONOCYTES ABSOLUTE 0.4 0.1-0.9 x10E3/uL
EOS ABSOLUTE 0.1 0.0-0.4 x10E3/uL
BASO ABSOLUTE 0.0 0.0-0.2 x10E3/uL
There are a few important comparisons to make from my CBC, fasting glucose, and fasting cholesterol on 8/9/16 and 5/2/17:
8/9/16
GLUCOSE 80 65-99 mg/dL
PROTEIN, TOTAL 6.7 6.1-8.1 g/dL
CHOLESTEROL, TOTAL 156 125-200 mg/dL
5/2/17
GLUCOSE, SERUM 88 65-99 mg/dL
PROTEIN, TOTAL, SERUM 7.4 6.0-8.5 g/dL
CHOLESTEROL, TOTAL 187 100-199 mg/dL
Total proteins and total cholesterol look much better. Glucose will hopefully improve with improved insulin resistance from TRT.
My urologist agreed over the phone this morning to prescrib test cyp and hCG if I freeze some swimmers 
Great news. Sorry I didn’t read the whole thread but are you also going to be prescribed anastrozole? And are you getting private labs and taking them in to the doc or are you getting labs done at the docs office?
OP to be honest I dont think you have a testosterone problem.
You are not depressed and you have morning woods each day.
Ksman knows his stuff but he is also a big time well-being meds user.
You could try testosterone right now, and be disappointed just like me. My hormones arent better than yours and I have no problem in the gym.
Plus I don’t see low proteins, you are the middle of the range but I don’t know much about that.
T is low, but so is E2 and the ratio will be good.
Get other testosterone tests, your high LH and FSH could simply be your body responding and giving you a higher testosterone for the days after.
Joe Rogan is an idiot and his stuff is aimed for basic bros on steroids.
Sorry I didn’t see this, but why are you trying to get an inaccurate picture? Just try testosterone now if you really want to do this anyway.
I don’t think he will prescribe anastrozole right away but he knows that I want it if E2 gets out of control. My E2 was 11.5 pg/mL at TT=393 ng/dL so I am hoping that I won’t need one. I have three sets of labs that my doc ordered over the next twelve weeks - TT, E2, PSA and CBC.
"OP to be honest I dont think you have a testosterone problem.
You are not depressed and you have morning woods each day."
I wrote in my initial post that I am not depressed because I am not in comparison to in the past. My father is clinically depressed so I definitely downplay my own state. If you asked people who know me IRL they would probably tell you that I am not as happy as most people. People I know have been outspoken about that in the past.
I typically have morning every day but the erections are definitely weaker.
"Ksman knows his stuff but he is also a big time well-being meds user.
You could try testosterone right now, and be disappointed just like me. My hormones arent better than yours and I have no problem in the gym."
I think you need to consider that not everyone is going to have symptoms manifest in the same way.
These are the symptoms that I sent to my doctor and am currently experiencing:
-decrease in energy and vitality
-decrease in physical strength
-weaker erections/morning erections
-loss of libido
-brain fog if I don’t take large amounts of vitamin C and vitamin D3
-spot thinning of facial and pubic hair
-dry skin
-lack of desire to socialize
-lack of normal motivations
“Plus I don’t see low proteins, you are the middle of the range but I don’t know much about that.”
I was happy to see that go up but I also don’t know much about it.
"T is low, but so is E2 and the ratio will be good.
Get other testosterone tests, your high LH and FSH could simply be your body responding and giving you a higher testosterone for the days after."
1/12/17 TESTOSTERONE, TOTAL 458 250-1100 ng/dL
3/9/17 TESTOSTERONE, TOTAL 393 348-1197 ng/dL
3/9/17 ESTRADIOL 11.5 7.6-42.6 pg/mL
5/1/17 TESTOSTERONE, TOTAL 343 250-1100 ng/dL
“Joe Rogan is an idiot and his stuff is aimed for basic bros on steroids.”
My comment was not about any advice from Joe Rogan and if you actually read my comment you would know that. I suggest you go listen to his podcasts with Rhonda Patrick before you continue bashing. You will quickly learn why vitamin D and magnesium are so important.
“Sorry I didn’t see this, but why are you trying to get an inaccurate picture? Just try testosterone now if you really want to do this anyway.”
The other tests were done at ~10:00AM so there really isn’t much inconsistency. I am going to try it, Lol.
5/4/17
VITAMIN D, 25-OH 62.9 30-100 ng/mL
FERRITIN, SERUM 287 30-400 ng/mL
HEMOGLOBIN A1C 5.3 4.8-5.6 %
TSH 2.170 0.450-4.500 uIU/mL
T4, TOTAL 7.4 4.5-12.0 ug/dL
T4, FREE 1.59 0.82-1.77 ng/dL
T3, FREE 3.3 2.0-4.4 pg/mL
T3, REVERSE 16.6 9.2-24.1 ng/dL
Very happy to see my vitamin D at a reasonable level. Note that TSH is up from my usual ~1.15-1.23 because of iodine - I was taking 5mg/day for several weeks since it is a safe lower limit for consumption. I will retest TSH in a few weeks just to be completely sure it goes back down.
My fT3/rT3 ratio is borderline but I am not concerned since my body temperatures are good. However, like my cortisol profile, rT3 points to slightly week adrenals. I still believe I have a minor degree of adrenal fatigue since my DHEA is strong and cortisol is slightly weak. This will hopefully all improve with TRT since my adrenals will no longer have to pull me along.
Any update on how TRT is going?
I’m waiting on an appointment to freeze swimmers. I won’t be starting TRT until that gets done because my urologist is worried about my long term fertility from HPTA shut down. It’s another hassle but not a bad thing.
Update:
After finally getting everything sorted out, my urologist has only prescribed 100mg of testosterone cypionate every two weeks…
I have an appointment tomorrow morning to go over injections where I am going to tell him straight up that this is unacceptable and I need 100mg/week of testosterone cypionate with 250IU hCG EOD.
For supporting documents I have two publications on hCG - the article on maintaining blood serum equivalent levels of intra-testicular testosterone with 125, 250, and 500IU EOD and another study on maintaining semen parameters with 500IU EOD. I also have a study showing 6 week steady state TT levels with 50 and 100mg of testosterone enanthate injected subcutaneous, which are 422.4 and 895.5 ng/dL respectively.
If anyone has any other helpful supporting documents please post them here.
hCG preserves testes and fertility. Not many here are freezing the swimmers. Guys here on T+AI+hCG have been making babies.
I am not familiar with saliva cortisol numbers or interpretation.
Progesterone cream might increase cortisol - if needed.
He doesn’t seem to understand that nor did he want to listen to me when I told him that explicitly. I told him that all the guys I read about use hCG and they are fine. He said, “those are nice stories but not everyone is going to talk about it on the internet.”
I really didn’t want to go through the whole process of searching for another doctor so I agreed to freeze…
Update:
Finally, I have some positive news.
At my follow-up appointment on 6/13/17 my urologist prescribed 500IU hCG per week. Test cyp dosing was also discussed and we agreed to start at 50mg/week and slowly increase the dose until all symptoms are relieved. He’s proved to be reasonable with everything and I’m sure he will also allow me to increase the hCG if needed.
Results of testicular ultrasound were discussed. I received a letter regarding the imaging results which were ruled normal while lying but standing showed varicoceles on both testes - left = 5.4mm and right = 3.6mm. Diameters larger than 2.7mm are ruled varicoceles. Varicocles of this size are not significant enough to require surgery and we were in agreement to proceed with TRT and not do any surgery.
On 6/13/17 I started TRT and the protocol has gone as follows:
Week 1, 6/13 - 50mg test cyp Tuesday
Week 2, 6/20 - 50mg test cyp Tuesday
TESTOSTERONE, TOTAL 380 250-827 ng/dL
ESTRADIOL <15 <=39 pg/mL
PSA 0.5 <=4.0 ng/mL
WBC 5.7 3.8-10.8 x10E3/uL
RBC 4.61 4.20-5.80 x10E6/uL
HEMOGLOBIN 14.5 13.2-17.1 g/dL
HEMATOCRIT 42.6 38.5-50.0 %
MCV 92.3 80-100 fL
MCH 31.5 27.0-33.0 pg
MCHC 34.2 32.0-36.0 g/dL
RDW 12.7 11.0-15.0 %
PLATELETS 179 140-400 x10E3/uL
MPV 10.4 7.5-12.5 fL
Week 3, 6/27 - 50mg test cyp Tuesday
Week 4, 7/4 - 37.5mg test cyp Tuesday+Friday
Week 5, 7/11 - 37.5mg test cyp Tuesday+Friday and 250IU hCG Friday
The current protocol is:
I feel pretty good right now so the plan is to wait 4 weeks for levels to stabilize and then do labs - TT, FT, BioT, E2 sensitive, and CBC. It’s very early but I have absolutely no signs of high E2. My hope is that with my good TT/E2 ratio I can adjust to an optimal test cyp dose and I will not need an AI.
The strange sensation in my hands when waking in the morning has also subsided.
For some reason my eyebrows had been thinning and thinned further while on 50mg of test cyp for three weeks. Body temperatures have remained normal in morning and afternoon so hopefully it is a rogue low T symptom that will improve as T levels stabilize.
Thanks, @KSman
I’ve also had a strange feeling in my hands upon waking on some mornings, is it a numb tingling sensation?
I’m also on 75mg (weekly, no AI, no HCG) for 3 months now and only just starting feel better. Glad to hear you’re feeling better.
It’s a tingling sensation as if my hands were elevated for a while or I slept on my arm the wrong way cutting off circulation. My thinking is that it is either related to adrenals being fatigued from low T or it’s from low E2 - my E2 was 11.5 7.6-42.6 pg/mL with TT 393 348-1197 ng/dL.
Does anyone have a timeline on body hair growth after starting TRT?
I have some patches that fell out of my beard from before TRT, and a google and forum search didn’t provide much in the way of a rough timeline.
Body and facial hair development takes time.
Thinning eyebrows are typical with longer term low thyroid function. Taking iodine will help resolve that. TRT may increase hair follicle turnover and there may be some transient effects.
Are you watching your body temperatures?