T Nation

27 Y/O, TRT Regimen


#1

Hey all, new to the forum and looking forward to getting some informative answers from you all. I started TRT when I was just about to turn 26. I got sober from heroin and alcohol about 2.5 years ago and became more aware of my low energy levels, insomnia, zero libido, ED, depression, anxiety, etc. Not sure if the drug and alcohol abuse had any long term effect on hormone levels, but I definitely had low libido and all the above symptoms starting around 18 years old, I just didn’t care at the time.
I got my T levels tested and immediately began T injections, HCG and arimidex (can’t remember if this was added later but I’m on it now)

Here are my initial levels (I don’t have the full labs) about 2 years ago, prior to starting TRT:
Testosterone, Serum: 159 mg/dL Low (348 - 1197)
Free Testosterone: 4.0 pg/mL Low (9.3 - 26.5)
DHEA-Sulfate: 420.5 ug/dL (164.3 - 530.5)
Estradiol: 10.7 pg/mL (7.6 - 42.6)

I wish I had more for you all but I just got a hormone panel done last Thursday (see below) so I’m hoping to have that information in the next few days and I’ll update this post.

After starting TRT, I noticed an improvement pretty quickly. Got my levels tested every 3 months and then just every 6 months the past year.

About 4 months ago, I began having some symptoms of ED, insomnia and low energy (which I believe may be linked to my E2 being off - low or high, I’m not sure and of course, I may be wrong because I’m not too knowledgeable on TRT in general). My T levels have been pretty solid and a little high at one point so we lowered the T dose, but my E2 was fluctuating a little - It was a little high the first year but I was having no symptoms to complain about.

My current protocol:
Test injection 50mg twice weekly

HCG: I think it’s 600 iu twice weekly - here is what is says on the 5ML vial: HCG/B12 1,000IU/.5mg/mL; inject .6mL subq twice weekly

Arimidex .25 mg twice weekly

My next post will include updated labs where we tested:
CBC, CMP, DHEA-S, E2 (sensitive), FSH, Hgb A1C, LH, SHGB, Test free and total, TSH, T3 reverse, total and free, T4 total and free, aand Vit D3

She mentioned that she wants to add Clomid to my current protocol… EVERYTHING I have been reading is saying Clomid OR HCG with T injections, not both. I have also been seeing more mention of HCG being used instead of Clomid.

I know it’s hard to provide any input without updated labs but they will be here soon! Any thoughts on the clomid situation though?

Also - best time to dose AI? I have read some differing opinions, some leaning towards 24 hours post injection and others saying at the same time as injection. I have been doing all at the same time in the morning 2x weekly but was considering trying my AI 24 hours post-injection to see if I notice any difference. I have noticed I feel kind of flat on the day of my injections but that may just be in my head.

Thanks for the tips below @KSman I’ll update the post with my new lab results today or tomorrow as soon as I receive them. I don’t mind abruptness, I very much appreciate any insight/help provided from the board. Also - I will evaluate body temps in the next few days and update with that info.

History of iodized salt: I haven’t made an effort to consume iodized salt at any point as I was completely unaware of the benefit - any recommendations on how to increase consumption? Should I just start adding it to my food? I’ve actually avoided using salt in my diet but this changes things I would assume…

Body temps: will update in a few days

Here is some more info about myself:
-27 y/o
-5’7
-30" waist
-168 lbs
-Muscular/lean build, stocky thighs/calves; full beard
-my body fat% is consistently low; no noticeable areas where I carry my fat, I guess it’s evenly spread out in my abdomen, thighs?

Diagnoses/history:
Hypogonadism
OCD, major depression, general anxiety disorder at age 21
Substance use disorder - daily alcohol/oxy/heroin use for several years; currently ~3 years clean
Degenerative disk disease and spinal stenosis in my C4 vertebrae (result of head-head collisions in football I was told)
Compression fracture @ L2 vertebrae
ACL replacement surgery
Fractured both elbows, both ankles

Rx and OTC drugs, any hair loss drugs or prostate drugs ever
*Wellbutrin (depression), Trazodone (insomnia) currently but trying to come off of these; I have been on/off AntiD’s for OCD/depression/anxiety over the past 5 or 6 years but often have relapse of symptoms when I try to come off - TRT has helped with anxiety/depression a little bit
*Have used Lexapro in the past but discontinued eventually due to ED and returned to normal functioning once discontinued

*Minoxidil/Rogaine 3-4x per week; Began losing my hair at age 16-17 and have continued slow balding since then; I tried propecia for like 2 or 3 days but discontinued after reading more about it - never got any side effects or changes in libido/sexual fx

*Sildenafil 20-30mg over past month due to decreased libido/ED; limit to twice/week and have been decreasing usage

Supplements
Morning: Fish oil, multivitamin, B-complex, Ginkgo biloba, Ashwaghanda, Vit D; considering adding Zinc but have read mixed reports on dosages
Night: Magnesium citrate; sometimes 1.25 mg melatonin
*any thoughts on Maca powder? I have used it in the past but I’m unsure of the benefits if it was placebo or what.

Lab results with ranges
Will update ASAP when I recieve them either today (12/13) or tomorrow

Diet
*Breakfast: Smoothie every day (kale, banana, cinnamon, chia, MCT oil, peanut butter, oatmeal, protein, yogurt, almond milk); I drink 2 - 3 cups of coffee/day but trying to decrease to 1 cup/day
*Lunch: homemade turkey or chicken wraps with spinach/kale with granola bar and yogurt
*Snacks: banana, pumpkin seeds, granola
*Dinner: Turkey/chicken/fish with vegetables (maybe caluiflower, carrots, broccoli, sweat potatoes, etc.) or eggs with ham and vegetables
*I drink a good bit of green tea everyday

Training: Has been modified as a result of C4 spinal stenosis; can no longer do much heavy lifting
Strength training 3-4x per week: low weight/high rep full body lifting; a lot of body weight exercises (push ups, pullups, etc.)
Cardio: 3x per week: running ~ 2 miles or stationary bike (never sit down on bike though longer than first 5 minutes); jump rope up to 20 minutes almost every work out

No symptoms related to testicles/aching genitals

Morning wood and nocturnal erections:
Every morning/nightly occurrence since starting TRT about 1.5-2 years ago but have been greatly reduced over the past 3 months.
Trazodone taken at night sometimes induces erections I think

If there is any extra info please let me know and I will update this post. Looking forward to getting some good tips from you all.


#2

Low estradiol is the reason why you have no libido and erections, your doctor is a moron. TRT shuts down your pituitary gland, clomid restarts your pituitary gland. You need a new doctor for the fact that you’re here instead of your doctor taking the reins.

Low Estradiol Symptoms:

Fatigue along the lines of sleepiness
hypersomnia (sleeping too much and too often)
strong erections but limited sensitivity
loss of erections
osteoporosis and osteopenia
joint pain, clicking or popping joints
eye fatigue (eyes seem more tired despite adequate sleep, dark circles)
loss of libido (interest in sex)
difficulty retaining water (constant urination)
anxiety, depression, irritability


#3

We have no idea what your current E2 levels are. Blind.

250iu hCG subq EOD is a good LH replacement dose. Twice a week is stretching the half-life a bit thin. 1200iu/week increases you costs. T injections increase T levels, should not be doing that with higher doses of hCG.

Evaluate overall thyroid function via oral body temperatures - see below. There are expected problems if not using iodized salt.


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.

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 can’t 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.


#4

FINALLY got my lab results. Please see below
I discussed results over the phone and the following are main points of concern:
Test too high
DHEA too high
Estradiol too high
LH and FSH too low
SHBG too high

She wants me to do the following:
-Drop back test dosage from 50mg 2x weekly to 40mg 2x weekly
-Keep HCG same
-Continue with .25 mg anastrazole 2x weekly
-Start on Clomid 25 mg every day

I have no idea what to think about the clomid - I’ve been reading some mixed reviews on in. Also, how am I supposed to get my E2 down if I’m keeping my AI dosage the same?

@KSman hope you get a chance to take a look at this - I’d really appreciate some advice on next steps.

Also, I’m chancing my doc in January and I was wondering if I should be seeking out an HRT specialist, endocrinologist, urologist, or what?





#5

Others will reply. But I just want to comment. HCG is a LH like substance. It keeps testes functioning. LH and FSH r expected to be near 0.It looks like she is treating the low LH and FSH by adding clomid. Does not sound right. I read like you did, that maybe, just maybe, TRT with clomid may keep pituitary active to produce some LH & FSH to keep testes alive. But u are taking HCG for that.
Maybe its good not to increase AI yet, because maybe with the lower dosage of T, it will come down.
Once you make the changes, I would not start clomid, retake labs. SHBG high, see of it remains high after dosage adj or may have to inject 1x a week instead of 2.


#6

Yeah I haven’t yet seen any anecdotal reports of people taking Clomid, HCG + Test… It threw me off when she suggested it. Thanks for the suggestions though!

In terms of getting re-tested (I assume you need a proper script for that) I would like to do so under a diff doc. Any idea on what the go-to HRT doctor is? My urologist brought it up with me but I just said I already had it covered with my PCP…


#7

The dr. it all depends on how knowledgeable they are with TRT. I live in NY, my primary said he would never prescribe TRT. Went to a reproductive urologist, knows hormones, and he said I was within range - idiot. But he said he would not prescribe me TRT but just give me clomid.
So the I went to an endo, who saw my labs (showed 2 reading of T less than 300, and bunch of other labs) and immediately dx secondary hypogonadism. He gave me option of gel, clomid, injections, pellets, etc. Long story short (ihave a thread on here) I ended up just this week on injections and he said do 200 mg 2x per month. So he have me the T but is an idiot on how I should administer it. I am not listening to him and ordered insulin syringes and injecting 50 mg 2x per week. I may end up switching dr. as when my e2 goes up (hope it does not), and he fails to give me an AI. I am also thinking about adding hcg but have not asked. I am not concerned with fertility ever (already have 3 kids) but may want it just to have LH and testes.


#8

You lowered your testosterone dose, this is why your AI dose is staying the same. If you decrease testosterone, and increase your AI, you chance going too low on your E2…

Clomid increases SHBG and estrogen. Plus I don’t think you are suppose to take HCG and a SERM at same time.


#9

The fact that your doctor is bothering to check LH and FSH is a red flag, you’re on TRT of course they’re going to be low. It sounds like she expects LH and FSH to be restored to higher levels and is trying to get them up, anybody on TRT is going to have lower LH and FSH numbers. Your test dosage is too high, that’s why you’re feeling as if TRT has become less effective. High E2 will make it seems as if TRT isn’t working anymore.

Your doctor has a terrible understanding of male hormones and treatment.


#10

I think in OP case need to look at your hcg dosage, It looks like your injecting 1200 2x per week. This may also be causing high T and E2. ksman also commented on that above.


#11

Here is what the bottle says:

HCG/B12 1000IU/0.5MG/ML Injectable
Inject 0.6 ML subcu 2x per week


#12

Any thoughts on my TSH levels?

1.680 uIU/mL (0.450 - 4.500)

This seems on the low end?

@KSman any thoughts?


#13

SHould be closer to 1, but its ok. You really need Ft3 and ft4 to tell us how well thyroid is working.


#14

Ah I see. I was considering iodine supplementation just because I don’t get any from my diet other than my multi vit which is 150 mcg so maybe I’m good there.

What about Maca powder? I’ve been on and off with that for a couple of years at about 3g/day. Not sure if it’s placebo or a real benefit but I feel it does make a difference in libido/energy.


#15

Here’s my plan moving forward with a few questions as well…

Monday & Friday:
-40 mg test + 600 iu HCG

Tuesday & Saturday:
-0.25 mg anastrazole 24 hours post-test injection

Daily Supplements:
-Bodytech Men’s Sport Multivitamin, caffeine (coffee), fish oil, Vit D3 (5000 IU), ginkgo (200mg), pycnogenol (100mg), ashwaghanda (800mg), Black Maca (2 - 3g)

Pre-workout/pre-sex:
-Arginine (3-6g) + Citruline (2g)

Questions:
1) HCG timing: I have seen some different protocols for HCG (some 2x/week, 3x/week, EOD, etc.) - I was just going to continue dosing my HCG + Test at the same time. Any recs here?

2) Anastrazole timing: I was initially taking my AI at the same time as Test/HCG but have been reading that it’s better to take it 24 hours post-test injection - any recs?

3) Clomid: I’m not planning on starting the Clomid as everyone seems to be in agreement that it’s unnecessary at this time… Would it be worth it do dose 2x per week or at all or should I just hold off?

4) Supplements: Anything else I need to be taking or should change? The ginkgo/maca/pycnogenol have been beneficial to sex drive/erection quality so I plan to continue those but will probably take 1 week off per month.

Thanks for all the help/comments/suggestions everyone. It has been very informative thus far. I will begin looking into a new doc in January who is more knowledgeable on HRT.


#16

That’s a great starting protocol, I’m on 80mg weekly dose and it’s not aggressive and therefore any issues you end up having will be minor course corrections. I believe the HCG dosing is one of those things that varies from person to person, it will depend on how fast your body processes the HCG. I would always start out on the low side and work my way up until I feel I’ve reached my limit, that’s just me though.


#17

Thank you! I appreciate that and will continue with the above protocol.

Any other thoughts from members on my questions?


#18

So now that I’ve nailed down my TRT protocol (for now, at least), what else should I be doing to optimize my trt results? Any supplements/diet tips that are key on TRT?

I started 3-4g of Maca again, not sure if that helps at all. Along with 5000 iu vit D, multivitamin, fish oil, ginkgo, and ashwaghanda. Also just started taking 100mg pycnogenol.

I’ve noticed when I take my Arimidex that I am sort of down that day, low libido, erectile difficulties as well. Is that normal? And should I be taking it 24 hours post injection?


#19

You wrote:
Hey all - my body temps measured 4-5x throughout the day stay around 96 and rarely go above 97 degrees. I was going to start with iodine supplementation but not sure what kind of supplement would be best. My MV has 150 mcg or whatever but it doesn’t appear to be enough. Any specific brands? Also do I need a probiotic?

Have you not been using iodized salt? -no
Are your outer eyebrows sparse?
Do you get cold easily?

Taking high dose iodine when selenium deficient is dangerous!
Get a high potency B=complex multi-vit with trace elements and 150mcg iodine + 150-200mcg selenium.

Blows to the head can damage pituitary leading to secondary hypogonadism via low LH/FSH

SERMs increase E2, not lowering E2. You need more anastrozole.
Your E2=40 may be from too much hCG!
hCG+SERM would be worse.
Lower hCG dose.
Take 0.5mg anastrozole twice a week at time of T injections.

hCG dose is too much, expensive, 250iu hCG SC EOD will get the job done.

HCG/B12 1000IU/0.5MG/ML Injectable
Inject 0.6 ML subcu 2x per week
1000iu/ml * 0.6ml is 600iu

TSH should be nearer to 1.0
thyroid lab ranges are mostly useless
fT3 is the active hormone and well above mid-range
rT3=18 is in range, but lab range may be off.
If body temps are low, this strongly points to rT3, see these terms in the thyroid basics sticky: stress, infection, inflammation, surgery, accidents, adrenal fatigue, Wilson’s book.

Take anastrozole at time of T injections.

Your doc does not understand what she is doing.


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.

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 can’t 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.


#20

@KSman
-outer eye brows aren’t noticeably sparse
-I get cold very easily
-no iodized salt intake

I get 150 mcg and 200 mcg selenium currently and I just bought a iodine (potassium iodide) supplement today with 225 mcg per drop - I was going to dose about 5 mg’s per day and see if my body temp gets above 98.

I have since lowered my T dose but you think I need to also lower my HCG and increase the anastrazole all at the same time? Or should I just do one at a time? I have thought I had high E2 for a while now.