T Nation

27 Year Old Getting Dialed In - Low Sex Drive, Fatigue, Trouble Sleeping (Extensive Details & Test Results Listed)


Are your doctors not willing to upping your dose when you came back low? I’m on the cream also and my doc told me that there was a chance I could end up right back where I was at or possibly lower and we would adjust. I’m not saying your going to absorb the cream or not but here is a honeymoon phase with starting injections also so I’m just saying keep that in mind before you give up whatever route you take. As I think your being quick to throw it in with the cream after only one month that is just my opinion. Just keep keep in mind that TRT is not an immediate fix and needs to be dialed in and need to give it time. Good luck.


I agree - I hate needles, but my first injection was basically painless and I noticed a difference the next day - horrible anxiety and fatigue greatly reduced, among other things. I’m excited to see how I respond after a few months after getting dialed in.

From what I understand SHBG ties up testosterone and impacts how quickly your body uses/processes the TRT doses. Beyond that I am unsure of its function or how to raise it (or if that’s even necessary).

I’ve read a number of experiences of guys starting well on the creams/gels for a month or 2. Then they end up transitioning to injections due to not absorbing enough after their natural production shuts down. My current blood work showed levels lower than Baseline (Pre-TRT) - I doubt even doubling the cream dose would have made a huge difference. So I decided to switch so that I could hopefully get dialed in a little quicker.


I am now in week 6 of the new TRT protocol (60mg SubQ injections with 29 gauge, 1/2" insulin syringes twice a week; 120mg weekly). The new doctor and I decided to change to 80mg twice a week (160mg weekly) with 0.25mg arimidex with each injection (0.5mg weekly). Current blood tests for the 120mg weekly protocol below:

TOTAL TESTOSTERONE 663 ng/dL 300 - 1,080 ng/dL 10/15/2018 7:54 AM
FREE TESTOSTERONE 163 pg/mL 47 - 244 pg/mL 10/15/2018 7:54 AM
BIO TESTOSTERONE 475 ng/dL 131 - 682 ng/dL 10/15/2018 7:54 AM
% FREE TESTOSTERONE 2.5 % 1.6 - 2.9 % 10/15/2018 7:54 AM
DIHYDROTESTOSTERONE 32 ng/dL 16 - 79 ng/dL 10/15/2018 7:54 AM
ESTRADIOL (ULTRASENSITIVE/PED) 34 pg/mL < OR = 29 pg/mL 10/15/2018 7:54 AM
SEX HORMONE BIND PROTEIN-SHBG 18 nmol/L 11 - 80 nmol/L 10/15/2018 7:54 AM
PSA (BECKMAN) 1.27 ng/mL 0.0 - 4.0 ng/mL 10/15/2018 7:54 AM
SOMATOMEDIN C (IGF-1) 380 ng/mL 63 - 373 ng/mL 10/15/2018 7:54 AM
WBC 8.6 K/uL 4.0 - 10.7 K/uL 10/15/2018 7:54 AM
RBC 5.15 10*6 4.20 - 5.60 10*6 10/15/2018 7:54 AM
HEMOGLOBIN 15.2 GM/DL 13.2 - 17.4 GM/DL 10/15/2018 7:54 AM
HEMATOCRIT 44 % 38 - 50 % 10/15/2018 7:54 AM
MCV 85 80 - 98 10/15/2018 7:54 AM
MCH 29 27 - 34 10/15/2018 7:54 AM
MCHC 35 % 33 - 37 % 10/15/2018 7:54 AM
RDW 13.4 8.0 - 18.5 10/15/2018 7:54 AM
PLATELET COUNT 303 10*3 140 - 450 10*3 10/15/2018 7:54 AM
Neutrophils, Absolute 6.00 K/uL 2.00 - 7.30 K/uL 10/15/2018 7:54 AM
Lymphocytes, Absolute 1.90 K/uL 1.00 - 3.40 K/uL 10/15/2018 7:54 AM
MONOCYTES, ABSOLUTE 0.60 K/uL 0.00 - 0.80 K/uL 10/15/2018 7:54 AM
Eosinophils, Absolute 0.10 K/ul 0.0 - 0.5 K/ul 10/15/2018 7:54 AM
Basophils, Absolute 0.10 K/uL 0.0 - 0.2 K/uL 10/15/2018 7:54 AM


Tell us how you feel?


I am still having issues sleeping at night (wake up 1-2 times and need to pee, and can’t fall back asleep after 3-4am) and fatigue during the day. Anxiety and depression are somewhat better overall, but not 100%. Sex drive is still pretty low.

I began doing the Starting Strength weight lifting program (3 times a week for an hour) on my own (no more PT) about a month ago.

I started Flomax last night to prevent excessive urination. I have tons of side effects, but will keep taking it for 1-2 weeks to see what happens.

Finally, I also did oral body temperatures (the oral thermometer is off by as much as 1 degree either direction based on testing 2 thermometers in a cup of fairy warm water multiple times):

Upon “wake up” (6am) temps:

Mid Afternoon temps:
96.4F (2:30pm)
97.9F (1:30pm)
98.3F (5:30pm)
97.0F (3:20pm)
97.4F (3:30pm)
97.2F (?)
97.7F (?)

Am I missing anything? Any advice?


20-25mg EOD and this will keep levels stable and keep estrogen on lower end which is where a lot of below SHBG men feel good.

Lower SHBG means more free T and more free E2, so an E2 on the higher end can hurt libido.


I considered this protocol, but I don’t want to get needle fatigue. I am going to try 160mg testosterone and 0.5mg arimidex split into 2 weekly doses for now and see what happens.

How does my thyroid function look?


If you want to know thyroid status you need more than temperature.

Free t3
Free t4
Total t3
Total t4
Reverse t3
Thyroid antibodies


I have some prior lab results (reposted below) from just before I started TRT. Isn’t free T3 and T4 more important than total? Do I need Thyroid antibodies? Does TRT impact thyroid function?

TSH 1.36 uIU/mL 0.3 - 5.5 uIU/mL 07/12/2018 6:57 PM
TSH 2.28 uIU/mL 0.3 - 5.5 uIU/mL 07/31/2018 8:26 AM
TSH 1.25 uIU/mL 0.3 - 5.5 uIU/mL 08/07/2018 8:53 AM
FREE THYROXINE (FT4) 0.89 ng/dL 0.6 - 1.4 ng/dL 07/24/2018 8:46 AM
FREE THYROXINE (FT4) 0.88 ng/dL 0.6 - 1.4 ng/dL 08/07/2018 8:53 AM
FREE T3 2.7 pg/mL 2.4 - 4.4 pg/mL 08/07/2018 8:53 AM
REVERSE T3 13 ng/dL 8 - 25 ng/dL 08/07/2018 8:53 AM


Free numbers much more important. Free t3 is the active one. That’s the one you need at least mid-range. T4 converts to t3. Next time you do labs just monitor. TSH free t3 and free t4


I would like to see T4, if that’s low then it would explain why Free T4 and Free T3 are on the lower end. T4 is the total thyroid hormone being produced before it converts to Free T4–> Free T3–>Reverse T3.


Thanks for the continued advice and assistance! I plan on getting Total and Free T4, Total and Free T3, TSH, and Reverse T3 tests redone next time I do bloodwork for TRT (Which will be in about 8 weeks unless I start having adverse symptoms).

Should I check or do anything else?