T Nation

27 Year Old Getting Dialed In - Low Sex Drive, Fatigue, Trouble Sleeping


#1

EDIT: As of December 3rd, I am now in week 6 of the new TRT protocol (80mg SubQ injections with 29 gauge, 1/2" insulin syringes twice a week; 160mg weekly along with 0.25mg Arimidex per injection; 0.5mg Arimidex per week).

Main issue is that 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 still not 100% - depression has been MUCH improved compared to anxiety. Sex drive is still somewhat low, but I can have sex with my girlfriend a few times a day (assuming I am not too tired/fatigued).

I discontinued the Flomax a month or so ago due to persistent side effects and not resolving my nighttime urination/sleep issues.

Current blood tests for the 160mg weekly protocol below in post 33.

ORIGINAL FIRST POST BELOW:

My name is Jeff and I am considering going on TRT. Any advice/additional information on the blood test or MRI results? Is there anything else I should check or do? Or is TRT the way to go at this point? I have a follow up appointment on Wednesday (8/15/2018).

Specifically, I am considering starting with a 20% compounded cream/gel (200mg/mL) from a compounding pharmacy. I do not think that I need HCG as I do not plan on having kids (had a vasectomy). After starting TRT I’m thinking of doing 2 blood tests the first month, 1 at two months, 1 at three months, and then twice a year from that point in order to get the levels balanced. I will add 0.25mg of Arimidex (twice weekly) to keep Estradiol balanced if E2 starts to get too high.

I am a 27-year-old Caucasian male, height 5’11", weight 170 pounds, 14% Body Fat, 32-inch waist. I have a full head of hair and can grow a full beard and mustache. I also have hairy legs and lower stomach but have almost no upper body hair. I carry most of my visible fat on my abdomen - it has always been like this.

I feel consistently and excessively fatigued, depressed a fair amount, high stress/anxiety, low sex drive, trouble getting and maintaining erections (occasional), trouble gaining muscle mass (even with proper diet and training), and I also have trouble sleeping. I recently had a night time sleep study completed and no sleep disorders were found. Also have trouble concentrating and thinking at times. I used to get morning wood when I was younger - I have not gotten morning wood in years (don’t remember when it stopped). Testes ache slightly, but it’s very random when it happens.

I do not take any prescription drugs, but I have used a lot of recreational drugs in the past (nothing in the past year, except occasional alcohol). Supplement wise I take creatine and beta-alanine along with a whole food multivitamin. No hair loss or prostate drugs.

I eat a 2500 calorie diet (50% Carbs, 30% Protein, 20% Fat) with approximately 180 Grams of Protein. This is split between 2 meal replacement shakes (Athletes Fuel), 3 protein shakes, and servings of carbs and protein with olive oil (noodles and salmon; mashed potatoes and lunch meat; etc.). Between the 2 servings of Athletes Fuel and multivitamin, I am certain all my vitamin and mineral (micro-nutrients) needs are being met, including iodine and selenium.

Training wise I work out 3 times a week for 30 minutes with a Personal Trainer, alternating between weight lifting and boxing. In the past 4 months of training, I have gained no visible muscle mass (the first 2 months of training I was with a different Personal Trainer, who had me weight lifting for 60 minutes, 3 times a week).

I had a colonoscopy recently (July 2018) and “everything looked normal”. Blood test and Pituitary MRI results are below:


#2
CHEMICAL NAME CHEMICAL LEVEL LAB REFERENCE RANGE DATE & TIME COLLECTED
TOTAL TESTOSTERONE 210 ng/dL 220 - 800 ng/dL 07/13/2018 8:24 AM
TOTAL TESTOSTERONE 361 ng/dL 250 - 1,100 ng/dL 07/24/2018 8:46 AM
TOTAL TESTOSTERONE 346 ng/dL 300 - 1,080 ng/dL 08/06/2018 7:57 AM
FREE TESTOSTERONE 80.9 pg/mL 35.0 - 155.0 pg/mL 07/24/2018 8:46 AM
FREE TESTOSTERONE 67 pg/mL 47 - 244 pg/mL 08/06/2018 7:57 AM
FREE TESTOSTERONE 82.4 pg/mL 35.0 - 155.0 pg/mL 08/06/2018 7:57 AM
BIO TESTOSTERONE 210 ng/dL 131 - 682 ng/dL 08/06/2018 7:57 AM
% FREE TESTOSTERONE 1.9 % 1.6 - 2.9 % 08/06/2018 7:57 AM
DIHYDROTESTOSTERONE 24 ng/dL 16 - 79 ng/dL 07/31/2018 8:26 AM
ESTRADIOL (ULTRASENSITIVE/PED) 7 pg/mL < OR = 29 pg/mL 07/31/2018 8:26 AM
SEX HORMONE BIND PROTEIN-SHBG 22 nmol/L 10 - 50 nmol/L 07/31/2018 8:26 AM
SEX HORMONE BIND PROTEIN-SHBG 25 nmol/L 11 - 80 nmol/L 08/06/2018 7:57 AM
LH 3.0 mIU/mL 1.7 - 8.6 mIU/mL 07/24/2018 8:46 AM
FSH 10.1 mIU/mL 1.5 - 12.4 mIU/mL 07/24/2018 8:46 AM
DHEA-SULFATE 318 mcg/dL 160 - 449 mcg/dL 08/07/2018 8:53 AM
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
SOMATOMEDIN C (IGF-1) 369 ng/mL 63 - 373 ng/mL 08/07/2018 8:53 AM
IGFBP-3 4.7 mg/L 3.4 - 7.8 mg/L 08/07/2018 8:53 AM
PREGNENOLONE LCMS 31 ng/dL 22 - 237 ng/dL 08/07/2018 8:53 AM
PROGESTERONE 0.5 ng/mL 0.2 - 1.4 ng/mL 08/07/2018 8:53 AM
PSA (BECKMAN) 0.290 ng/mL 0.0 - 4.0 ng/mL 07/31/2018 8:26 AM
CORTISOL 9.7 mcg/dL 6 - 19 mcg/dL 07/24/2018 8:46 AM
PROLACTIN 7.1 ng/mL 2.5 - 14 ng/mL 07/24/2018 8:46 AM
CHOLESTEROL 135 mg/dL 100 - 199 mg/dL 07/31/2018 8:26 AM
HDL CHOLESTEROL 43 mg/dL 40 - 120 mg/dL 07/31/2018 8:26 AM
TRIGLYCERIDES 114 mg/dL 40 - 249 mg/dL 07/31/2018 8:26 AM
LDL CHOLESTEROL 69 mg/dL ? mg/dL 07/31/2018 8:26 AM
SODIUM 141 MEQ/L 135 - 145 MEQ/L 07/13/2018 8:24 AM
SODIUM 141 MEQ/L 135 - 145 MEQ/L 07/24/2018 8:46 AM
POTASSIUM 4.2 MEQ/L 3.5 - 5.2 MEQ/L 07/13/2018 8:24 AM
POTASSIUM 5.0 MEQ/L 3.5 - 5.2 MEQ/L 07/24/2018 8:46 AM
CHLORIDE 104 MEQ/L 99 - 108 MEQ/L 07/13/2018 8:24 AM
CHLORIDE 103 MEQ/L 99 - 108 MEQ/L 07/24/2018 8:46 AM
CARBON DIOXIDE 28 MEQ/L 22 - 32 MEQ/L 07/13/2018 8:24 AM
CARBON DIOXIDE 31 MEQ/L 22 - 32 MEQ/L 07/24/2018 8:46 AM
GLUCOSE 106 mg/dL 65 - 140 mg/dL 07/13/2018 8:24 AM
GLUCOSE 99 mg/dL 65 - 140 mg/dL 07/24/2018 8:46 AM
BUN 19 mg/dL 6 - 24 mg/dL 07/13/2018 8:24 AM
BUN 19 mg/dL 6 - 24 mg/dL 07/24/2018 8:46 AM
CREATININE 1.10 mg/dL 0.50 - 1.40 mg/dL 07/13/2018 8:24 AM
CREATININE 0.90 mg/dL 0.50 - 1.40 mg/dL 07/24/2018 8:46 AM
CALCIUM 9.8 mg/dL 8.6 - 10.3 mg/dL 07/13/2018 8:24 AM
CALCIUM 10.2 mg/dL 8.6 - 10.3 mg/dL 07/24/2018 8:46 AM
TOTAL PROTEIN 7.8 G/DL 5.8 - 8.0 G/DL 07/24/2018 8:46 AM
ALBUMIN 4.8 G/DL 3.4 - 5.2 G/DL 07/13/2018 8:24 AM
ALBUMIN 5.2 G/DL 3.4 - 5.2 G/DL 07/24/2018 8:46 AM
BILIRUBIN, TOTAL 0.4 mg/dL 0.2 - 1.1 mg/dL 07/24/2018 8:46 AM
AST 19 U/L 6 - 35 U/L 07/24/2018 8:46 AM
ALK PHOS 108 U/L 30 - 125 U/L 07/24/2018 8:46 AM
ALT 33 U/L 5 - 50 U/L 07/24/2018 8:46 AM
GFR – NON-AFRICAN AMERICAN above 60 ML/MIN 60 - 100 ML/MIN 07/13/2018 8:24 AM
GFR – NON-AFRICAN AMERICAN above 60 ML/MIN 60 - 100 ML/MIN 07/24/2018 8:46 AM
HEMOGLOBIN A1C 5.2 % 4.5 - 5.6 % 07/13/2018 8:24 AM
ESTIMATED AVERAGE GLUCOSE 103 mg/dL ? mg/dL 07/13/2018 8:24 AM
WBC 8.1 K/uL 4.0 - 10.7 K/uL 07/24/2018 8:46 AM
RBC 5.21 10*6 4.20 - 5.60 10*6 07/24/2018 8:46 AM
HEMOGLOBIN 15.3 GM/DL 13.2 - 17.4 GM/DL 07/24/2018 8:46 AM
HEMATOCRIT 44 % 38 - 50 % 07/24/2018 8:46 AM
MCV 85 80 - 98 07/24/2018 8:46 AM
MCH 29 27 - 34 07/24/2018 8:46 AM
MCHC 35 % 33 - 37 % 07/24/2018 8:46 AM
RDW 13.4 8.0 - 18.5 07/24/2018 8:46 AM
PLATELET COUNT 195 10*3 140 - 450 10*3 07/24/2018 8:46 AM
Neutrophils, Absolute 5.30 K/uL 2.00 - 7.30 K/uL 07/24/2018 8:46 AM
Lymphocytes, Absolute 2.00 K/uL 1.00 - 3.40 K/uL 07/24/2018 8:46 AM
MONOCYTES, ABSOLUTE 0.60 K/uL 0.00 - 0.80 K/uL 07/24/2018 8:46 AM
Eosinophils, Absolute 0.10 K/ul 0.0 - 0.5 K/ul 07/24/2018 8:46 AM
Basophils, Absolute 0.00 K/uL 0.0 - 0.2 K/uL 07/24/2018 8:46 AM

Pituitary MRI Study Result (08/12/2018)

Impression:

1. Normal MR Sella w/wo contrast exam.

Collected:

08/12/2018 5:01 PM

Narrative

[HST]: HYPOGONADOTROPIC HYPOGONADISM

HYPOGONADOTROPIC HYPOGONADISM

Exam: MRI Sella without and with gadolinium.

History: HYPOGONADOTROPIC HYPOGONADISM:: HYPOGONADOTROPIC HYPOGONADISM

Comparison: none

Technique: Precontrast sagittal T1 whole brain, sagittal and coronal

T1 thin section, Coronal T2 FSE thin section. Coronal T1 dynamic

post-gadolinium through the pituitary. Post gadolinium sagittal and

coronal T1 FS thin section.

15 cc’s of Multihance was administered IV.

Findings:

Pituitary gland is normal. No evidence of microadenoma on dynamic

post-contrast images. No evidence of macroadenoma on standard

post-contrast imaging. Pituitary infundibulum is midline.

No evidence of midline shift. Ventricles, sulci, and cisterns are

normal.

No abnormal signal or abnormal enhancement within the visualized

brain parenchyma.

No extraaxial lesions. Normal vascular flow voids.


#3

You won’t be able to balance estrogen taking the AI once weekly, half life is 50 hours and by the end of the week it’s all cleared out of your system, estrogen will then be fluctuating during the week. Take the AI a minimum twice weekly.

You may be better served going on an EOD protocol, 20-25mg EOD do to lower SHBG. SHBG may decrease months after starting TRT making more frequent injections best.


#4

Good catch - I meant 0.25mg of Arimidex twice weekly to start, and then monitor bloodwork closely the first few months while I get levels right. I’m thinking 2 blood tests the first month, one at two months, 1 at three months, and then twice a year from that point. I went ahead and updated the post. Thanks!

I want to try transdermals to start, as I do not like needles. If 20% compounded cream does not bring my levels high enough, then I will do SubQ injections twice a week.


#5

What size syringes are you using? Most use 29 gauge insulin syringes, painless.


#6

A “starting” protocol should NEVER include an AI.

If you EVEN NEED e2 control, you can first adjust your dose, second lose weight and include some natural methods to help lower e2.

How will you know if you EVEN need an AI, if you don’t try it without first.

Using an AI right off the bat is a terrible, terrible decision.


#7

Wow really 29g? I draw with an 18g then the Dr had me pinning with a 21g. That felt like I was stabbing my self. Now, I am using a 23g and I feel like I am in heaven. I barely even notice it slide into my quad. Takes about 10 seconds to inject the oil. I am also doing IM, not subQ.


#8

Good info - thanks! I’ll keep an eye on E2 levels (along with the other things to watch in the “Lab Work, Blood Testing and Symptoms” thread) with frequent blood draws in the beginning. Then proceed from there if E2 is high and I have adverse symptoms.


#9

You’re not in heaven yet using a 23 gauge, 23- 29 gauge and the comparison is huge.


#10

Maybe I am not understanding your post right here, but I feel you didnt understand his point from the beginning. Dont judge your self or if TrT is succeeding or failing based on blood draw numbers. Judge by how well you feel or how shitty you feel. Then treat according to symptoms not the numbers. Blood draws can be used to verify symptoms and ensure other aspects are not getting out of control.


#11

Comparatively speaking I am. That 21g feels like a nail being stuck compared to the glide of this 23g. I have never used a 29g, so I cant compare it.


#12

I was using 25g IM in quads and it was OK but now I use 30g SQ in abdomen and I don’t feel a thing. The shorter needle (5/8") is less of a mind fuck too.


#13

Any advice/additional information on the blood test results? Is there anything else I should check or do? Or is TRT the way to go at this point?

@KSman what do you think?


#14

Updated blood test results and added Pituitary MRI results.

Any advice/additional information on the blood test or MRI results? Is there anything else I should check or do? Or is TRT the way to go at this point? I have a follow up appointment on Wednesday.


#15

Here’s what I think. First listen to @alphagunner no ai. Your e2 was measured at 7!!! That’s disease level low.

Second your fsh which is more stable that LH was normal high. I would do a testicular ultrasound. You maybe primary hypogonadism. Could to check for tumors too.

Your igf is normal high to. That’s interesting.

Then take it from there.


#16

Got it - no AI unless I have symptoms of high E2 (and confirmed by blood tests).

I do not have any lumps on my testes, and they have not been subjected to any trauma (except the Vasectomy). The endocrinologist said they appear normal sized as well. I will look into a testicular ultrasound.

Not sure why IGF-1 is high - I also found that interesting.

Thanks for the additional information!


#17

I started TRT on Saturday, August 18th 2018 using 20% compounded cream (200mg/mL) 0.5 mL per day. First two days I noticed nothing, days 3-4 were amazing, day 5 was OK, and today (day 6, Thursday) I feel less OK (not as bad as pre-TRT, but close; granted I only slept 4-5 hours last night). Is it normal for things to swing around like this while getting dialed in? Does it take awhile for the body to stabilize on TRT?

I am thinking it could be E2 going up, natural testosterone production shutting down, and/or not a big enough dose. I plan on getting first follow-up blood work done at weeks 3-4 (Testosterone Total & Free; Estradiol “Sensitive” Assay (Not Ultrasensitive or Normal); SHBG; PSA; DHT; CBC with Platelet/Differential). Thoughts?


#18

I am in week 4 now of TRT. The cream seemed to be helping at first, but that must have been the combination of my natural production and the supplemental cream. Based on the even lower Testosterone numbers (and returning of most symptoms, such as extreme fatigue, no libido, etc.), I will be switching to SubQ injections with 29 gauge, 1/2" insulin syringes shortly. Here are my labs for 3-4 weeks (tested before my next dose of 0.5mL 20% compounded cream):

CHEMICAL NAME CHEMICAL LEVEL LAB REFERENCE RANGE DATE & TIME COLLECTED
TOTAL TESTOSTERONE 258 ng/dL 300 - 1,080 ng/dL 09/07/2018 7:32 AM
TOTAL TESTOSTERONE 293 ng/dL 250 - 1,100 ng/dL 09/07/2018 7:32 AM
FREE TESTOSTERONE 55 pg/mL 47 - 244 pg/mL 09/07/2018 7:32 AM
FREE TESTOSTERONE 66.5 pg/mL 35.0 - 155.0 pg/mL 09/07/2018 7:32 AM
BIO TESTOSTERONE 156 ng/dL 131 - 682 ng/dL 09/07/2018 7:32 AM
% FREE TESTOSTERONE 2.1% 1.6 - 2.9 % 09/07/2018 7:32 AM
DIHYDROTESTOSTERONE 48 ng/dL 16 - 79 ng/dL 09/07/2018 7:32 AM
ESTRADIOL (ULTRASENSITIVE/PED) 16 pg/mL < OR = 29 pg/mL 09/07/2018 7:32 AM
SEX HORMONE BIND PROTEIN-SHBG 18 nmol/L 10 - 50 nmol/L 09/07/2018 7:32 AM
SEX HORMONE BIND PROTEIN-SHBG 22 nmol/L 11 - 80 nmol/L 09/07/2018 7:32 AM
FERRITIN 77 ng/mL 30 - 400 ng/mL 09/07/2018 7:32 AM
VITAMIN B-12 652 pg/mL 180 - 914 pg/mL 09/07/2018 7:32 AM
DHEA-SULFATE 259 mcg/dL 160 - 449 mcg/dL 09/07/2018 7:32 AM
VITAMIN D (25 HYDROXY) 31 ng/mL 20 - 50 ng/mL 09/07/2018 7:32 AM
PSA (BECKMAN) 1.27 ng/mL 0.0 - 4.0 ng/mL 09/07/2018 7:32 AM
WBC 7.0 K/uL 4.0 - 10.7 K/uL 09/07/2018 7:32 AM
RBC 5.52 10*6 4.20 - 5.60 10*6 09/07/2018 7:32 AM
HEMOGLOBIN 16.3 GM/DL 13.2 - 17.4 GM/DL 09/07/2018 7:32 AM
HEMATOCRIT 47 % 38 - 50 % 09/07/2018 7:32 AM
MCV 86 80 - 98 09/07/2018 7:32 AM
MCH 30 27 - 34 09/07/2018 7:32 AM
MCHC 34 % 33 - 37 % 09/07/2018 7:32 AM
RDW 13.3 8.0 - 18.5 09/07/2018 7:32 AM
PLATELET COUNT 200 10*3 140 - 450 10*3 09/07/2018 7:32 AM
Neutrophils, Absolute 4.50 K/uL 2.00 - 7.30 K/uL 09/07/2018 7:32 AM
Lymphocytes, Absolute 1.80 K/uL 1.00 - 3.40 K/uL 09/07/2018 7:32 AM
MONOCYTES, ABSOLUTE 0.40 K/uL 0.00 - 0.80 K/uL 09/07/2018 7:32 AM
Eosinophils, Absolute 0.10 K/ul 0.0 - 0.5 K/ul 09/07/2018 7:32 AM
Basophils, Absolute 0.10 K/uL 0.0 - 0.2 K/uL 09/07/2018 7:32 AM

#19

Under 300NG/DL for 20% compounded very EARLY in Morning before 8AM. that is actually AWFUL JEFF. myself i am transitioning onto Shots too, as i been on Cream 2 MONTHS and it’s finally wearing off too. I am Glad i didn’t wait any longer on the cream otherwise be going crazy. I believe for some guys they just can’t absorb it right, and it don’t work at all.


#20

also these are definitely LOW too should be in early 30’s of SHBG for perfect number i think, or Late 20’s your best one is 22nmol SHBG still low. that is if you did 2 of same tests, of which you posted.