T Nation

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


#21

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.


#22

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.


#23

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:

CHEMICAL NAME CHEMICAL LEVEL LAB REFERENCE RANGE DATE & TIME COLLECTED
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

#24

Tell us how you feel?


#26

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:
96.5F
97.1F
97.1F
96.8F
97.2F
96.2F
97.6F

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?


#27

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.


#28

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?


#29

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

Get
TSH
Free t3
Free t4
Total t3
Total t4
Reverse t3
Thyroid antibodies


#30

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

#31

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


#32

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.


#33

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?


#34

@systemlord @charlie12

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:

CHEMICAL NAME CHEMICAL LEVEL LAB REFERENCE RANGE DATE & TIME COLLECTED
TOTAL TESTOSTERONE 708 ng/dL 300 - 1,080 ng/dL 12/03/2018 8:09 AM
FREE TESTOSTERONE 159 pg/mL 47 - 244 pg/mL 12/03/2018 8:09 AM
BIO TESTOSTERONE 482 ng/dL 131 - 682 ng/dL 12/03/2018 8:09 AM
% FREE TESTOSTERONE 2.3 % 1.6 - 2.9 % 12/03/2018 8:09 AM
ESTRADIOL (ULTRASENSITIVE/PED) 49 pg/mL < OR = 29 pg/mL 12/03/2018 8:09 AM
SEX HORMONE BIND PROTEIN-SHBG 22 nmol/L 11 - 80 nmol/L 12/03/2018 8:09 AM
LH LESS THAN 0.2 mIU/mL 1.7 - 8.6 mIU/mL 12/03/2018 8:09 AM
FSH LESS THAN 0.2 mIU/mL 1.5 - 12.4 mIU/mL 12/03/2018 8:09 AM
TSH 1.60 uIU/mL 0.3 - 5.5 uIU/mL 12/03/2018 8:09 AM
FREE THYROXINE (FT4) 0.88 ng/dL 0.6 - 1.4 ng/dL 12/03/2018 8:09 AM
TOTAL T4 6.2 mcg/dL 4.8 - 10.4 mcg/dL 12/03/2018 8:09 AM
FREE T3 3.3 pg/mL 2.4 - 4.4 pg/mL 12/03/2018 8:09 AM
TOTAL T3 110 ng/dL 70 - 170 ng/dL 12/03/2018 8:09 AM
REVERSE T3 21 ng/dL 8 - 25 ng/dL 12/03/2018 8:09 AM
THYROID PEROXIDASE AB LESS THAN 1.0 IU/mL 0.0 - 6.0 IU/mL 12/03/2018 8:09 AM
THYROGLOBULIN AB LESS THAN 1 IU/mL < OR = 1 IU/mL 12/03/2018 8:09 AM
CHOLESTEROL 150 mg/dL 100 - 199 mg/dL 12/03/2018 8:09 AM
HDL CHOLESTEROL 36 mg/dL 40 - 120 mg/dL 12/03/2018 8:09 AM
TRIGLYCERIDES 56 mg/dL 40 - 249 mg/dL 12/03/2018 8:09 AM
LDL CHOLESTEROL 103 mg/dL ? mg/dL 12/03/2018 8:09 AM
SODIUM 139 MEQ/L 135 - 145 MEQ/L 12/03/2018 8:09 AM
POTASSIUM 4.0 MEQ/L 3.5 - 5.2 MEQ/L 12/03/2018 8:09 AM
CHLORIDE 104 MEQ/L 99 - 108 MEQ/L 12/03/2018 8:09 AM
CARBON DIOXIDE 26 MEQ/L 22 - 32 MEQ/L 12/03/2018 8:09 AM
GLUCOSE 97 mg/dL 65 - 140 mg/dL 12/03/2018 8:09 AM
BUN 13 mg/dL 6 - 24 mg/dL 12/03/2018 8:09 AM
CREATININE 0.90 mg/dL 0.50 - 1.40 mg/dL 12/03/2018 8:09 AM
CALCIUM 9.6 mg/dL 8.6 - 10.3 mg/dL 12/03/2018 8:09 AM
TOTAL PROTEIN 7.6 G/DL 5.8 - 8.0 G/DL 12/03/2018 8:09 AM
ALBUMIN 4.9 G/DL 3.4 - 5.2 G/DL 12/03/2018 8:09 AM
BILIRUBIN, TOTAL 0.8 mg/dL 0.2 - 1.1 mg/dL 12/03/2018 8:09 AM
AST 22 U/L 6 - 35 U/L 12/03/2018 8:09 AM
ALK PHOS 101 U/L 30 - 125 U/L 12/03/2018 8:09 AM
ALT 47 U/L 5 - 50 U/L 12/03/2018 8:09 AM
GFR – NON-AFRICAN AMERICAN above 60 ML/MIN 60 - 100 ML/MIN 12/03/2018 8:09 AM
WBC 7.0 K/uL 4.0 - 10.7 K/uL 12/03/2018 8:09 AM
RBC 5.35 10*6 4.20 - 5.60 10*6 12/03/2018 8:09 AM
HEMOGLOBIN 15.6 GM/DL 13.2 - 17.4 GM/DL 12/03/2018 8:09 AM
HEMATOCRIT 45 % 38 - 50 % 12/03/2018 8:09 AM
MCV 84 80 - 98 12/03/2018 8:09 AM
MCH 29 27 - 34 12/03/2018 8:09 AM
MCHC 35 % 33 - 37 % 12/03/2018 8:09 AM
RDW 13.4 8.0 - 18.5 12/03/2018 8:09 AM
PLATELET COUNT 210 10*3 140 - 450 10*3 12/03/2018 8:09 AM
Neutrophils, Absolute 4.50 K/uL 2.00 - 7.30 K/uL 12/03/2018 8:09 AM
Lymphocytes, Absolute 1.80 K/uL 1.00 - 3.40 K/uL 12/03/2018 8:09 AM
MONOCYTES, ABSOLUTE 0.60 K/uL 0.00 - 0.80 K/uL 12/03/2018 8:09 AM
Eosinophils, Absolute 0.10 K/ul 0.0 - 0.5 K/ul 12/03/2018 8:09 AM
Basophils, Absolute 0.00 K/uL 0.0 - 0.2 K/uL 12/03/2018 8:09 AM

#35

Your making progress. That’s good. Not everything gets better in 6 weeks. Other things take months.

You can try magnesium glycinate at night before bed. Should help you sleep. Magnesium good anyway.

Curious on e2 #. Wish you can stop ai because that had sides. Let’s see what number comes in at. You have room to lower dose. Let’s see.

I was doing subq it actually kept my e2 higher and stable. It was good. Now I switched to IM and it seems like my e2 is low on some days. I can either higher my dose or switch to subq. But I will wait because next week I expect to be getting synthroid from my sluggish thyroid. That can change my shbg which right now is like yours.


#36

Good point - thanks. I am planning on sticking at this dose (160mg) depending on what E2 comes in at. I don’t think going higher on the Testosterone Cypionate dose at this point would be beneficial. What sides does the AI typically have?

I will look into magnesium glycinate, thanks! I am also surprised my Reverse T3 went up to 21 ng/dL. Is that fairly high?


#37

I def would not go higher. If anything lower.
Reverse t3. Can fluctuate during a day. I would not read into it unless it comes up high again.

Arimidex - Google that. You can read side affects. Affects lipids too.

Physio has said 400 mg before bed.
I still get up 1x every night but usually go back to sleep.

U also should monitor PSA while on trt.

If your e2 levels are fluctuating because of shots or most likely from AI. That can cause you to pee more at times because as you are loosing the water you retained. Unless you don’t notice that.

I never tried try the phos you can read about it.


#38

6 weeks is too early to be feeling 100 percent, I like your testosterone levels that you posted. I would like to see estrogen levels before recommending anything. If you were naturally at these numbers, I seriously doubt you would have any symptoms.

Your tissues are being repaired, give it time.


#39

Estradiol 49 pg/mL, post 33 updated. @charlie12 @systemlord

I am thinking of leaving Test dose alone and increasing Adex to 0.5mg per injection (1mg per week) and retesting in 6 weeks. Although 0.75mg might be a better dose, as 0.25mg didn’t seem to do much (although I went from 120mg to 160mg Test as mentioned in past posts). Thoughts?

I also just started a cutting diet (300-350 calories above RMR) to reduce body fat, which is currently at 26%.


#40

It sounds to me like you should just kill yourself. Your life is over. When you can only have sex with your girlfriend a few times a day … WTF live?

:slight_smile:
hahahahahahahahahah


#41

I would not. Stay the course and retest in about 4-6 weeks. Your body still needs time to adjust.

If your e2 was 60 and had constant itchy nips different story.

If you wait you will be more confident in your next move. Or else you will increase ai then decrease again and you are on a rollercoaster with no end.

And my first reaction would not be to increase ai it would be to lower t. This is trt for life. You really want to take arimidex for life?

You probably still thinking more t the better and higher total t the better…