T Nation

29 Y/O. 9 Wks on Test, Anastrozole, and HCG. Not Sure What To Do


#1

Hi everyone, I’m very happy to have come across this site. I’m a 29 year old male that has been experiencing depression, anxiety, fatigue, concentration/memory issues, reduced libido and erectile dysfunction for the past decade. I have had 12 blood tests showing Total Testosterone between 300-400 ng/dl dating back to 2007. After trying 8 different psychiatric medications, with little success and major side effects, I decided to try a TRT protocol. My Urologist insisted that my levels were normal, but my research taught me that they were fairly low for my age and might be causing or contributing to my symptoms. I sought out an Anti-anging doctor and was put on Testosterone, HCG and Anastrozole. I have been on this protocol for 9 weeks and my feelings are mixed.

Positives: increased energy, slight libido increase, morning wood, increased muscle mass.

Negatives: Acne, facial bloating, facial flushing, reduced penile sensitivity, sensitive nipples, and testicular atrophy/decreased ejaculate (despite being on HCG), aching joints.

I’m not sure what I should do. I don’t believe the benefits I’ve experienced outweigh the adverse effects. Do you believe my levels were low enough to be causing symptoms? If so, what can I do to optimize my protocol? Do I just need to give it more time?

Thank you, any advice is greatly appreciated.

Age: 29
Height: 6’4"
Waist: 33"
Weight: 173 lbs

Body/Facial Hair: Moderate amount of hair on legs, no hair on chest or stomach, sparse hair on chin, upper lip and cheeks.

Fat Distribution: Fat tends to accumulate on thighs and hips. Stomach remains fairly lean. This has not changed.

Health conditions: hypertension, pectus excavatum, scioliosis, atrial septal defect, varicocele, recurring lower respiratory tract infections, depression, social anxiety.

Symptoms: fatigue, difficulty concentrating, poor memory, poor libido, erectile dysfunction, depression, social anxiety.

Rx/OTC Drugs: Testosterone Cypionate (50 mg/every 3.5 days), HCG (200 IU/daily), Anastrozole (.25 mg/every 3.5 days), Adderall (30 mg/daily), Vitamin D (3,000 IU/daily).

Labs:

1/10/2017- Before beginning Testosterone, HCG and Anastrozole

LH: 4.8 (1.5-9.3)
FSH: 13.2 (1.6-8)
Estradiol: 54 (<39)
TSH: 1.28 (0.40-4.50)
T4 Free: 1.3 (0.8-1.8)
T3 Reverse: 18 (8-25)
Testosterone Total: 376 (250-1100)
Testosterone Free: 63.1 (35.0-155.0)
DHEA: 469 (85-690)

3/10/2017 6 weeks on Testosterone, HCG and Arimidex

Estradiol: 46 (<39)
Testosterone Total: 725 (250-110)
Testosterone Free: 141.1 (35.0-155.0)
IGF 1: 257 (63-373)
DHT: 41 (16-79)
DHT Free: 3.63 (1.00-6.2)

Doctor increased Anastrozole to 0.5 mg/every 3.5 days after the 3/10 labs.

Testes have never ached with or without a fever. They are and have always been about 40% below average in volume (according to my urologist)

Before beginning Testosterone, HCG and Anastrozole, I very rarely( a few times a year) experienced morning wood. After beginning, I’ve noticed weak morning wood 3/4 times per week, after the first two weeks on the protocol.

Again, any advice is greatly appreciated. Thanks for reading.


#2

I would increase anastrozole to 1mg, 2x/week.


#3

Thanks for the reply. I forgot to mention my doctor increased the Anastrozole to 0.5 mg/twice a week after my most recent labs. Do you think I should increase it now, or wait until after my next set of labs?


#4

I don’t think that will be enough, it does not sound as though you are feeling better, but I would not increase my dose w/o the doctor’s approval.


#5

Why is my LH normal and my FSH elevated?


#6

hCG 200iu ED to too much
250iu hCG SC/SQ EOD is more than enough

Please change hCG dose, try 250iu SC/SQ EOD.

For a few guys, 250iu hCG SC EOD is too much.
hCG has a longer half-life and EOD is fine.

High dose hCG can lead to high amounts of T–>E2 inside the testes and high SERM E2 levels. Note that anastrozole cannot manage T–>E2 inside the testes. Then sometimes we see higher doses of anastrozole simply not working. Do not expect to find doctors who understand this or understand why.

We normally see guys needing 1mg/week anastrozole per 100mg T per week. A few are over-responders who crash E2 on that and they need 1/4th that expected dose.


TSH does not tell the whole thyroid story. Self-eval thyroid function via last paragraph in this post.


FSH is high. If you test FSH one time on TRT you should get FSH–>zero, otherwise testicular cancer is suspected [not rare]. FSH secreting pituitary adinomas are rare.


Your TT and FT suggest high SHBG that is made in the liver to clear sex hormones. SHBG can be elevated from high E2 which you do have. With lower E2, SHBG should decline slowly.

You might consider having a fertility test if you have not made any babies already.

You can inject T cyp SC/SQ and get smoother T levels and avoid decades of muscle damage. Use #29 1/2" 0.5ml insulin syringe. Pinch up skin over upper leg and inject into end of fold parallel to tissue underneath. After injecting, press finger on injection site for 10-15 seconds to allow tissues to stick together, preventing leakage and bleed bruises.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • 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.