T Nation

3 Weeks on TRT, Some Questions

Hello, i just found this forum and am looking for some feedback on if i made the right decision.

I am 40 years old and very athletic. I have been working out my entire life and competed competitively in sports my entire life. I am somewhat obsessive with my workouts and there have been times in my life where i have trained so hard i pretty much crashed. In highschool i would get up at 430 for swim practice and swim until 630 shower and off to class. Have a protein shake and then go to glass until lunch after lunch i had gym and study halls which were set up by my coaches. I would lift weights for two periods and after school attend my second swim practice for another hour and then hang out for intramural track practice until 8pm. Rush home and eat then do my home work. Back then i did not have a grasp of nutrition and proper rest . My junior year my body essentially shut down and i was deathly sick for months because of this insane schedule. I had zero sex drive back then. I remember being devestated at 16 and 17 having issues getting it up with girls. I had no clue at the time my workouts and sports were likely the culprit.

Throughout my life i still occasionally creep towards overtraining. I usually notice my sex drive dropping and getting extremely moody and recovery plummets. I workout 1-2 hours a day 5 days a week and run every day for 30-45 minutes. When i was around 37 my desire for sex dropped off the planet. I could still function and have sex but it was the last thing on my mind. I also stopped having spontanious erections and zero morning wood. My diet has always been moderate protein, high fat and low carb. I maintained a great physique on his diet and people have always asked me if i was on steroids ( which i never did) i am 6ft3 220 lbs. Around 37 i started to notice no matter how much cardio or dieting i did my stomach would not get shredded anymore.

I reached out to a telemedic clinic and consulted on TRT. My labcorp range was TT 690, Free test 15, DHEA of 300, Thyroid ranges all good, E2 29, LH 8.8, IGF 200 and SHBG of 61. Liver and all other systems good.

I was prescibed 180mg of test cypionate a week twice a week. I am 3 weeks into these shots and not really noticing much with wakefullness. Still feel somewhat tired during the day. When i workout i do have a good deal of energy and look leaner somehow. I am also feeling my sex drive creeping back. After 3 weeks on these shots my testicles barely shrunk and they are still working.

My concern is that i am wondering if i jumped the gun. I made no lifestyle changes prior to jumping on TRT. I have always burnt the candle at both ends. In highschool, college and even now i get 4-5 hours of sleep, often times run on fumes, I am still on a carb restricted diet and have always enjoyed alittle too much alcohol to unwind at night. I have a glass or three of red wine 4-5 nights a week. I love working out and being in the gym so its easy for me to get lost and spend hours workout out.

You Total T and Free T numbers together with your very high LH is very telling of what’s going on here, your pituitary is increasing LH because it is detecting less than optimal Free T levels and is do in part to your elevated SHBG which binds testosterone.

SHBG levels usually increase with age and is not reversible. If we pay close attention to your LH, we can see that it’s attempting to increase Total T to increase Free T and unfortunately LH is already very high, likely maxxed out and cannot do much more.

You do not have hypogonadism, you do have less than optimal Free T as indicated by your LH and is because of your elevated SHBG which is more than likely genetic. Your condition can only go in one direction, more decline with age, higher Total T and less Free T the more time passes without TRT.

I would still be interested in seeing thyroid labs, mainly do to your mention of carb restriction and because I love reading labs. Also note you are in the process of HPTA shutdown and do not expect you to start feeling good until weeks 6 and beyond.

A question, do you mean 180x2 twice weekly? If so you should rethink who you entrust with your health because this dosage would be over the top and more than most men can handle.

Onset of effects of testosterone treatment and time span until maximum effects are achieved

Jumped gun.

  1. you’re not hypo.
  2. dr should’ve run at least 3 tests to confirm low T (which you’re likely not).

I seriously doubt his SHBG levels are going to decrease by half and free up more testosterone in the next 100 tests. The sick care rules are two tests below the ridiculous unrealistic <300, the levels of elderly old men forced upon us men half that age by a system that wants to deny us the right to be healthy, the insurance companies that want to deny us the medical care we deserve to be our best.

The OP would never get TRT from the managed health care system, so there is no point in playing the by sick care rules.

He could have a TT of 3000 but if its bound up and unless then what does the TT # matter. Bottom line is its his life. If he wanted to trade optimal natural levels for optimal exogenous just so he didnt have a dip late in the day then that would still be his choice.

As Systemlord already alluded to, your SHBG is high and therefore your Free T is on the low side. As also stated, there’s not much you’ll be able to do naturally because of this. However, there are lifestyle things that are glaring to me that put you in a worse situation than you would have been otherwise. First, you’ve probably overdone exercise, and still are, for over 20 years now. Couple that with lack of sleep and not enough rest and it will kill your T levels and sex drive. Your cortisol is probably chronically high, and there’s a negative correlation between T and cortisol. Throw in your diet, which may be all the rage, but low carb diets are not good for T levels. Carbs should have been higher - especially given your activity level. Next, you’re a regular over-consumer of alcohol, which is terrible for T levels, cortisol, sleep, recovery, SHBG levels, and estrogen levels. In sum, you’ve been doing a lot wrong and it’s not surprising to see your current situation.

All that said, I’d probably stick with the TRT (effects will get better in a few weeks time), you’re 40, so now is the time to start making up for T decreases with age – not to mention to make up for your high SHBG. Get more sleep – if you want your TRT treatment to be optimal. You’re too old and too active for so little sleep. Cut down some on the exercise by adding more recovery time. Cut out the wine. It’ll help you sleep better and help balance your hormones in the right direction.

System, it is 90mg and 90 mg two times a week. I was given the option of HCG and prescribed an AI but told just keep it on hand and DO NOT it unless something drastic happens. I will get you my thyroid results when I get home from work. I agree my lifestyle has probably put me in this bind. In my 20’s I ate very low carb and got shredded. It was super easy but as time went on I always felt sleepy and lethargic during the day. My counter was caffeine… lots of it. I still killed myself in the gym and practicing whatever sport I was playing. It wasn’t until about mid 30’s that I noticed I could not get shredded anymore. So my counter was workout harder, cut calories more, cardio more, less carbs.

This is why you have elevated SHBG, these scenarios usually wreck the thyroid as well. The thyroid also needs carbs which is why I was interested in your thyroid labs.

System, T4 1.4, Reverese T3 18.7. TSH 2.9, Thyroid Peroxidase 10 and T3 free 3.5

Need reference ranges for all labs, but T3 is better for diagnosing hyperthyroidism, not hypothyroidism. You need Free T4, Free T3 tested. Your TSH is no good and indicating thyroid is struggling and I expected to find a problem. I wonder what your thyroid labs look like on a bad day when not testing. Your thyroid is not optimal and are asking for optimal when optimising testosterone.

The reference range for TSH are not normal, the group that made up the ranges was done on older less sensitive TSH testing methodology, the newer more sensitive 3rd generation TSH testing revealed those previously thought to have normal thyroid function were later found to have thyroid dysfunction and still doctors are using the older TSH reference ranges gathered from sick people seeking medical treatment.

Reference ranges for TSH and thyroid hormones

Though TSH remains the most commonly used endocrine test in clinical practice, the issue of an appropriate TSH, and to a lesser extent, free T4 and free T3 reference ranges is still under debate. First of all the distribution of TSH reference range is not normal, with median values (also depending on population iodine intake) usually between 1-1.5 mU/L.

The evidence for a narrower thyrotropin reference range

It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group.

Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter. The remainder with higher values are outliers, most of whom are likely to have underlying Hashimoto thyroiditis

Thank you! In your opinion what should I do next ? Keep with TRT or stop and get thyroid checked out.

You’re welcome.

Regardless you need optimal testosterone, I wouldn’t be surprised to see your thyroid situation to worsen as TRT steps up the metabolic demand, if your thyroid was already on the brink then I expect your thyroid to struggle even more and all will be known on your next lab evaluation.

I would wait several weeks to give TRT a chance to see what your thyroid is made of, to see if TRT can make your thyroid blink and show it’s weaknesses.

What should I be looking out for ? I would hate for my thyroid to shut off in the middle of something important lol.

If you don’t feel amazing after several weeks with higher levels than pre-TRT, we’ll know based on labs and symptoms.

I have a quick question about this entire process. I see some people say they do not really notice much until they have been on this for a few months. I have noticed a huge surge in strength and endurance I am also starting to look very dry and lean. Prior to starting i was pretty much stuck at the same weights for years. Since week 1 of TRT my strength continues to climb each session. I have not felt like doing much cardio because it seems like I am leaning out quicker than pre trt without any cardio. My mood on the days of the shot is somewhat anxious and jittery but 24 hours after the shot I am in a euphoric mood, day 2 is even better and day 3 seems the best. Is it possible I am over responding to TRT or that my dosage is raising my levels too high and that’s why I am noticing such drastic physical and strength changes so quick ?

I will add I am not seeing any real negative sides on week 4. No test atrophy and every morning I wake up I examine my pillow and rarely see any hairs that shed.

Dsplash, I am no expert but my situation sounds very similar. Im 2 weeks in and have noticed similar effects so its not just you. I guess we will find out more after bloodwork if our numbers are off the charts. Ill be following along.

You may be one of those guy that doesn’t notice the HPTA shutdown that occurs after 1-3 weeks starting TRT, normally we hear men complaining of returning to the state they were in pre-TRT by at least week 3. I have a theory, maybe you protocol is providing high levels early on and when your natural production shutdown, you already had enough testosterone floating around to hold you over until levels become stable.

It could also mean levels are excessive which I wouldn’t worry too much about since you are doing well in the lack of sides effects department. If you spend enough time on T-Nation you’ll notice everyone will respond differently to TRT which has more to do with individual receptor sensitivity and the state of your health at the time you started TRT.

If you’re obese, insulin resistance and have undiagnosed thyroid problems, things will not go so well for you.

Thanks, I really did not notice any drop off in the first 3 weeks. My skin is oily which is the only real negative. I am lean and def not insulin resistant… only issue may be my thyroid which you pointed out.

If you feel as though you are injecting water 3 months in to TRT and not really noticing much at all in the terms of symptom relief and improvements, then this would be confirmation of thyroid problems or other deficiencies.

I started TRT with iron bottomed out and was working with doctors who had no clue about TRT, when everything came crashing down 2.5 years later I was potassium deficient as well which lead to severe symptoms that landed me in the emergency room multiple times.

Iron and/or ferritin deficiencies can wreak havoc on your thyroid.