30 Y/O 8 Weeks on TRT, Shrunken Testicles

Pharma / TRT Testosterone Replacement
1

-Age: 30

-Height: 6’2

-Waist: 34

-Weight: 210

-Describe body and facial hair
Normal levels of body and facial hair / no change.

-Describe where you carry fat and how changed
Carry fat in stomach, lovehandles, rear.

-Health conditions, symptoms [history]
Early onset of male pattern baldness, TRT related issues described at the end.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
On Doxycycline, Rogaine, Propecia 1MG (Was on propecia for 4 months before TRT without issue)

-Lab results with ranges
Will attach lab history at the end.

-Describe diet [some create substantial damage with starvation diets]
Few processed foods, mostly protien (steak / chicken) and vegtables with rice etc. Think Chipotle Steak bowls, Homemade tacos etc.

-Describe training [some ruin there hormones by over training]
Moderate weight training 3x week

-Testes ache, ever, with a fever?
Have noticed small amount of testicle ache, accompanied by VERY noticeable shrinkage after two months of TRT.

-How have morning wood and nocturnal erections changed
Morning wood and nocturnal erections were rare before starting TRT, have improved on TRT however in the last few weeks not as much as they had been.

2/14/2013 -INITIAL TEST RESULTS FROM COMPLETE PHYSICAL BEFORE TRT (Not on Propecia here)
-CBC
WBC 7.8 4.0 - 10.0 th/mm3
RBC 5.32 4.40 - 5.70 mil/mm3
HGB 15.5 13.0 - 17.0 g/dL
HCT 46.2 39.0 - 51.0 %
MCV 86.8 81 - 100 fL
MCH 29.2 27.0 - 35.0 pg
MCHC 33.7 32.0 - 37.0 g/dl
RDW 12.5 0 - 15.1 %
PLATELET CT 219 150 - 400 bil/L

COMPREHENSIVE METABOLIC PANEL (CMP)
SODIUM 138 136 - 144 mEq/L
POTASSIUM 4.1 3.6 - 5.2 mEq/L
CHLORIDE 101 101 - 111 mEq/L
TOTAL CO2 29 22 - 32 mEq/L
ANION GAP 8 5 - 15
GLUCOSE 88 60 - 99 mg/dL
Normals printed are for fasting.
No normals for random.
UREA NITROGEN 16 8 - 20 mg/dL
CREATININE 0.9 0.5 - 1.5 mg/dL
CALCIUM 9.7 8.9 - 10.3 mg/dL
PROTEIN, TOTAL 7.5 6.1 - 7.9 g/dL
ALBUMIN, S 4.7 3.5 - 4.8 g/dL
GLOBULIN 2.8 2.3 - 3.8 g/dL
A/G RATIO 1.7 1.0 - 2.0
BILIRUBIN,TOTAL 0.9 0.3 - 1.2 mg/dL
AST(GOT) 20 15 - 41 U/L
ALT (GPT) 22 17 - 63 U/L
ALK PTASE 43 38 - 126 U/L

LIPID PROFILE
CHOLESTEROL 207 100 - 200 mg/dL
200-239 Borderline-High (Adult)
TRIGLYCERIDE 78 0 - 150 mg/dL
<150 Normal (Adult)
HDL CHOLESTEROL 49 40 - 59 mg/dL
LDL CHOLESTEROL 142 0 - 129 mg/dL
<100 Optimal
100-129 Near or above optimal
130-159 Borderline high
160-189 High

189 Very high
CHOL/HDL RATIO 4.2 0 - 6.7
4.0-6.7 Avg risk (Male)
TRIG/HDL (CALC) 1.6
NON-HDL (CALC) 158

THYROID PROFILE
THYROXINE,FREE 1.11 0.57 - 1.25 ng/dL
TSH 1.41 0.34 - 5.60 uIU/mL

VITAMIN D
VIT D (25 OH) 27.6 32 - 100 ng/mL
Values vary with exposure to sunlight.

VITAMIN B12 / FOLATE
VITAMIN B12,SRM 618 pg/mL
Normal 180-914
Equivocal 145-180
Deficient (Low) <145
FOLATE,SERUM >20 ng/mL

6.6 Normal
3.1-6.5 Indeterminate
<3.0 Deficient

TESTOSTERONE BATTERY
TESTOSTERONE, TOTAL 374.63 241 - 827 ng/dL
SEX HORM BND GLB 35.1 nmol/L
20-50 years 13.3-89.5
FREE ANDROGEN IND 37.0
20-50 years 24.3 - 110.2
(range updated 9/13/2012, previously 13.3-89.5)
TESTOSTERONE,FREE 9.2 8.7 - 25.1 pg/mL

ESTIMATED GLOMERULAR FILTRATION RATE (EGFR)
EGFR (NON-BLACK) 99 >60 mL/min
EGFR (BLACK) 120 >60 mL/min
eGFR imprecision is increased for values greater than or equal to 60.

3/12/2013 --BEFORE STARTING TRT BASELINE TESTS from Urologist
(Different lab so different test methodologies possibly)

TESTOSTERONE TOTAL
Testosterone Total 414 ng/dL 241-827

TESTOSTERONE, FREE
Testosterone Free 72.2 pg/mL Range: 46.0 - 224.0

DIHYDROTESTOSTERONE, LC/MS/MS
Dihydrotestosterone DHT 28 ng/DL Range: 16-79

ESTRADIOL, TOTAL
Estradiol 26.2 pg/mL Range: 11.6 - 41.2

LUTEINIZING HORMONE
LH 4.3 mIU/mL Range: 2.00-12.00

PROLACTIN
Prolactin 12.0 ng/mL Range: 1.6 - 18.7

SEX HORMONE BINDING GLOBULIN (SHBG)
SHBG 33.2 nmol/L Range: 11.0 - 80.0

4/16/2013 SECOND BASELINE TESTS (He wanted two before starting TRT) I had been on Propecia for a month or more for these without noticing any difference in mood / sexual performance etc.

TESTOSTERONE TOTAL
Testosterone Total 386 ng/dL 348-1197

TESTOSTERONE, FREE
Testosterone Free 7.5 pg/mL Range: 8.7 - 25.1

6/12/2013 After 6 Weeks TRT on 200mg (1mL). Test is 1 week after injection.

TESTOSTERONE TOTAL
Testosterone Total 838 ng/dL 300-1200

SUMMARY:

I went to my Primary Care doctor complaining of classic low Testosterone symptoms. Low energy, low sex drive, brain fog, etc. He ran the first battery of tests and said I was fine. I looked closer at the Testosterone numbers and saw that I clearly wasn’t fine especially the free test. I went back and forth with him to try to get him to test E2 and DHT and everything else for a complete picture of what was going and to consider TRT, he refused. I began looking for a doctor who would work with me and consider TRT.

I found the Urologist and showed him the tests the Primary Care doctor had done, he said I was fine. Low end but fine. I pressed and explained symptoms and he agreed to retest. He did two blood tests spaced apart and finally agreed to trial TRT. I was given a 200mg injection every two weeks. After 6 weeks he ran total testosterone and it came back 830. He said everything is great and at this point allowed home injections. I came in and was trained on home injections and received one more 200mg injection at the 8 week mark. The doctor wanted me to do a sperm analysis after the 6 week mark which I did.

So far I have had four total injections of 200mg each over 8 weeks. This is without an AI or HCG as he made no mention of them and I forgot to persist. A few days after the last injection I finally noticed how much my testicles had shrunk. I would estimate probably 50% shrinkage, and most of the time the scrotum is pulled up against my body. I called and made an appointment to see the doctor to talk about the shrunken testicles and the results of the sperm analysis.

I need some advice as to what the best course of treatment would be at this point to restore my testicles and get into a TRT regimen that keeps everything working properly. I will probably need documentation to show the doctor to convince him of whichever is the best course of action.

I was planning on splitting the doses as is recommended in the sticky and then pressing for the Urologist to prescribe hCG and Arimidex. Will adding them to the continuing TRT be sufficient to reverse the testicular shrinkage?

Is Clomid the correct route? What would the Clomid dosage optimally be? Is Clomid by itself while stopping the TRT the best option for returning testicles to size?

Alternatively, is it possible to continue the 100mg/wk Testosterone while adding Clomid and Arimidex? With possibly switching from Clomid over to hCG after the testicles have returned to size.

I would like to continue the TRT as I am enjoying the benefits, but shrinky balls are a serious downer on the whole process.

I have a sinking feeling that I am going to walk in knowing more about all of this than him, so I would like to be equipped! Thanks very much guys.

EDIT: I just saw the Urologist who had no idea about HCG or an AI and said go see an Endocrinologist.

2

Your cholesterol is fine as is.

Please post your oral waking and mid afternoon body temperatures.
TSH is interesting and odd that fT4 is above mid range.

Sodium and Potassium were lowish. Any idea why? Do you drink large amounts of water?

TT=800 after two weeks is odd.

Testosterone Total 830 05/06/13: When was that relative to the two week injection?

TT=394 and E2=40: This is estrogen dominance. You need AI.

hCG will normalize your testes, 250 iu SC EOD
Clomid will work, but has nasty estrogenic sides for some, suggest Nolvadex instead. Do not need much, too much can cause high T–>E2 inside the testes and AI cannot control that. SERMs [clomid, nolvadex] will produce better sperm counts and quality VS hCG. However, hCG is perfectly adequate for most.

Based on your body weight I suggest:
150mg T ester per week, injected in divided doses twice a week or EOD

  • as per stickies, you can try injecting SC with insulin needles .5ml [50iu] 1/2" 29 gauge
    1.5 mg anastrozole per week, as .5mg three times per week, understand “anastrozole over-responder”
    250iu hCG SC EOD [500mg for first two doses], same syringe type, not in same syringe with T

Do labs 1/2 way between injections and try to make the same for every lab.

3

Ask for a ft3 test ,if elevated,Test rt3 and demand a thyroid ultrasound. My thyroid labs are the same as yours. My ft3 is elevated and have now u covered a problem possible Graves’ disease with a thyroid ultrasound

After all this I am stopping trt. Trt with thyroid issues sucks

4

[quote]KSman wrote:
TSH is interesting and odd that fT4 is above mid range.

Sodium and Potassium were lowish. Any idea why? Do you drink large amounts of water?

TT=800 after two weeks is odd.

Testosterone Total 830 05/06/13: When was that relative to the two week injection?

TT=394 and E2=40: This is estrogen dominance. You need AI.
[/quote]

The total test value of 800 was at the 6 week mark after beginning TRT, so three injections of 200mg. I didn’t have any bloodwork at the 2 week mark.

I only had one E2 test, that was before any TRT. However I’m definitely going to try and get an AI from him.
ESTRADIOL, TOTAL
Estradiol 26.2 pg/mL Range: 11.6 - 41.2

So best bet is to ask him for hCG and an AI? Hopefully he will go for it!

5

Need to know how many days after the prior injection was the lab done.

6

[quote]KSman wrote:
Need to know how many days after the prior injection was the lab done.[/quote]

Ah yes. The 800 total testosterone was halfway between injections, so 1 week after the 3rd 200mg.

7

I saw the Urologist today and discussed my issues. I also got copies of the previous test results that I had estimated in the initial post (I will edit and update it), they are as follows:

4/26/2013 (Before TRT)
Total Testosterone 386 ng/dL 348-1197
Free Testosterone 7.5 pg/mL 8.7 - 25.1

6/12/2013 After 6 weeks treatment. (1 week after 200mg injection)
Total Testosterone 838 ng/dL 300-1200

Most recent test results: (1 week after 200mg injection)
6/26/2013
Total Testosterone 698 ng/dL 348-1197
Free Testosterone 18.4 pg/mL 8.7-25.1
Estradiol 30.6 pg/mL 7.6-42.6
Spermcount 0

The spermcount came back 0. I told him of my shrunken testicles, he looked at them and agreed. I asked him what he could do and he basically had no idea. He said to get off the testosterone and things should go back to normal, which clearly was an unacceptable answer.

I proposed HCG with an AI and he said he didn’t know anything about it and did not feel comfortable prescribing it. He recommended I go see an Endocrinologist. So back to square one to find a doctor to work with. The endocrinology clinic at the University works with TRT and should be knowledgeable, I told the Urologist to refer me there. How long it takes to see them and how long to get HCG or anything is unknown.

I am about to attempt to order / acquire Nolvadex and Arimidex online since of the massive delay due to ignorant doctors. I’m unsure how to get HCG online or otherwise without the doctor.

If I order Nolvadex and Amiridex while continuing the Test shots, what should the dosing be to straighten things out?

8

I am in same situation as you in regards to the AI and HCG . My dr is comfortable with test C home injections @ 100mg per week . Since I started with total T of 130 - normal 300-1200 this was an easy decision for me . Although I can’t say I had classic low T symptoms I was looking forward to a possible boost in all the good effects of higher T levels . My testicles have been small always so I did not care about shrinkage as they are not important to me .

My libido and sexual function are fine with them . As far as 0 Sperm count - I don’t want more kids ! The question I have is why do TRT patients need an AI if they stay in normal T range - regular people don’t take AI ? I have only been on TRT for 6 weeks and have a long learning road ahead . Btw I am 45 y/o .

9

Sir Toddington… I think staying in the upper range of Test will require an AI sometime in your lifetime of TRT maybe not at first but as you age you probably will need it. I think it has to do with aromatase enzyme production that increases as we age.

10

If E2 is elevated, even with high TT and FT, you can have mental/mood issues, libido and performance problems. AI is the only fix for that, see the stickies.

11

Why are the majority of drs opposed to prescribing AI along with TRT - why does the manufacture of the TRT rx not even mention AI in the rx pamphlets if it is needed?

12

Cause it is not… A lot of people do just fine without and AI or hcg… Everyone is different… My E2 dropped from 34 to 20 after 4 or 5 months of TRT.

13

Yeah, my main issue is the shrunken testicles which are a major alarm, and the possibility of becoming permanently sterile without hCG or something to keep them awake.

14

Did your balls work before you started?

I’m getting off the shit… I don’t like my shrunken balls either lol

15

Not sure if my balls actually do anything - they just dangle down there ! To me small nuts make my appendage look huge . But on a serious note - I have always had small nuts since I remember . I have had no ED in my history . Around age of 25 I wanted kids and tested 0 for sperm . Dr put me on clomid and possibly HCG - can’t remember . Brought my sperm up enough to have 3 boys .

Never tested my count again . Nuts never change size , btw size of almonds in shell . Never had problem putting on muscle thru life - always on chubby side though . Several blood tests over the years showed a total test below normal . A month ago I decided to try the 100mg per week injection . It gave me motivation to lift hard , watch my diet , and run . So far seems like a nice smooth boost in my shape .

My dr offered to put me on HCG to maintain nut function of sperm but since I don’t want more kids I declined . After a few more months on TRT I will get some more blood work to see how my body handled TRT without AI and without HCG .

16

So I purchased a thermometer and started taking my temperatures:

Morning at 8am: 96.1 F
Noon: 97 F
Night: 10pm: 97.1 F

I’ll do it a few more times and see if these values are consistent. I haven’t found a new Doctor yet to manage all of this however I did buy some HCG, Nolvadex, Arimidex etc online and at least will have them on hand.

So. Do the temps mean I need Iodine supplementation?

17

Ksman will tell you yes.

Iodine is dangerous and fucked me and my friend up.

My thyroid now hurts and is enlarged.

Test tgab tpo and tsi before doing anything with iodine.

50 mg is 333 times the daily recommended dose and iodine loading should be done under the care of a doctor.

Someone who is genetically prone to hashimotos or Graves’ disease may induce the condition by loading large amounts of iodine.

I listed many links to support this in ksmans thread

My rant is over lol good luck

18

I was going to bring up the topic with whichever Endo I wind up going to after they get around to scheduling me. I would think there would be a proper modulation of Iodine supplementation amount that would avoid the nasty things that you experienced.

19

Ya I’m sure at a lower dose is may be ok.

Your endo will not advise iodine at all, he will tell you it’s in your salt… :slight_smile:

20

So the HCG and Arimidex/Nolva/Clomid all of that finally arrived. I don’t plan on using the Nolva or Clomid but I will have it on hand just in case.

I have a question about HCG. I took the first dose of 500 IU. I was planning on doing a second shot of 500IU and then going to the 250IU EOD as recommended.

How long does the HCG usually take to restore testicle size and function?

Also I got some iodine drops and will supplement a small amount. 2-3 drops which is about 12mg I believe. Still haven’t been seen by an endocrinologist so I am flying on my own here till they get their shit together.