T Nation

30 Y/O Just Started TRT. Trying to Learn All I Can


#1

First I’ll try to give some context to my specific situation. Apologies in advance for lengthy explanations and background. I’ve read some of the stickies but not all (there’s a lot to read). So hopefully I’m giving the info needed.
HISTORY/RESULTS:
Grade 3 varicocele diagnosed at 18 yrs old & left untreated
Quest Labs from 2013 or 2014
Will post when I find it but total test was about 495 and SHBG/free % were almost the same and test free was somewhere around 120-130.

Quest Labs from 4/7/2016 (don’t recall the time)
Test. Free 77.5 pg/mL (Normal is 47-244 pg/mL)
Testosterone, % Free 2.4 % (Normal is 1.6-2.9 %)
Testosterone Total 329 ng/dL (Normal is 280-1100 ng/dL)
SHBG 20 nmol/L (Normal is 13-71 nmol/L)
Testosterone, Bioavailable 206.8 ng/dL (Normal is 131-682 ng/dL)
Vitamin D 25 OH 34 ng/mL (Normal is 30-80ng/mL)
WBC 4.8 K/mcL (Normal is 3.6-10.6 K/mcL)
RBC 4.95 x10^6/mcL (Normal is 4.50-5.90 x10^6/mcL)
Hemoglobin 14.4 g/dL (Normal is 13.5-17.5 g/dL)
Hematocrit 43.9 % (Normal is 41.0-53.0 %)
MCV 88.7 fL (Normal is 80.0-100.0 fL)
MCH 29.1 pg (Normal is 26.0-34.0 pg)
MCHC 32.8 g/dL (Normal is 32.0-36.0 g/dL)
RDW SD 43.5 fL (Normal is 35.1-43.9 fL)
RDW 13.4 % (Normal is 11.3-15.6 %)
Platelets 214 K/mcL (Normal is 150-400 K/mcL)
MPV 10.5 fL (Normal is 6.6-12.4 fL)
Nucleated RBC Auto 0.0 /100(WBCs)
Immature Granulocytes 0.2 % (Normal is 0.0-0.4 %)
Differential Type Auto
Neutrophil % Auto 59.3 % (Normal is 36.0-66.0 %)
Lymphocyte % Auto 29.3 % (Normal is 24.0-44.0 %)
Monocyte % Auto 9.8 % (Normal is 0.0-12.0 %)
Eosinophil % Auto 0.8 % (Normal is 0.0-5.0 %)
Basophil % Auto 0.6 % (Normal is 0.0-5.0 %)
Immature
Granulocyte,
Absolute 0.01 K/mcL (Normal is 0.0-0.03 K/mcL)
Neutrophil 2.9 K/mcL (Normal is 1.8-6.8 K/mcL)
Lymphocyte 1.4 K/mcL (Normal is 1.2-3.4 K/mcL)
Monocyte 0.5 K/mcL (Normal is 0.2-0.9 K/mcL)
Eosinophil 0.0 K/mcL (Normal is 0.0-0.5 K/mcL)
Basophil 0.0 K/mcL (Normal is 0.0-0.3 K/mcL)
Sodium Level 137 mmol/L (Normal is 137-146 mmol/L)
Potassium Level 4.0 mmol/L (Normal is 3.5-5.0 mmol/L)
Chloride Level 103 mmol/L (Normal is 98-109 mmol/L)
CO2 25 mmol/L (Normal is 19-30 mmol/L)
Anion Gap (Na Cl
CO2)
9 mmol/L (Normal is 3-16 mmol/L)
Glucose Level 74 mg/dL (Normal is 65-99 mg/dL)
BUN 13 mg/dL (Normal is 6-21 mg/dL)
Creatinine Level 0.90 mg/dL (Normal is 0.79-1.37 mg/dL)
GFR, Estimated
(mL/min/1.73 m2)
114 mL/min/1.73
m2
(Normal is >60 mL/min/1.73 m2)
Average GFR for
age
107 mL/min/1.73
m2
Cmt: GFR See Note:
Calcium Level 9.1 mg/dL (Normal is 8.4-10.4 mg/dL)
Protein Total 6.5 g/dL (Normal is 6.0-8.4 g/dL)
Albumin Level 4.3 g/dL (Normal is 3.3-4.8 g/dL)
Albumin Level 4.3 g/dL (Normal is 3.3-4.8 g/dL)
Bilirubin Total 0.8 mg/dL (Normal is 0.2-1.3 mg/dL)
Alk Phos 98 unit/L (Normal is 40-120 unit/L)
AST 30 unit/L (Normal is 9-40 unit/L)
ALT 44 unit/L (Normal is 12-61 unit/L)
Cholesterol Total 137 mg/dL (Normal is 138-199 mg/dL)
HDL 34 mg/dL (Normal is 40-63 mg/dL)
LDL 90 mg/dL (Normal is <100 mg/dL)
Cmt: LDL See Note:
Chol/HDL 4.0 (Normal is <4.5)
Triglycerides 63 mg/dL (Normal is 50-149 mg/dL)
Patient Fasting? Yes
Non HDL
Cholesterol
103 mg/dL (Normal is <130 mg/dL)
VLDL 13 mg/dL (Normal is 10-29 mg/dL)
TSH 0.65 mcIU/mL (Normal is 0.45-4.67 mcIU/mL)

Quest Labs 9/15/16 @ 8 am
Cortisol, Untimed 10.1 mcg/dL (Normal is 2-23 mcg/dL)

LabCorp results from 3/9/17 taken @ 1030 am
Test free & total 191 ng/dL (348-1197)
Free test (Direct) 8.2 pg/ml (8.7-21.5)
LH 5.5 miu/ml (1.7-8.6)
FSH 3.7 miu/ml (1.5-12.4)
Prolactin 13.7 ng/ml (4.0-15.2)
Estradiol 12.9 pg/ml (7.6-42.6)

12/2014 Knee surgery on meniscus & mcl
6/2016 Knee surgery ACL reconstruction
I mention these because the symptoms of low t became much more prevalent after the 1st and even worse after the 2nd.

Rx/OTC:
Adderall
Sleep Aids (i.e. melatonin, unison, zzzquil, etc.)

I was fairly fit and muscular prior to the first knee surgery. I lifted weights 2-3 times a week and played a lot of bball, softball, and occasionally football. I had dealt with some fatigue for years but attributed it to other things and still enjoyed playing. After 1st surgery I gained about 35 lbs and struggled through rehab. Later on, ended up tearing my ACL and having that replaced. I struggled even more through that rehab and at 9 mo. post-op I’m not where I should be physically which caused some pretty severe depression. I just started TRT two days ago. After meeting w/ the urologist to discuss my lab results he diagnosed me w/ primary hypogonadism and we decided to begin a regimen of 200 mg E2W (at their office, he didn’t seem thrilled with the idea of me doing an EOD/E3D or twice/wk @ home ) and 1 mg Arimidex w/o any clear instruction. I had already read on here that although different for each individual a dose of .25 mg or .5 mg anywhere from ED to once a week should be sufficient. But when I asked the doc about taking .25 or .5 so that I don’t crash my E2 (which seemed a little low, isn’t 22-30 preferred?) he was not very clear. He said he’d see me in 6 months to follow up and do some labs. Once again, I’m glad I combed through this forum prior to seeing him. I requested to atleast test it at 6-8 weeks to see if it’s working and to check my PSA, especially since my PSA hasn’t been checked. He agreed and provided me 2 orders for labs to be done whenever I’d like within the 6 months. Anyway, I took the 1 mg when I got the prescription filled about 30 minutes after the first injection. I may get some of this wrong as I’m trying to learn all that I can from everyone here but if my E2 is on the low end of the range, will the AI help make the most of the T being injected or will it crash my E2 and make things worse?

OTHER Q’s:
Would an Endo be preferred over a Urologist? Assuming they’re both proactive and competent (think I saw a sticky saying that’s near impossible)

Is there any benefit to HGH while on TRT, to protect joints and keep my knee healthy?

Thanks for reading and I look forward to any advice. I’ll keep reading the stickies. After looking at some of the Thyroid sticky. I’ll have to start taking Temps and looking into iodine and selenium sups.


KSman is Here
#2

@KSman I’ve only been a member for a day or two and will continue reading the stickies. I’ll be sure to search out answers before asking questions next time, as many of your posts have answered my questions at the end of my post. But I wanted to know if you could check my labs. I think I may be sensitive to the AI and crashing my E2. Wanted to know if I’m on the right track. Thanks.


#3

Anybody willing to take a quick look @ my labs and see if my doc and I are missing anything?


#4

Cholesterol Total 137 mg/dL

This is horrible. Try to change diet to increase, 180 is ideal. <160 associated with increased all-cause mortality. Cholesterol is foundation for creation of sex hormones, cortisol and Vit-D3.

Your Vit_D status is suboptimal. Please get 5000iu tiny Vit-D3 gel caps. Take one a day, take 25,000iu for first 5 days. Do not take this or any other oil based supplement with high fiber foods.

Your blood is thin as expected with low-T, but beyond that. Please increase iron in your diets and may be a problem with B vitamins as well. Get a high potency B-complex multi-vit with trace elements including 150-180 mcg iodine and 150-200mcg selenium, and with iron. Normally men should avoid extra iron. You can’t use a men’s formula because these are expected to be iron free. Some things in your labs are triggering my response.

TSH is less than 1.0, but thyroid is complex and TSH is only one shadow to consider. Please eval overall thyroid function via last paragraph in this post re oral body temperatures. Also explain your use of iodized salt over the years.

PSA problems in younger guys are rare and then more often related to prostatitis [infection].

Which type of doctor? Hard to say when most seem to be idiots when dealing with these things. A urologist typically has tunnel vision.

hGH? Only if low and then only if you can get an Rx then afford it. First you would want to do IGF-1 lab work. Your knee is not going to be perfect ever.

You can order your own labs in USA in most, not all, States.

When you inject T every two weeks levels get very high for a few days then drop to very low levels. Anastrozole is a competitive drug and its effect depends on your serum T levels. So it is quite impossible to manage E2 levels properly with T levels changing that way. Taking 1mg 30 minutes after the injection - T levels are still low, anastrozole is quickly absorbed and has high bio-availability. T–>E2 would have been greatly reduced and E2 levels would be falling as via normal liver E2 clearance. After 24 hours. This method will reduce the high T–>E2 of the T peak period. But as time goes on during these two weeks, further dosing of anastrozole is a problem. You really need steady T levels to manage E2 with an AI.


#5

Thank you KSman for your response. It’s been a busy couple of months so I haven’t been as diligent studying the forum and taking my temps etc. I did have my labs done and the results are posted below. Still need to have some other tests done to get a more complete picture but I plan on really focusing on this when summer starts in a few weeks. I did start taking vit d as suggested. As far as use of iodized salt, we always use it for cooking and flavor but not sure how much I’m actually consuming. I’m on a fairly high dose of Adderall so I was leary of using a lot of salt. I feel I need to quit Adderall because of the stress it causes on the body (i.e.sleep disruption, suppressed appetite leading to a catabolic state, vasoconstriction, etc.) and because I feel better physically when I don’t take it. Lack of motivation and productivity is the main downfall of quitting. I haven’t noticed a huge bump in strength or energy and I think the Adderall plays a role in that, but my mood is much better. I asked the dr about doing my own injections and he wants to evaluate treatment a little longer before he allows that. Hopefully I can get on a E3D SQ regiment at that point. Thanks again for your all your help.

4/27/17
Labs done @ about 7 am and 10 days after 200 mg cyp. IM and 1 mg of anastrozol.
Hematocrit 46.9 % (Normal is 41.0-53.0 %)
Albumin Level 4.1 g/dL (Normal is 3.5-5.2 g/dL)
T3 Free 3.2 pg/mL (Normal is 2.4-4.2 pg/mL)
T4 Free 0.92 ng/dL (Normal is 0.76-1.44 ng/dL)
FSH 0.1 mIU/mL (Normal is 1.0-12.0 mIU/mL)
Testosterone Free 207.1 pg/mL (Normal is 37.0-147.0 pg/mL)
Testosterone, %
Free
2.9 % (Normal is 1.1-2.7 %)
Testosterone Total 721 ng/dL (Normal is 240-871 ng/dL)
Sex Hormone
Binding Globulin
16 nmol/L (Normal is 13-71 nmol/L)
Testosterone,
Bioavailable
528.0 ng/dL (Normal is 115.0-407.0 ng/dL)
LH 0.1 munit/mL (Normal is 0.6-12.1 munit/mL)
Estradiol by
tandem mass
spectrometry
32.7 pg/mL (Normal is 10.0-42.0 pg/mL)
Vitamin D 25 OH 33 ng/mL (Normal is 30-80 ng/mL)

A few other items I forgot to add/ask.
Height: 6’2"
Weight: 275 lbs
Waist: 42

All of these questions probably don’t lend themselves to short answers but if you could point me in the right direction I can narrow down my reading. Also want to see if I’m understanding things correctly.

Is my free T and Bioavailable T high because my E2 is binding to the receptors and preventing T from binding, allowing it to build up?

If so, I’d like to get tested again right before my next injection to see what the numbers look like during the trough. I would expect E2 to continue to rise as long as there is available T to convert to E2.

I know LH and FSH will shut down as a result of hrt but is that healthy?

The first couple days after my injection I get flushed really bad. Face, neck and ears get red hot and lasts most the day and sometimes all day. I would occasionally get this symptom before starting injections but they’re getting worse. I tried drinking a lot of water to cool off but I was going to the bathroom every hour and symptoms remained the same. Also feel really weak with tight and achey muscles. From what I’ve read it seems to be a mix between high AND low E2 symptoms. I’m also noticing some localized swelling in my left arm pit. Not a huge lump but definitely more pronounced than the other side. Not painful at all but l notice it.

Thanks for the help. This site is amazing and has a lot to offer people who just want answers to their problems. Glad I found it.


KSman is Here
#6

200mg T E2W
labs done at day 10

Your FT is very good after 10 days.
FT if relatively high VS TT, because SHBG is/was low
Need current SHBG
Concerned re body weight and diabetes with SHBG connection.
Should test A1C to screen for diabetes

Do not test LH/FSH as these will be zero. Waste of money.
Your HPTA is shutdown as expected and you need 250iu hCG SC EOD to preserve testes.
Are you OK with small testes and high risk of loss of fertility?
You should know all of this from the stickies!

fT3=3.2 seems ideal, but only in the context of body temps that you have not posted. fT4=0.92 is horribly below mid-range.

Do not understand why you associate Adderall and salt!

Your labs are very meaningless as your hormone levels are changing so much over two weeks. Your lab results are more determined by lab timing than anything else. The idea that your doctor is evaluating anything based on this is insane. Your E2 levels earlier on would be a lot higher as more FT for FT–>E2.

Your unsteady hormone levels are undermining your mood and other quality of life factors.

Please carefully read my prior posts for issues that you have not responded to.

Post body temps!

Muscles:
Any leg or foot cramps? - magnesium deficiency.
Muscle ache: Are you using a cholesterol lowering drug?

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

  • advice for new guys - need more info about you
  • 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.