T Nation

31 Y/O, Just Started HRT Last Week


#1

-Age: 31
-Height: 5'11"
-Waist: size 34 pants
-Weight: 193
-Describe body and facial hair: Plenty of hair on legs, forearms, chest, thicker beard bellow the jaw, thinner above
-Describe where you carry fat and how changed: Mostly lower back, some thighs, same as younger but not as lean
-Health conditions, symptoms [history]: Mild BPH over the last year, gallbladder removal 3 years ago
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Rogaine and Flomax (didn't help much, used for 2 weeks only)
-Describe diet [some create substantial damage with starvation diets]: In the last 3 years mostly whole foods: meats, eggs, potatoes, rice, dairy, fruits, vegetables, I limit the junk-food, alcohol occasionally
-Describe training split, 2x a week for each
-Testes ache, ever, with a fever?: No
-How have morning wood and nocturnal erections changed: Went from frequent and rock hard to infrequent and not as firm

Up to about 3 years ago I had zero problems/symptoms. Sex drive was sky high, performance was great, could get hard on demand, could bang the girlfriend 3 times in a row without losing wood. After gallbladder surgery (related?) the libido slowly started going downhill. Less interest, refractory period increased, more stimulation needed to get a good erection. The decline was gradual, I assumed my body was naturally slowing down as I got to 30s and accepted the fact that I wont always be a stud in my 20s. However, over the last year it has gotten to the point where symptoms are getting worse a little too fast. Nowadays, I can lose interest and the erection mid-act. When I do finish, the orgasm is not nearly as strong and I also noticed that the ejaculation velocity has diminished. This has taken a huge toll on my relationship with my gf. Luckily, the libido and erections are the only problems I have. I am not depressed, energy is pretty good. I have decent levels of strength in the gym considering my labs. I noticed a slight dip in competitiveness at work, however.

Labs prior to HRT:

Total T: 264, Range: 196 - 782
Free T: 5.18, Range: 5.2 - 18
Bioavailable T: 132, Range: 119 - 470
Percentage Free T: 2.0, Range 1.5 - 3.1%
SHBG: 30, Range: 12 - 59
Estradiol: 24, Range <39
FSH: 5.9, Range: 1.6 - 8
Prolactin: 11.7, Range: 2.0 - 18
Glucose: 90, Range: 70 - 99
BUN: 17.1, Range: 8.4 - 25.7
TSH: 1.51, Range: 0.35 - 4.94
PSA: 0.67, Range: 0 - 4
Vitamin D: 35, Range: 30 - 96
Red Blood Cell Count: 4.65, Range: 4.2 - 5.8
Hemoglobin: 15.1, Range: 13.2 - 17.1
Hematocrit: 44.2, Range: 38.5 - 50.0

Total Cholesterol: 246, Range: <200
Total LDL: 170, Range: <130
Total HDL: 59, Range: >40
Triglycerides: 54, Range: <150

C REACTIVE PROTEIN: 3.4, RANGE: <1.0
HOMOCYSTOINE: 13.0, RANGE: <11.4

-The last 2 markers have me worried as they are above range. Any insight into this would be appreciated. Also, my total and LDL cholesterol raised an eyebrow. Should I be worried?

-After weeks of deciding which doctor, blood labs, semen analysis, I finally got my first T shot last week on Friday, 6/6/14.

-Doc's protocol is 160mg Test Cyp IM 1x/week. Arimidex .5gm 2x/week. Asked him about HCG for testicles/mood, he thinks I don't need it but is willing to prescribe it. I have a 10,000 vial on the way.

-From what I read here, Test Cyp might be little high at that dosage. I want to work with my doc but also tweak my protocol just a little:

Test Cyp 60mg E3D, 140mg/week
Arimidex 0.5mg E3D, 1.17mg/week
HCG 250iu E3D

I will keep this thread updated whenever I do blood tests or notice change in symptoms (good or bad). Any input is greatly appreciated.


KSman is Here
#2

I forgot to ask this in my original post. Have any of you guys, after dialing in your hormones, been able to alleviate your BPH symptoms? And to what degree?


#3

UPDATE: Blood draw 7/2/14 - 4 weeks after the first draw

Current protocol:
Test Cyp 60mg E3D, 140mg/week
Arimidex 0.5mg E3D, 1.17mg/week
HCG 250iu E3D

Results, 4 weeks:

Testosterone, Serum 966 348-1197 ng/dL
Testosterone,Free 46.08 5.00-21.00 ng/dL 02
% Free Testosterone 4.77 1.50-4.20 %

Estradiol, Sensitive <3 3-70 pg/mL 02 <------- AI OVER RESPONDER?

IGF-1 148 88-246 ng/mL 02

Prostate Specific Ag, Serum 0.9 0.0-4.0 ng/mL 01

TSH 1.880 0.450-4.500 uIU/mL 01
Thyroxine (T4) 7.2 4.5-12.0 ug/dL 01
T3 Uptake 29 24-39 % 01
Free Thyroxine Index 2.1 1.2-4.9 01

WBC 5.2 3.4-10.8 x10E3/uL
RBC 4.65 .14-5.80 x10E6/uL
Hemoglobin 14.8 12.6-17.7 g/dL
Hematocrit 42.8 37.5-51.0 %
MCV 92 79-97 fL
MCH 31.8 26.6-33.0 pg
MCHC 34.6 31.5-35.7 g/dL
RDW 13.2 12.3-15.4 %
Platelets 250 150-379 x10E3/uL
Neutrophils 48 40-74 %
Lymphs 38 14-46 %
Monocytes 7 4-12 %
Eos 5 0-5 %
Basos 2 0-3 %
Neutrophils (Absolute) 2.5 1.4-7.0 x10E3/uL
Lymphs (Absolute) 2.0 0.7-3.1 x10E3/uL
Monocytes(Absolute) 0.4 0.1-0.9 x10E3/uL
Eos (Absolute) 0.3 0.0-0.4 x10E3/uL
Baso (Absolute) 0.1 0.0-0.2 x10E3/uL
Immature Granulocytes 0 0-2 %
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL

Glucose, Serum 85 65-99 mg/dL
BUN 15 6-20 mg/dL
Creatinine, Serum 1.09 0.76-1.27 mg/dL
eGFR If NonAfricn Am 90 >59 mL/min/1.73
eGFR If Africn Am 104 >59 mL/min/1.73
BUN/Creatinine Ratio 14 8-19
Sodium, Serum 141 134-144 mmol/L
Potassium, Serum 4.2 3.5-5.2 mmol/L
Chloride, Serum 102 97-108 mmol/L
Carbon Dioxide, Total 23 18-29 mmol/L
Calcium, Serum 9.6 8.7-10.2 mg/dL
Protein, Total, Serum 7.2 6.0-8.5 g/dL
Albumin, Serum 4.8 3.5-5.5 g/dL
Globulin, Total 2.4 1.5-4.5 g/dL
A/G Ratio 2.0 1.1-2.5
Bilirubin, Total 0.5 0.0-1.2 mg/dL 01
Alkaline Phosphatase, S 48 39-117 IU/L
AST (SGOT) 17 0-40 IU/L
ALT (SGPT) 11 0-44 IU/L

Cholesterol, Total 219 100-199 mg/dL
Triglycerides 67 0-149 mg/dL
HDL Cholesterol 52 >39 mg/dL

Symptoms:
Libido is still low, morning wood infrequent and not strong. Bottomed E2?
The second week and little bit into the third I felt a little unexplained anxiety which now is gone. E2 again?
Also during 2nd and 3rd week, had a bland feeling. Not depressed or sad but just meh. Fine now. E2?
Energy is fine, just like prior to TRT.
More vivid dreams that I can recall easier. Anyone else?

Obviously I need to get my E2 up and would appriciate some input on the strategy. This is what I am thinking:

  1. Stop the AI for one week
  2. Continue with the dosage cut in half, .25mg E3D, .58mg a week
  3. Retest in another 4 weeks

Any suggestions would be greatly appriciated.


#4

Stop AI for 5-6 days and resume at 1/4mg per week in divided doses, you will need to make a solution and dispense by the drop, use vodka, dispense into water and drink. You will feel the difference and will not need labs to know you are on the right path.

BPH at your age is wrong. Sounds like prostatitis: http://en.wikipedia.org/wiki/Prostatitis
So your CRP is also consistent with a chronic infection/inflammation and inflammation can be in the arteries or affect the arteries, which can elevate homocystine. So you need to deal with a urologist. You may have hidden infections from your surgery and these can be hidden in cysts and can hide from CBC work. Keep E2 in lower 20’s; E2 can be bad for your prostate.

Please read the tyroid basics sticky, noting iodine intake, and check your body temperatures. TSH should be near 1.0 and T3, T4, fT3, fT4 need to be near mid range. T4 is low.


#5

Sir, thank you very very much for replying.

I will be making a solution for my AI and dose .25mg per week per your recommendation. I will switch to EOD protocol for more even T peaks and AI along with HCG 250IU EOD. When I make a solution for my AI, how long can I keep it before it loses potency, if ever?

I have read the thyroid stickies. Thank you for that post as well. I bought an oral thermometer. Here are my temperatures as of today:

7:45 am, just woke up - 97.5
1:35 pm, 30 mins after lunch - 98.7
3:45 pm, - 98.7

Not sure what to make of these and my labs. Seems OK? I don’t have problems with energy. If I get solid 7-8 hours of sleep, I am good. In april my TSH was 1.5. At that time I was cooking at home (using iodized salt) and for the last two months I’ve been eating out. Would an increase of TSH from 1.51 to 1.88 in few months be attributed to lower iodine intake while eating out?

I will check with my doc regarding my prostate and the posibility of prostatitis. I do have to say since I started HRT along with quality EPA+DHA and 4000IU of vit D, my nightly urination went from 2-3 times a night to only 1 to 0 sometimes. Not sure if linked but will keep track of the symptoms.

Just another quick question regarding my recent labs. The free T came in at 46, way above the range. Can this be problematic? I am guessing it will come down some once my E2 comes back up from the bottom. Correct?

Once again, thank you very very much. I know you don’t have to do any of this and for that I am greatful.


#6

Yes, low E2 can lower SHBG, FT goes up and TT can go down.

BPH improved, lower inflammation, EFA’s reduce inflammation. Greater T:E2 can help with BHP.

Anastrozole in alcohol solution is very stable.


#7

UPDATE: Blood draw on 7/29 to check for E2.

As per KSman’s recommendation, I stopped the AI for 6 days then went with .25mg per week. The E2 came up some from <3 but still very low:

Testosterone, Serum 1147 348-1197 ng/dL
Testosterone,Free 44.96 5.00-21.00 ng/dL
Estradiol, Sensitive 8 3-70 pg/mL <------------------'SIGH’
Prostate Specific Ag, Serum 0.9 0.0-4.0 ng/mL

Symptoms:

Energy is still fine as long as I get enough sleep. Sexual desire still low but did notice a very slight improvement in erections. Night and morning erections seem to be little more frequent but still not as firm as in my 20s.

Current protocol:
40mg Test Cyp EOD = 140mg/week
250IU HCG EOD
.25mg/week of Arimidex, dosed by drops ED

Need a pointer of where to proceed next. According to forum research this is what I came up with:

  1. Stop the AI for 6 days again
  2. Dose .09mg AI per week by drops. (8/22).25=.09

KSman, I dissolve my Adex in 80 proof vodka and dose by drops. Is it ok if I keep this solution in the fridge?


#8

You appear to know what to try next. No need to refrigerate the anastrozole solution. The molecule is stable and the alcohol prevents bacterial activity.


#9

Thank you for confirming.

KSman, have you noticed an increase in IGF-1 with TRT protocols before (self/others) and if yes, how common is it? I am sitting a little below mid range. Not necessarily worried about it since I feel good but would be a nice bonus to TRT.


#10

I have not noticed that trend because we see very few guys who are doing labs to detect that. And many do not test IGF-1 because they or their doc’s don 't see how it would be paid for if one was deficient.

The organs and systems that produce hormones are sensitive to the hormones released by other systems. Thyroid is the poster child for this because when it is low, everything slows down. We have also seen TRT restore some degree of thyroid function.

Cross hormone improvements probably are more dramatic in younger people where youthful vitality can be restored.


#11

Ok, time for an update:

PROTOCOL:

40mg Test Cyp EOD = 140mg/week
250IU HCG EOD
.0875mg/week Adex, dosed by drops ED

SYMPTOMS:

I’ve been waking up with nightly erections. Good. I find my self with spontaneous erections while driving home from work, specifically. Weird. But good I guess. Sexual performance increased and quality of erections is fine. However, I still don’t have that sexual drive and sexual aggressiveness of my early and mid 20’s. I can get into the mood but it usually doesn’t come on its own like it used to. Time will tell.

Gym performance? Fuck Yeah. All of my lifts are up considerably, WHILE ON A CALORIC DEFICIT. I am slowly dieting in attempt to get to about 10% body fat. About 14.5% now. No starvation, just nice and steady loss. Lost 2+ inches off my waist, gained about 0.5 inches on my biceps, all while dieting. Love it.

Mood and energy are fine as long as I get enough sleep. Little cranky in the morning but within an hour or two I am good.

NUMBERS:

WBC 4.9 3.4-10.8 x10E3/uL
RBC 4.93 4.14-5.80 x10E6/uL
Hemoglobin 15.8 12.6-17.7 g/dL
Hematocrit 46.4 37.5-51.0 %
MCV 94 79-97 fL
MCH 32.0 26.6-33.0 pg
MCHC 34.1 31.5-35.7 g/dL
RDW 12.8 12.3-15.4 %
Platelets 264 150-379 x10E3/uL
Neutrophils 51 %
Lymphs 35 %
Monocytes 9 %
Eos 3 %
Basos 2 %
Neutrophils (Absolute) 2.6 1.4-7.0 x10E3/uL
Lymphs (Absolute) 1.7 0.7-3.1 x10E3/uL
Monocytes(Absolute) 0.4 0.1-0.9 x10E3/uL
Eos (Absolute) 0.1 0.0-0.4 x10E3/uL
Baso (Absolute) 0.1 0.0-0.2 x10E3/uL
Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL

Glucose, Serum 84 65-99 mg/dL
BUN 16 6-20 mg/dL
Creatinine, Serum 1.24 0.76-1.27 mg/dL
eGFR If NonAfricn Am 76 >59 mL/min/1.73
eGFR If Africn Am 88 >59 mL/min/1.73
BUN/Creatinine Ratio 13 8-19
Sodium, Serum 141 134-144 mmol/L
Potassium, Serum 4.5 3.5-5.2 mmol/L
Chloride, Serum 100 97-108 mmol/L
Carbon Dioxide, Total 25 18-29 mmol/L
Calcium, Serum 9.9 8.7-10.2 mg/dL
Protein, Total, Serum 7.4 6.0-8.5 g/dL
Albumin, Serum 4.8 3.5-5.5 g/dL
Globulin, Total 2.6 1.5-4.5 g/dL
A/G Ratio 1.8 1.1-2.5
Bilirubin, Total 1.0 0.0-1.2 mg/dL
Alkaline Phosphatase, S 59 39-117 IU/L
AST (SGOT) 14 0-40 IU/L
ALT (SGPT) 12 0-44 IU/L

Cholesterol, Total 202 HIGH 100-199 mg/dL
Triglycerides 58 0-149 mg/dL
HDL Cholesterol 54 >39 mg/dL
VLDL Cholesterol Cal 12 5-40 mg/dL
LDL Cholesterol Calc 136 HIGH 0-99 mg/dL

TSH 1.65 0.40-4.50 mIU/L
T4, FREE 1.2 0.8-1.8 ng/dL
T3, FREE 3.2 2.3-4.2 pg/mL
T4 7.3 4.5-12.0 ug/dL

Testosterone, Serum 950 348-1197 ng/dL
Testosterone,Free 41.26 HIGH 5.00-21.00 ng/dL
Estradiol 25.5 7.6-42.6 pg/mL

IGF-1 180 88-246 ng/mL

DHEA-S 205 106-464 mcg/dL

KSman, just a few questions:

What do you think of my thyroid labs? Lowish T4, elevated TSH, yet fT3 and fT4 pretty much perfect. I read that T can push down TBG, lowering the total hormones but the free hormones are fine and the conversion to T3 should be fine. I may have misunderstood that. Once again my energy is fine and no issues with diet and fat loss. Would like your 2 cents.

Also, what do you recommend for my sub stellar DHEA-S numbers? Too low? Supplementation?

By the way, I asked you few months back if T increases IGF-1. Looks like I jumped 20%. Perhaps individual but there seems to be some correlation.

If anything jumps at you about those numbers, please share. Thanks again.


#12

Do you take anything to help with digestion?

I am assuming you are eating a lot of dietary fat and you may want to think about taking something to help with bile. I have read a lot of great info on Ox Bile (GB-3), just something to consider due to your gall bladder removal.


#13

I don’t take anything currently. I don’t have much trouble with digestion even after removal. Maybe if the meal is overly greasy it may send me to the bathroom. What I’ve found with my diet lately is that moderate fat diet and higher carbs give me more energy and I am able to lose body fat with less problems.

But that could be T as well. Currently losing body fat steadily on 275C, 150P, 60F. No digestion issues at all this way. However, I will look into the Ox Bile fore sure, thanks for your suggestion.


#14

Time for another update:

I have switched from LabCorp to Quest for my blood tests. If you have a choice and/or can afford it, I would recommend the same. I find Quest to be much more reliable and consistent.

SYMPTOMS:

Acne:
I lowered my T dose from 140mg/week to 105mg/week. One of my tests came back with TT at 1389. Completely unnecessary. While I had no ill feelings, the acne started to creep up on my neck and chest. I knew this dose was way too high (for me) since I had zero acne even during puberty. At 105mg/week it’s clearing up but still pops up here and there. I think I will lower my dose to 85mg/week in the future and see how it goes.

Libido/erections:
Erections are solid. Morning wood definitely more frequent and harder. The sex drive is still lagging a little, it takes more initiation to get me going where in the past I wanted it no matter what.

Body comp/strength:
Been eating at very mild caloric deficit while strength training on a consistent basis. My efforts along with healthy T levels are showing. I am approaching the level of leanness I had in my early 20s. I’d say I even have more muscle since I doubt my T levels were ever this high naturally. I don’t think I was ever a high T guy.

Energy/mood/behavioral:
Energy is good. Mood is good. I am even keeled and don’t let too much bother me. However, the patience is little shorter, especially with stupidity and ignorance. I am much quicker to call someone out if they are feeding me bullshit. Also, I am little more emotionally distant than I used to be.

Current protocol:

105mg/week T - EoD dosing
250iu HcG EoD
.225/week Adex - EoD dosing

Labs:

TESTOSTERONE, TOTAL, LC/MS/MS 1069 250-1100 ng/dL
TESTOSTERONE, FREE 274.8 H 46.0-224.0 pg/mL
TESTOSTERONE,BIOAVAILABLE 564.5 110.0-575.0 ng/dL
SHBG 18 10-50 nmol/L
ESTRADIOL 28 < OR = 39 pg/mL

CHOLESTEROL, TOTAL 218 H 125-200 mg/dL
HDL CHOLESTEROL 54 > OR = 40 mg/dL
TRIGLYCERIDES 62 <150 mg/dL
LDL-CHOLESTEROL 152 H <130 mg/dL

TSH 1.7 0.40-4.50 mIU/L TP
T4, FREE 1.2 0.8-1.8 ng/dL TP
T3, FREE 3.2 2.3-4.2 pg/mL

WHITE BLOOD CELL COUNT 5.4 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 4.90 4.20-5.80 Million/uL
HEMOGLOBIN 15.6 13.2-17.1 g/dL
HEMATOCRIT 47.5 38.5-50.0 %
MCV 96.8 80.0-100.0 fL
MCH 31.9 27.0-33.0 pg
MCHC 32.9 32.0-36.0 g/dL
RDW 13.1 11.0-15.0 %
PLATELET COUNT 235 140-400 Thousand/uL
ABSOLUTE NEUTROPHILS 2678 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 2047 850-3900 cells/uL
ABSOLUTE MONOCYTES 454 200-950 cells/uL
ABSOLUTE EOSINOPHILS 162 15-500 cells/uL
ABSOLUTE BASOPHILS 59 0-200 cells/uL
NEUTROPHILS 49.6 %
LYMPHOCYTES 37.9 %
MONOCYTES 8.4 %
EOSINOPHILS 3.0 %
BASOPHILS 1.1 %

GLUCOSE 84 65-99 mg/dL
Fasting reference interval
UREA NITROGEN (BUN) 20 7-25 mg/dL
CREATININE 1.14 0.60-1.35 mg/dL
eGFR NON-AFR. AMERICAN 85 > OR = 60 mL/min/1.73m2
eGFR AFRICAN AMERICAN 98 > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO NOT APPLICABLE 6-22 (calc)
SODIUM 139 135-146 mmol/L
POTASSIUM 4.3 3.5-5.3 mmol/L
CHLORIDE 103 98-110 mmol/L
CARBON DIOXIDE 22 19-30 mmol/L
CALCIUM 9.8 8.6-10.3 mg/dL
PROTEIN, TOTAL 7.5 6.1-8.1 g/dL
ALBUMIN 4.6 3.6-5.1 g/dL
GLOBULIN 2.9 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 1.6 1.0-2.5 (calc)
BILIRUBIN, TOTAL 0.9 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 51 40-115 U/L
AST 15 10-40 U/L
ALT 15 9-46 U/L

I would definitely say that TRT does work. Yes, I feel good.

HOWEVER:

For new guys: TRT is not a magic pill that will fix shitty lifestyle, sleep/diet/stress etc.
If you eat like shit, you will get FAT, even on TRT.
If you don’t sleep enough, you will be tired, even on TRT.
If you don’t manage your time/stress, you will feel like garbage, even on TRT.

But when you get all those things in order and then get your testosterone to a healthy level, boy, what a difference.

Any feedback is appreciated.


#15

lgs - Your post is a little confusing. You’re saying that 140mg per week was too much, you lowered it to 105mg per week, and you’re thinking of lowering it to 85mg per week, stating that 140mg per week and TT of 1389 is completely unnecessary. Yet in the steroid forum your posting that you’re starting CJC-1295 and Ipam peptides, and you’re going to go on a cycle of 350mg of test prop per week.

In one forum you’re saying 140mg raises your testosterone too high and is is unnecessary, and in the other one you’re saying you’re going to go to 350mg per week. Kind of hard to have it both ways.


#16

I will be running a 10 week blast, yes. But for long term excessive testosterone is not necessary. 10 weeks is only a fraction of time if I blast once a year. So I will probably go 350mg/week for 10 weeks and rest of the year run 85mg/week to maintain.

Cjc1295 and ipamorelin I will be using to bring my lacking IGF-1 levels. That is if the peptides even do anything. I hope they do.


#17

Thyroid fT3, fT4 look decent.

What are your body temps?
What is your iodine iodized salt intake?

ref thyroid basics sticky

E2 could be a bit lower, seek E2=22


#18

I use iodized salt at home. I grew up in one of the Balkan countries where bread has to be iodized by law. We ate bread every day. The only time frame I could have missed the iodine intake were my teenage years when I moved to USA. But in my teenage years I was lean and muscular no matter what I ate. I doubt my thyroid was in question.

My energy is fine. I look forward to my workouts. This is even before TRT when my T was tanked.

It’s 9:30pm now and my temperature came out at 98.4. Months back when I started talking to you, my mid afternoon temps were always 98.6 and 98.7

Can elevated TSH be problem in itself?

Also, have you had any experience with CJC-1295 and/or Ipamorelin?