T Nation

31yr Old - Need TRT Advice

Hi All, I have been trying to get the proper advice for quite some time now regarding TRT. I have been to an endo and a TRT and they are at both end of the spectrum. I have been reading a lot on TRT and I think I came to the right place for some real advice :slight_smile: Recently, I went to another TRT doctor and he wants me to take 15mg ED of Test Cyp, HCG ED, DHEA 75mg pills ED. Here’s my info below: please let me know if you need anything else.

-age: 31
-height: 5ft 10in
-waist: 36 in
-weight: 217 lbs
-describe body and facial hair: slender body, fat at midsection. Pretty hairy, getting more and more as I age; facial hair grows back very quick. I do have a wide back, strong thighs but I think I have chicken legs.

-describe where you carry fat and how changed: I carry most of my fat at the midsection which I think is from sitting down at work for a long time and then in class at night. I have some fat also on the face. I usually bloat sometimes for a reason I am trying to figure out and sometimes I can get my ring off my finger.

-health conditions, symptoms [history]: I developed sleep apnea out of no where on Jan 2012. Before that I never had problems sleeping. I believe it is linked to the weight gain and the cycle listed below. I have been using the CPAP machine since then. Other then that no other medical problems Thank GOD!

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: I was on a cycle from 9/11 to 3/12, where a HRT/TRT doc put me on HCG, HGH, Test Cream, DHEA (it was all low dose) but I swelled up a lot and then I developed problems sleeping at night. Once I was diagnosed with sleep apnea, I stopped everything. Currently, I am seeing an endo for 2 months now but he is giving me 50mg of Test ONCE A MONTH! Obviously it is not really doing anything major but I was just curious. I have lab results from last year and from 6 months ago.

-lab results with ranges (1 week old)
Free thyroxine: 1.29 (0.65-2.3)
TSH, Sensitive: 1.39 (0.4-4.0)
Free T3: 4.1 (2.1-4.9)
DHEA-Sulfate: 300 (350-430)
E2: 30
TEST, TOTAL: 396 (262-1593)
FREE TEST: 10.84 (3.8-34.17)
PSA (PROSTATIC ANTIGEN): 0.3 (0-0.4)
PSA, FREE: 0.1 (0.0-0.7)
PSA,%,FREE: 33 (> 20)
IGF-1, LC/MS: 230 (53-331)
IGFBP-3: 5.24 (3.50-7.60)
FSH: 3.4 (1.5-12.4) - taken on 9/2012
LH: 2.2 (1.7-8.6) - taken on 9/2012

Lipid Panel/Cardiac Risk
Cholesterol: 149 (<200)
Triglycerides: 125 (<150)
HDL Cholesterol: 39 (>40)
VLDL Cholesterol: 25 (<30)
LDL Cholesterol: 85 (<130)
Cholesterol/HDL Ration: 3.82 (<4.97)
LDL Cholesterol,direct: 92 (<100)

-describe diet [some create substantial damage with starvation diets]: I followed leangains diet (16hr fast, 8hr eating window) but it did not really help me loose weight. I currently have been eating egg white with veggies for breakfast, for lunch I would eat a chicken salad and for dinner I would have the same. On workout days, I add a protein shake and more chicken or red meat. I don’t eat bread, rice and don’t take any sugar in coffee. Typically I get around 2000-2200 calories.

-describe training [some ruin there hormones by over training]: I workout 3 times a week. Legs/back, Chest/Arms, Shoulders/triceps. Here’s my typical routine:

Wednesday:
Chin Ups: 9,8,7
Squat: 155lbx10x3
Body Row: 10, 10, 10
Cable Row: 120lbx10,130lbx10,140lbx10
Wide Grip Pull Down: 120lbx10x3
Upright Cable Row: 60lbx8x3
Deadlift: 155lbx10x3
Rear Delt Row with Barbell: 155lbx10x3

Friday:
Wide Grip Push Ups: 24,14,10
Bench Press: 115lbx8x3
Pushdown with Rope: 40lbx10x3
Flys: 30lbx12x3
Incline Barbell Bench Press: 115lbx8x3
Bent Arm Dumbell Pullover: 45lbx8x3
Lying Cable Triceps Extension: 30lbx10x3
Dips: 8x3

Sunday:
Chinups: 15,11,7
Reverse Grip Pull Down: 110lbx10x3
Close Grip Barbell Curl: 55lbx8x3
Shurgs with Barbell: 95lbx8x5
Hammer Cable Curl: 40lbx10x4

-testes ache, ever, with a fever? No

-how have morning wood and nocturnal erections changed: I have morning wood but no wood during the day that I used to have. Libido is very very low.

Thanks


3/27/13 - UPDATED BLOOD WORK

T4: 7.3 (4.5-12.5)
FREE THYROXINE: 1.39 (0.65-2.30)
TSH, SENSITIVE: 1.51 (0.40-4.00)
T3 UPTAKE: 32 (24-35)
T3, TOTAL: 94 (84-172)
FREE T3: 3.1 (2.1-4.9)
(FT4 INDEX) CALC.: 2.3 (1.1-4.6)
THYROID PEROXIDASE AB. <10.0 (0.0-35.0)

ANTI-THYROGLOBULIN ANTIBODIES: <20 (0-40)
THYROGLOBULIN: 5.8 (0-55)

CHOLESTEROL: 124 (<200)
TRIGLYCERIDES: 74 (<150)
HDL CHOLESTEROL: 33 (>40) LOW
VLDL CHOLESTEROL: 15 (<30)
LDL CHOLESTEROL: 76 (<130)
CHOLESTEROL/HDL RATIO: 3.76 (<4.97)
LDL CHOLESTEROL, DIRECT: 79 (<100)

VIT D-25: 46.25 (19.10-57.60)
DHEA SULFATE: 226 (35-430)
ESTRADIOL: 32
TESTOSTERONE, TOTAL: 1035 (262-1593)
FREE TESTOSTERONE: 16.74 (3.80-34.17)

PSA: 0.5 (0-4.0)
PSA, FREE: 0.1 (0-0.70)
PSA, % FREE: 20 (>20) LOW

IGF-1, LC/MS: 292 (53-331)
Z-SCORE: 1.5 (-2-2)
IGFBP-3: 5.4 (3.5-7)


Results 7/21 taken in the morning fasted.

T4: 1.77 (0.82-1.77)

CHOLESTEROL: 155 (100-199)
TRIGLYCERIDES: 65 (<149)
HDL CHOLESTEROL: 39 (>39) LOW
VLDL CHOLESTEROL: 13 (5-40)
LDL CHOLESTEROL: 103 (0-99) HIGH

DHEA SULFATE: 315 (160-449)
ESTRADIOL: 22 (7.6-42.6)
TESTOSTERONE, TOTAL: 1381 (348-1197)
FREE TESTOSTERONE: >50 (8.7-25.1)
LH: 0.1 (1.7-8.6)
FSH: 0.1 (1.5-12.4)
INSULIN: 6.4 (2.6-24.9)
TSH: 2.350 (0.450-4.5)
IGF-1, LC/MS: 296 (71-241)
IGF-2: 455


Results from test taken on 10/31/13 fasted

T4: 1.76 (0.82-1.77)

CHOLESTEROL: 143 (100-199)
TRIGLYCERIDES: 57 (<149)
HDL CHOLESTEROL: 39 (>39) LOW
VLDL CHOLESTEROL: 11 (5-40)
LDL CHOLESTEROL: 93 (0-99) HIGH

DHEA SULFATE: 291.1 (160-449)
ESTRADIOL: 23.8 (7.6-42.6)
TESTOSTERONE, TOTAL: 977 (348-1197)
FREE TESTOSTERONE: 43.8 (8.7-25.1)
INSULIN: 6.4 (2.6-24.9)
TSH: 1.350 (0.450-4.5)
IGF-1, LC/MS: 280 (71-241)
IGF-2: 514

So you know the labs that are needed?

Edit ranges into the labs in your post above.

DHEA-S=300, what was the DHEA dose for that?

hCG is better injected EOD, it has a good half life and you can spend less time poking holes in yourself.

DHEA 75 seems nuts, start with 25

You need LH/FSH labs. Do you have more lab data?

Ok I added the ranges and LH/FSH levels from 9/2012. My doctor didnt check for those. Is there any other lab you need?

I wasnt on dhea since march 2012 so the 300 is without any suplements.

What do you think about the trt plan my doctor wants to put me on?

35mg test cyp every day is bogus, do you know the standard protocol recommended here?

Your description is not very good!!! Get specific

Your T level is consistent with your lowish LH/FSH. You are secondary, not primary. This does not make sense for your age.

fT4 is a little bit below mid range and fT3 is higher than mid range. Do not know what to think about that. However, is your body temperatures are low, that tells a different story. Post body temperatures and re-read the advice for new guy stick with iodine and thyroid issues in mind.

Do not take more than 25mg DHEA for now.

With E2=30, you will need anastrozole.

Post your cholesterol numbers.

Yes, the standard recommended is:

  • 100mg test cypionate or ethanate injected per week with two or more injections per week.
  • 250iu hCG SC EOD [every other day]
  • 1.0mg Arimidex/anastrozole per week in divided doses

Should I follow the dosage as well? + DHEA = 25mg. I don’t have the Anastrozole on hand, I would have to procure it.

I changed some of the descriptions to make it more clear. Let me know if there’s something else that is confusing I will change it. Sorry about that.

I updated the cholesterol numbers above.

I will update the temperature tomorrow.

Thank you

Do you have total cholesterol?

TRT looks good. Start small with DHEA and see what that does. For some guys, large doses can create a lot of E2. And your DHEA-S = 300 was quite good for a starting point.

To increase HDL:

  • CoQ10, the ubiquinol type is better, 50mg
  • high potency B complex multi vitamin and trace minerals, including iodine [typically 150 mcg]
  • vitamin E
  • DHEA
  • vitamin C and other antioxidants
  • fish oil and other EFA’s [nuts, flax seed or flax seed oil]

The above are good for overall health. And when dieting, one is also limiting nutrients, making supplements more important.

I have spent a few hours reviewing papers describing thyroid disorders, including the ones that do not make sense… And I have yet to find on that discusses body temperatures or iodine deficiency. The medical community is blind to these basics.

Red wine in moderation also increases HDL.

[quote]AliAli wrote:
Yes, the standard recommended is:

  • 100mg test cypionate or ethanate injected per week with two or more injections per week.
  • 250iu hCG SC EOD [every other day]
  • 1.0mg Arimidex/anastrozole per week in divided doses

Should I follow the dosage as well? + DHEA = 25mg. I don’t have the Anastrozole on hand, I would have to procure it.

I changed some of the descriptions to make it more clear. Let me know if there’s something else that is confusing I will change it. Sorry about that.

I updated the cholesterol numbers above.

I will update the temperature tomorrow.

Thank you
[/quote]

Yes. This dosage is based on how much a functional male produces throughout the course of a week. A virile male produces around 70mg of T per week. Out of the 100mg injections, you’ll absorb around 70mg. This is the standard. Some have success and others require a little more. Adjust after blood tests.

Absolutely no reason to inject T or hCG everyday. Best to inject EOD or 2x/week. Do the combo (T+hCG+AI) at same time. Cutting adex into quarters is tricky. May want to look into liquid anastrozole RC if you’re going the EOD route.

I would probably cut out the DHEA all together. It was exacerbating my E2 issues.

[quote]Kaynon311 wrote:
This dosage is based on how much a functional male produces throughout the course of a week. A virile male produces around 70mg of T per week. Out of the 100mg injections, you’ll absorb around 70mg. [/quote]

It is not 70mg that is absorbed. 100mg of the testosterone ester is absorbed, then there are a number of processes in the body that remove the ester group which changes the molecule to bio-identical testosterone, yielding roughly 70mg. The yield depends on the type of ester group, lighter ester groups yield more T than heavier, such as ethanate VS cypionate. Note that lighter ester groups also convert faster and have shorter half lives. 100% of the testosterone is delivered. The fact that a round number like 100mg turns out to be the correct dose is a coincidence.

[quote]KSman wrote:
Do you have total cholesterol?
[/quote]

I updated the OP with total cholesterol and IGFBP-3 results.

The body temperature is 97.4 F degrees @ 6pm. I will take temperatures every 3 hours tomorrow and will post it tomorrow night.

Should I take Vitamin D also? I ordered all the supplements you recommended and I ordered liquid anastrozole. I had asked my trt doctor to get me some and he said that my E2 range is perfect for building muscle.

Here’s another one: As far as injecting EOD and I am just throwing it out there. On the sheet where my TRT doctor writes down the blood test ranges and the recommended dosage to correct it, there is a note in bold written “Warning: Do not inject test C every other day as HDL drops”.

Temperature has been around 97.3 - 97.6 throughout the day.

I have been injecting T EOD for 6 years. My HDL was high before I started and has remained that way.

So to increase HDL in normal guys we need to castrate them so they do not have steady levels, then have them inject once a week!

No one seems to have good Vit-D25 levels without supplementing.

So your thyroid hormone labs are ambiguous and your body temperatures suggest that you have functional hypothyroidism. Can you verify that some other family members can get 98.6 with that thermometer?

I created a post today that will become a sticky. Please read “thyroid basics”

Just wanted to do a quick update I started my TRT last week. Last night was my 3rd shot of test. I am doing:

  • 100mg test cypionate two injections per week. (Wed & Fri)
  • 250iu hCG SC EOD [every other day]
  • 1.0mg LiquiDex per week in divided doses

I am also taking the supplements to increase HDL as suggested above.

I will report back with hopefully some good news but its too early to say anything.

Regarding the temperature, I took the temp another day at the evening it was 98.6 on the money so I will get a better thermometer to verify this. KSman I will get back to you. Thanks.

I have been feeling very tired and lazy lately. I have noticed it usually happens when I take LiquiDex. I took it in the morning one day and I was tired the whole day and I didn’t feel like working out. To prevent that I tried taking it before I go to sleep but I woke up feeling the same way.

Should I stop Liquidex for a little while and restart with the dosage down to 0.25mg x 3 / week.

Thanks

Kindly please reply

If an over responder, stop adex for 5-6 days and resume at 1/4th of the expected dose. Try 2 drops EOD.

Without lab work, you are on a fishing expedition.

Hi there, I just got the new blood work results (see OP). Testosterone definitely went up from 3 months ago; I feel much better, confident, stronger, more libido. I do however feel tired sometimes through out the day and it might be the iodine deficiency so I ordered some supplements few days ago to see if that helps.

My Doctor said that my HDL cholesterol went down and asked if I was taking the shots everyday as he requested; I said no I didn’t. He said I must take shots everyday or the HDL will keep dropping to dangerous levels. He said I have to increase it. He wants me to up the test to 200mg weekly. I have been taking the supplements suggested above everyday to increase HDL.

I have been on the following protocol for the last 3 months: 100mg test broken into biweekly injections, 250iu HCG and 1mg of Liquidex.

The Doctor also said that I should take 75mg of DHEA pills (I did not use DHEA in this cycle) and prescribed ArmourThyroid based on the thyroid results. I asked if I could get prescribed anastrozole, he said I don’t need it.

So what do you guys think?

.

KSMAN, where are you?

You can inject EOD, ED is nuts with a T ester. Doc is weird. Ask doc for references on T ED preventing and otherwise causing. We never see this. Never heard of this.

What was lab timing for:
TESTOSTERONE, TOTAL: 1035 (262-1593)
FREE TESTOSTERONE: 16.74 (3.80-34.17)

200mg, he must be aiming for high normal FT. Does the doc sell the drugs?

High T may not be good for you.

I would not start 75mg DHEA, start small in case you freely DHEA–>E2

More eggs and red meat, increase cholesterol.

Anastrozole. Increase dose by 32/22 to get E2=22. Then if you double your T dose, you will probably have to double the anastrozole for 2* 32/22. [maybe hCG is pushing up your E2, this happens to a few guys].

HDL is low:

  • fish oil, nuts, flax seed meal or oil, olive oil
  • anti oxidants, natural source vit-E, C etc
  • high potency B-complex multi-vits with trace elements AND iodine
  • DHEA as needed

What is going on with iodine and body temperatures?