T Nation

33 Y/O in a Funk - Starting TRT


#1

I’ve been a natural bodybuilder for around 12 years now, highly ignorant when it comes to test and other similar substances. This last year has been tough. I struggle through workouts, no energy, low libido (taken ashwaghanda, trib, DAA, etc. to try to help here), depression…goes on and on. Finally decided to get some lab work done and see what’s wrong. Luckily, I was referred to a good clinic with knowledgeable Endo’s (we’ll see).

Been married for 6 years now, 2 little kids now, want a couple more. I am just struggling with energy/motivation/etc.

By far, most helpful info I have read is on this site…hands down. After checking the basics, thyroid is not the problem with good readings and no body temp problems. Here are my labs (thank you for the insight on what labs to get):

Metabolic:
Glucose (mg/dL) - 87 (70-99 supposedly optimal)
Vit D (ng/mL) - 65 (30-100 – been supplementing approx. 5000 iu D3 daily)

Thyroid:
TSH (IU/mL) - 1.39 (0.27 - 4.2)
T4, free (ng/dL) - 1.39 (0.93 - 1.7)
T3, free (pg/mL) - 2.9 (2.0 - 4.4)

Hormones:
DHEA-S - 340 (160-449)
Estradiol aka E2 (pg/mL) - 16.6 (25.8 - 60.7)
Estrone aka E1 (pg/mL) - 15 (13 - 58)
FSH (mIU/mL) - 4.4 (1.5 - 12.4)
LH (mIU/mL) - 6.7 (1.7 - 8.6)
SHBG (nmol/L) - 42 (10 - 80)
TT (ng/dL) - 442 (from what I read this should be at least 600-800?)
Free T (ng/dL) - 7.84 (4.7 - 24.4)
DHT (ng/dL) - 34 (24 - 65)
Prolactin (ng/mL) - 7.51 (4.04 - 15.20)

CBC:
WBC - 5.6
RBC - 5.6
Hemoglobin - 16.1
Hematocrit - 48%
MCV - 85
MCH - 29
MCHC - 34
RDW - 13.6%
Platelets - 266
Neutrophils - 50
Lymphocytes - 35%
Monocytes - 10%
Eosinophils - 4%
Basophils - 1%

PSA - 0.3 (0.1 - 3.9)

DR prescribed protocol (corrected upon closer inspection-slightly different than the ideal suggestion, but the hCG seems high while the anastrozole low):

50mg Test Cyp 2x/wk
750iu hCG 2x/wk
1/2mg anastrozole per wk

How does this protocol look based on my labs? New labs will be done in 6 weeks, but I want to make sure the DR is not a quack. Any other advice would be appreciated!


#2

Your test numbers look very similar to mine. Your thyroid function seems slightly inadequate as well – but doubt that’s your whole problem.

I’m very split on going on TRT at 30 myself. I have a scrip and going to my PCP for his opinion. Most of the PCPs are against it if you’re with that “normal” range, so I’m hoping if I go in there with a scrip he will actually give me a reason why not to do TRT and actually look into why my T is sub optimal in the first place – instead of telling me not to worry about it. That’s what I’m doing. From all the research I’ve read, it seems like TRT should be the last course of action you try after exhausting all other reasons your T could be low.

BTW, How do you sleep at night?


#3

I sleep very well, or too well. Never any issues there. I have struggled waking up in the morning for the last year or two, which is strange because I used to get up at 5 or 6am to workout before work, but I simply can’t do workout early anymore. I get plenty of sleep, usually a solid 8 hours. Wifey is awesome at taking care of the kids through the night so I can function at work the next day. And the wife has also confirmed that I have no snoring problems either, so it rules out sleep apnea. The only other thing I can think of other than that is possibly Adrenal Fatigue, but need more info on that also.

What do you mean by Thyroid inadequate? The Endo says low #s are good here, so I’m confused? The stickies say that body temp is biggest indicator and #s can be skewed anyway.

I went to a GP first who said I’m just depressed. Granted the symptoms are all there along with previously mentioned symptoms. But at this point, I know my body well enough to know something has been way off for awhile now and time to do something about it. This is my last resort. At this point I just want to feel like a fully functioning man and feel better physiologically & psychologically.


#4

Have you tested your morning temp? Typically you want your TSH on the lower side and FT3 and FT4 above the middle. That’s definitely where I feel the best at least.

I’m envious of your sleep! I feel like sleep deprivation is a good part of my problem. I just don’t know if it’s the low T giving me insomnia or the insomnia giving me low T…

I did the same thing with my GP, he just told me I was depressed and gave me a scrip for Antidepressants. I feel like going back again with a test scrip and lab work might force him to look into my health a little more.

My main concern about TRT with those levels is it might not help at all, then you’ll need to do a restart and possibly end up with even worse numbers after going off the TRT. Valid concern? Not sure – there doesn’t seem to be enough research one way or the other.


#5

I checked evening and morning and midday for a few days all right at around 98, so from what I’ve read and my Endo DR confirmed, this should not be a thyroid thing.


#6

Agreed, and I said in my first post I doubt that’s your whole problem. I have a thyroid disease and taking medication for it. I know for sure that going slightly hyper or slightly hypo makes no difference in my symptoms.


#7

How are you feeling these days? are you on AD’s now? If so, how are they working? I’ve tried natural brainfood supps like bacopa, theanine, kava, etc. All they do is make me feel even more lethargic.


#8

I feel pretty terrible. Low libido, low sense of well being, depressed a lot, crazy anxiety and very short fuse, bad insomnia. These are all new to me over the past 2-3 years, I was never like this. I tried two types of anti depressants. One of them just kind of removed all my emotions, I never really was happy or sad on while on it, I felt like my head was in a cloud. I got off of that one and tried another. It helped me sleep for a month, then stopped working, then made my sleep even worse. I also gained 40lbs on that one over the course of 4 months. Just got off that one. Seeing my primary doc on Monday about all of this.

Here’s the thing – I am fairly sure TRT will help me, but I will need to get it through one of these sketchy anti-aging clinics. They are more of a business than a doctors office, and really don’t care about your health. So I have a few worries about going on TRT at my age.

  1. What happens if laws change and NDs can no longer prescribe?
  2. What if I want to move or travel out of the US and have to stop?
  3. What if I’m diagnosed later with the actually issue causing my Low T?
  4. What if TRT makes things worse or doesn’t have any affect?
  5. What happens if I can no longer afford treatment?

A lot of “what ifs” but they are all things that frighten me – especially if planning on doing this for the next 40 years – which is longer than I’ve been alive!


#9

Honestly, I had the same concerns…and still do. But, I came to a point where I decided I need to at least try something, and I’ve heard about similar issues with AD’s that you’ve had (feeling numb). And per the suggestions in the stickies T levels should be in the 800-900 range, so I figured a small cycle of TRT is worth a shot.

These concerns are also why I share the same hatred for the entire medical profession as a lot of ppl on this site – you have to take your health optimization into your own hands from what everyone on this site seems to suggest. Docs are primarily concerned with disease prevention, and worrying about lawsuits or inquiries from med boards. At least that’s the conclusion I have come to from my experience…someone correct me if I’m off-base.


#10

I think you’re right. ADs didn’t help me at all, just made things worse. Not sure I would recommend them to anyone unless they’re seriously suicidal or something and need to remove their emotions temporarily while they improve their lifestyle…

How’s your diet BTW? You mentioned you’re a BB. Are you still able to get stronger or have you plateaued on your lifts like I have? I never had newbie gains, just pretty much plateaued at the bottom even though I was eating enough calories and nutritious foods, training hard 4x per week…

Also, from what I’ve read from other’s experiences, you need to go in with the mindset that you’ll be on TRT for the rest of your life, and not that you want to do a trial cycle. Maybe that advice is dead wrong, opinions about it seem to be split.


#11

My diet is always pretty solid, eating good foods, low glycemic for most part, occasional cheat meals in true BB fashion. I’ve even experimented with the diet to see if that influences things for me from an energy/mood standpoint. Low Carb/High Fat seemed to make things worse. I typically do about a 40/30/30 P/C/F split totaling 3500-4000 cals, and most of my foods are very healthy. I’ve tried cutting out things like gluten, milk, and other things to rule out food intolerances. i could eat more veggies (though i get 2-3 servings/day), but then again so can everyone.

When I started over a decade ago, I was a skinny kid 5’11", 170 lbs. I gained 15 lbs first month i learned how to eat and taking creatine. then steadily about 5 lbs/yr on avg after that. My stage weight was about 200 when i was on point, but I’m just an amateur, and have had no desire to get back on stage anytime soon. And again my energy levels and everything are making it very difficult to have desire for anything, though i do still force myself to workout at least 3-4 times per week. I’ve tried changing up my routine, thinking maybe i was overtraining, took time off to recover, didn’t help either. I’m already sitting at about 230lbs and probably 15% bodyfat. I can still see some abs, but not nearly as cut as i feel i should be with how healthy i try to eat.

From my understanding, unless you are doing a crazy BB cycle, a small cycle (100mg or less) by comparison won’t affect your baseline T levels once off, though i could be wrong here too as I’m relatively new to researching this topic, and like you say opinions are split, it’s hard to know what sources to trust. take everything with “a grain of salt.” I mean, if we are already low, and feeling like shite, how much worse can it get (i really hope it’s not any worse though).


#12

Sounds like we are in a similar boat. I am going to keep researching and talk more with my doctors. Hopefully that will make the decision easier. I get what you mean, feeling like garbage all day is definitely going to take a toll on your health and life in itself, so if TRT does improve those in the long term, than that’s a huge plus.


#13

@KSman can you analyze this for me and make sure I am on the right track?


#14

whats up fellas. I am in a pretty similar boat except my total T is quite a bit lower. 30 year old with a total T of 265 or so tested 4x now. I met with a super informed doc last week that put it like this, 1 you can eat healthy and do it the natural way which will prob take over a year to get you T up, 2, i can go monotherapy on HCG for 6 weeks to see if that boosts my T naturally via my testes, or start TRT right there and then and leave feeling great he claimed. I opted for HCG and see if i can reset my system naturally to get my T up and if that doesnt work that prob will go the TRT route. I too like you guys go in and out of the FUNK which blows. Also, I cant get out of bed to save my life, deep sleep tired feeling. I joke with my wife, it was easier for me to get out of bed in my drinking days then it is now and im sober as a nun. Let know if you guys have any success and what route you guys go.


#15

I decided to go the natural rout myself, I’d like to see how you do on HCG and we can compare.


#16

as I have been eating healthy, option 1 wouldn’t get me much better. I wasn’t given option 2, so I went with option 3. from what I’ve read you don’t typically feel a difference until at least week 3…I will keep you all posted if I get to feeling any better. and obviously will update my labs when I get the report (labs in wk 6, doc f/u w/lab review wk 8). when I tested it was in the morning (when T levels are highest) and it was a fasting lab so glucose figures are fasted as recommended.


#17

From the labs, nothing stands out as something that needs to be fixed, so TRT is a good option. Did doc examine your testes? Testes ache?

Thyroid:
TSH (IU/mL) - 1.39 (0.27 - 4.2)
T4, free (ng/dL) - 1.39 (0.93 - 1.7)
T3, free (pg/mL) - 2.9 (2.0 - 4.4)

fT3 is the active hormone and is significantly below mid-range. fT4 is good, fT4–>fT3 conversion could be suboptimal. TSH better closer to 1.0
How much iodized salt to you consume?
Using a vitamin that lists iodine+selenium?

Your lab units are mixed. Where are you located? Affects diagnostic and treatment options.

I agree with your comments re protocol. Anastrozole can be adjusted based on next labs. hCG is indeed higher than needed to preserver testes and fertility. 250iu SC EOD is effective and cheaper. Higher doses can create high E2 levels from LH receptor overload and we often see docs that do not understand this.

Injecting T twice a week and anastrozole once a week is a disaster. You should take anastrozole at time of injections. If you can’t split the pills, dissolve 1mg/ml in vodka and dispense by volume or by drops. Understand from the stickies what anastrozole over-responder means.

Always do labs halfway between injections, at time of office visit will be mostly wrong. Need to avoid lab timing artifacts.

Your case is not well defined. Might be a combination of some primary and secondary. No expected issues from your prolactin or E2 levels.

If this works right, you and the wife will be very busy.

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

  • advice for new guys
  • 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.


#18

Thanks for reviewing my labs @KSman. no testes ache, the GP did the full physical and didn’t mention anything was wrong down there when i had to turn my head and cough.

I take a multi with iodine (150) & selenium (100), usually opti-men or vita-mode, and I eat iodized salt on all my meat & eggs.

Located in the Mountain West – USA. Most of my red meat is Elk.

I like the idea of only having to do two sets of injections at the same time every week, makes it easier with a busy schedule. Could I try 375iu hCG 2x/wk? Would the benefit of 250iu EOD be that much different?

Could you elaborate as to why T 2x/wk & anastrozole 1x/wk is a disaster? i split the pills but they are super tiny and obviously tough to get serving sizes equal at a quarter dose per. i prefer to not use any vodka or liquor. is there anything else i could dissolve in and dispense by volume or drops? how long would solutions keep?

I’ve read the stickies and I am grasping a lot, but a lot is still over my head. I have read, and re-read the stickies and seem to learn more every time through. That’s how i knew to check thyroid first, and what labs to get, ideal dosing protocol, etc. (again–thank you for the info). as mentioned above, my lowest temp at any point was 97.7, and that was in the morning. I like to sleep cold though, and turn off the heaters at night even in the winter (in the mountains). but i sleep like a rock. wifey is super jealous of this fact, i’m usually out fast, and don’t even move around much in my sleep.


#19

You also need to see if you are hitting 98.6 in the afternoon.

Anastrozole dissolves readily in alcohol and that also prevents bacterial growth. Anastrozole in vodka solution will have a very long shelf life.

There is [benzyl 0.9%] alcohol in T injectables as a preservative.

One can find anastrozole as liquid research chemicals on the internet that are made up with glycerine and PEG 1mg/ml which would avoid alcohol.

Your hCG plan will work.

If you inject T twice a week, lets assume fro sake of argument that serum T levels are then steady. When you take a weekly amount of anastrozole all at once you will be initially overdosed and E2 production and serum levels will get too low, then at the end of the week, two half lives, serum anastrozole is 1/4th of where it was and E2 production and serum levels get too high. You really need to be thinking about finding optimal and steady levels. The mental effects of changing E2 levels are not good, ask any fertile woman.


#20

This is a huge help, thank you so much KSman. I will put all of your good advice to use. I’ve also continued checking my temps, and I may have been running a fever last couple of weeks because I was right around normal. The last couple days I have had a lower temp, so I’ve ordered an iodine supplement and plan to take about 25 mg (not mcg) per day to see if that also helps. I appreciate the wealth of information, it has been so much more helpful than Doctors!