T Nation

37, 8 Months on TRT and Now Off. Questions


#1

I've read through all of the stickies so hopefully I have all the needed info. Here goes......

-Age: 37
-Height: 5 ft 10 in
-Weight: 188 lbs
-Waist: 36 in at largest spot
-Body hair: overall not very hairy, facial hair Icould get by shaving 2-3 times a week
-Body fat: about 14 percent and most fat deposits are belly. Legs/arms/hips are lean
-Health conditions: lower back issues due to herniated discs which cause sciatica. Have had "puffy" nipples my whole life (Even when very lean). Not sure if my high prolactin level is the reason.
-Drugs: ibuprofen nearly daily, vicoprofen maybe 1Xmonth - both for back pain, No tobacco, rarely drink, no recreational drug use, have tried rogaine before but not for any extended period of time, see TRT info later. OTC: multu-vitamin, glucosamine (just started to try it out), fish oil, supplements including creatine, pre-workout (300mg caffeine)
-Labs: see pics posted below
-Diet: Overall very clean. Recently Ive been trying to trim down (dropped ~20 lbs so far this year) so Im generally at a calorie deficit. Protein: ~220g/day, Fat: ~85g/day or less, Carbs: ~190g/day. Total kcal ~2400 split into about 5 meals. Generally drink 1-1.25 gallons water by noon and finish up at around 2 gal. Don't drink coffee. Generally don't salt my food much but I cook at home and often add sea salt during prep.
-Training: Generally 6 days/week. Weights 4 days and cardio 2 days.
-Health: no aching testicles, BP 120/80 to 115/70, Pulse ~55 BPM
-Morning wood: no real changes, donâ??t have it often

Summary of my TRT:

12/14 went to LowT clinic for bloodwork (results below). Started TRT at 120mg test cyp 1Xweek, HCG 500 iU 2Xweek to prevent testicular atrophy and hopefully maintain fertility and anastrozole 0.25mg 1Xweek (slight nipple sensitivity)
2/15 Labs (results below). Bumped T from 120 to 130mg/week
5/15 Labs (results below)
7/15 Discontinued TRT d/t insurance but continued HCG for ~1mo. Quit HCG as I read that I should not use it unless on TRT.
8/15 Labs, independently done out of curiousity. 5 weeks removed from TRT and 1 week removed from HCG

I didn't realize how much TRT was helping me until I stopped. Energy levels were much higher, I was making better gains at gym, I was more interested in sex, and I had a better overall sense of focus on TRT. I can restart TRT but would likely do it on my own instead of going to a clinic weekly as Im currently not insured. I would do periodic tests until I get insurance and then would go through the "normal" medical system then.

My questions are:
-Knowing my previous TRT protocol, could I just start up where I left off or do I need to do something first?
-To try and maintain fertility (I know there is no guarantee), I see you suggest HCG? If so, are there repercussions for being on it all the time? Should I just run it for a period of time every so often? (I see the sticky says to take it to maintain fertility but just curious if one can get "burned out" on it)
-I see the sticky says 1.0mg AI per week. I have 1mg pills into quarters....do I need to dissolve in liquid to administer accurately or can I just schedule based on quarter tabs? Can I get "burned out" here also??..in otherwords, will the anastrazole lose its effectiveness over time? Ive heard good things about aromasin. Should I consider this or stay away from suicide inhibitors?
-Are there alternatives to TRT that I can try to get my testosterone boosted up or am I just a "TRT guy" since my natural levels were low even before TRT?
-My LowT clinic administered T 1Xweek IM. Would I be a good candidate to split my dose in half and do SQ?
-Anything else I need to consider here?

Labs will follow


#2

Dec 2014 - First Labs
SHBG (range 13.3-89.5) - 16.9 nmol/L
Testo (range 350-758) - 307 ng/fL
PSA-Hyb (range 0.0-3.9) - 0.7 mg/mL

Rest of labs in 2 pics.


#3

Rest of Dec 2014 Labs


#4

Feb 2015 Labs.

Testo - 730
CFT - 18.7

Rest of results in picture


#5

May 2015 Labs

Testo - 780
CFT 22.4

Rest of results in pic


#6

Most Recent Labs - Aug 2015

Estradiol (range 7.6-42.6) - 16.6 pg/mL

Rest of results in picture

Sorry if Im posting too much info. Just thought Id try to be thorough. If you would, what are your thoughts of the labs and my original post?


#7

Your kidneys don’t seem to be working too well. This might indicate some underlying illness, and if so, it is something that you should definitely address before worrying about sex hormones.


#8

When prolactin is high, a MRI is used to check for a prolactin secreting pituitary adinoma. This can be managed very well with 0.5mg/week Dostinex/cabergoline.

Don’t question every detail of what is recommended here. If your concerns were valid, they would have been addressed in the stickies.

Elevated prolactin can cause hypogonadism and depression.

Water drinking seems excessive. You end up excreting many minerals, including iodine.

TSH=3.0 is way to high. You did not read the thyroid basics sticky.
Thyroid problems can cause low T.

So your prolactin problem and high TSH are combined very strong contributors to your low T. However, your LH=6 suggests a degree of primary hypogonadism. Did you have your testes physically examined?

TSH range is stupid. You would want to be closer to 1.0

If you have used iodized salt forever;
get thyroid autoimmune panel plus TSH, fT3 fT4
else
do iodine replenishment iodine+selenium
endif

Check oral body temperatures:

  • when you first wake up and still in bed, should be 97.7-98.8, higher is OK, 97.3 is a problem
  • also check for 98.6 mid-afternoon

Thyroid sore, enlarged, lumpy or asymmetrical?

  • get cold easily
  • dry skin
  • outer eyebrows sparse or gone.

You have two major issues to get sorted out.

AST/ALT suggests liver issues or you had sore or damaged muscles at the time.