T Nation

37m Starting TRT


#1

-age - 37
-height -6ft
-waist - 38
-weight - 230
-describe body and facial hair - Fair amount of facial hair, started balding at the age of 30
-describe where you carry fat and how changed. Mostly around the gut and maybe a bit of man boobs.
-health conditions: Cloudy, unmotivated, was always the alpha that tried to push past my peers, no longer have that drive.
No Sex Drive
No morning wood
Not lifting as much
Decrease in energy
Decrease in endurance
Poor Recovery after workouts
-Rx and OTC drugs: No prescriptions
-lab results with ranges See belw
-describe diet: Diet sucks as of now
-describe training I’m a firefighter and work out with the crew quite a bit (more cardio and body weight exercises) occasionally do weight training when I feel motivated
-testes ache, ever, with a fever? Never
-how have morning wood and nocturnal erections changed I have…… None

Done a few cycles in my late 20’s (with proper PCT and nothing too crazy) Although I never have gotten a full panel blood test till a few weeks ago

Few weeks ago I went to a TRT doc and he drew all the labs (posted below) his protocol is 150mg week/ 1mg Adex every 2 weeks/ Sublingual HCG 500iu week. I understand this protocol is less than desirable but I believe he is open to changing the HCG to injections and I’ll divide the Adex up myself. I see him again tomorrow and will voice my concerns.

After doing more research on this forum I have also come to the conclusion I may have Hypothyroidism and am going to be starting the protocol for that this week. I’ve always had a low temp (I know this because I have young ones and when testing the thermometer on myself I have never been above 97.5f. Thinning of outer eyebrows and the other symptoms that go along with thyroid/Low T issues.

Last but not least a couple of points on my blood work:

-I’ve always had high ALT values, had and ultrasound done and confirmed a “fatty liver”
-Cholesterol and LDL have always been elevated even when on a strict diet and also in my younger years when I was in the best shape of my life in the military.
-Not sure why my B12 is elevated (I don’t take supplements)
-Estradiol is extremely low. haven’t cycled or done a PCT in ~6yrs
-Free Test is also low which I expected
-The blood work was done at 2pm and I was not fasting

Just wanted to post this to have some of you guys look it over and reinsure me I’m looking at this the right way. Thanks for your time!

Free T3 (pg/mL) 3.3 2.0-4.4
Free T4 (ng/dL) 1.4 0.9-1.7
T4 Thyroxine (ug/dL) 8.5 4.5-9.8
T3 Triiodothyronine (ng/mL) 1.1 0.8-2.0
TSH (uIU/mL) 2.190 0.111-4.910

Estradiol (pg/mL) <5.0 L 25.8-60.7
DHEA-S (ug/dL) 282.3 88.9-427.0
SHBG (nmol/L) 51.7 16.5-55.9
Testosterone, Total (ng/dL) 465.1 348-1379
Free Testosterone (ng/dL) 7.04 L 9.00-30.00
FSH (mIU/mL) 3.0 1.5-12.4
LH (mlU/mL) 3.8 1.7-8.6
Cortisol (ug/dL) 19.3 PM: 2.3-1.9

Hemoglobin A1c (%) 5.3 <5.6

Cholesterol, Total (mg/dL) 267 High >241
LDL Direct (mg/dL) 194 High >130
HDL Direct (mg/dL) 59 >56
Triglyceride (mg/dL) 126 <149

Sodium (mmol/L) 142 136-145
Potassium (mmol/L) 4.4 3.5-5.1
Chloride (mmol/L) 101 98-107
Carbon Dioxide (mmol/L) 27 18-29
Calcium (mg/dL) 9.8 8.2-10.2
Magnesium (mg/dL) 2.0 1.6-2.6

ALT (U/L) 47 <=41
AST (U/L) 33 <=40
Bilirubin, Total (mg/dL) 0.5 <=1.2
Bilirubin, Direct (mg/dL) <0.2 <=0.3
Albumin (g/dL) 4.5 3.5-5.2
Alkaline Phosphatase (U/L) 61 40-130
Total Protein (g/dL) 7.2 6.6-8.7
GGT (U/L) 41.5 <=59.9
LDH (U/L) 187 135-225

Creatine (mg/dL) 1.0 0.7-1.2
BUN (mg/dL) 15 6-20
BUN/Creatinine Ratio 15 10-20
Cystitis C (mg/L) 0.85 0.68-1.44
eGFR (mL/min/1.73m2) 93 >=60
Glucose (Renal) (mg/dL 99 70-100
Phosphate, Inorganic (mg/dL) 3.4 2.5-4.5

Ferritin (ng/mL) 323 30-400
Iron (ug/dL) 127 59-158
UIBC (ug/dL) 144 112-347
TIBC (ug/dL) 271 171-505

Folate (ng/mL) 11.8 >=4.6
Vitamin D (ng/mL) 33 >=30
Vitamin B12 (pg/mL) 664 >=211


#2

I dont how to interrupt half those results but if hemoglobin is only 5.3 you need to go to hospital now, if it was that low your doc would have noticed. You would also have difficulty walking more than 20-30 ft.


#3

Hemaglobin A1c is a measure of long term sugar in the blood. His number is wnl.


#4

Your results are not terrible but much like my own. You likely have secondary hypo. Your protocol is not right though. Way to high of a starting dose. You should also not be on an anti-E. Look at your estradiol. You need some. Talk to your doc about waiting on the anti-E until your 6 week follow up labs. Low E can make you feel like shiz…


#5

That simply does not work and a study in India showed that hCG could not be detected in the blood stream. Peptide hormones are simply too large to pass through skin, oral or nasal tissues. If injecting, there is no rational to avoiding hCG injections. Your doctor is scary. If you do as he directs, you can see if you can get a positive on a home pregnancy test, following the instructions. Also, hCG should prevent testes from shrinking on TRT and prevent scrotum retraction.

Vitamin D: Was that D3 or D25? If Vit-D25, you should be getting closer to optimal=60. Take 5000iu tiny oil based caps.

AST/ALT elevated from training and sore muscles?

E2 is low because fT–>E2 is low as fT is low.
SHBG is made in the liver and is too high. There is nothing that you can do to directly lower SHBG other than getting high T levels and keeping E2 near 22pg/ml.

PM cortisol is way too high, pointing to adrenal issues.
fT3 should be supporting good body temperatures, so elevated rT3 is suspected to be blocking fT3. So stress maybe a significant factor. Again, this is an adrenal issue and may be adrenal fatigue.

Read these stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics
  • finding a TRT doc

High SHBG is inflating your TT by creating more T+SHBG, which is not bio-available. So FT is the better indicator of T status for you.

I assume that you have been using iodized salt to support thyroid function.

In thyroid basics sticky, note references to rT3, stress, adrenal fatigue, Wilson’s book.

Check that others get 98.6 on your thermometer to gain some accuracy confidence. What is waking temperature and mid-afternoon temperature?

Glucose and cholesterol need to be fasting.
Do AM cortisol, at 8AM