T Nation

38yr Old, Started TRT November 2014


#1

I have had a few lab tests over the past couple of years that showed low/lowering T and having all the symptoms associated with low T. Struggled to find a doc on my insurance that would work with me and finally bit the bullet and went to a Low T Clinic. I will not be having anymore kids, had a vasectomy a few years back.

6'2" - ~260lbs

Lab on 10/31/2014

AST (SGOT) - 28IU/L - Ref Range 0-40
ALT (SGPT) - 41IU/L - Ref Range 0-44
PSA - .5ng/mL - Ref Range 0.-4.0
T - 285ng/dL - Ref Range 348-1197
Free T - 5.9pg/mL - Ref Range 8.7-25.1
LH - 4.6mIU/mL - Ref Range 1.7-8.6
Estradiol - 13.1pg/mL - Ref Range 7.6-42.6

I was prescribed 200mg Test weekly with Clomid the day before my injection and Anastrazole the day after. Doc said no value in taking multiple injections a week but didn't care if I wanted to split them up. I did and split the pills for the Clomid and the Anastrozole as well. Everything comes shipped to me via mail and I do my own injections.

Labs on 12/31/2014

AST (SGOT) - 34IU/L - Ref Range 0-40
ALT (SGPT) - 44IU/L - Ref Range 0-44
PSA - .7ng/mL - Ref Range 0.-4.0
T - 988ng/dL - Ref Range 348-1197
Free T - 38.3pg/mL - Ref Range 8.7-25.1
LH - 0.2mIU/mL - Ref Range 1.7-8.6
Estradiol - 11.3pg/mL - Ref Range 7.6-42.6

Doc was pleased with T and Free T and lowered my dose to 180cc/week. Same Clomid and Anastrazole format.

The GOOD:

I can't tell you how much better I feel 60 days in. Libido has really been good the past 30 days, I took 5mg Cialis prior to T and still take it now and my wife told me the other day I am wearing her out but she isn't complaining. :slight_smile: I might stop the Cialis and see how things are different, wait and see.

Strength gains in the gym have been significant as well, put 40lbs on my squat and generally feel pretty good with my strength. Hadn't made much progress in the past year or more so this is really exciting. Pretty good energy most days but I still want/need a nap on the weekends. I can tell some days I have tons of energy and others not near as much.

The BAD:

I have severe elbow pain in my right elbow and minimal to moderate pain in my left. Right doesn't allow me to bench or press and any dips or curls are out of the question. I don't know if this is due to increased strength and just overloaded myself but its been pretty bad for the past 3 weeks. My TRT doc said he didn't know what it was and just rest and my primary care physician (PCP) said as much. Pain is under my elbow and not on the inside or outside. Hurts to touch, almost like you hit your funny bone all the time.

Acne was ramping up on my face which isn't cool for somewhere near 40. Been much more diligent to wash my face twice a day and take better care of it and right now its better but I have a feeling it will come back. Also, my face is flush and red most of the time but blood pressure has checked out OK.

I haven't dropped any scale weight, I am stronger and more muscular so I might have traded some fat for muscle but I need to get serious about my diet and drop 25-30lbs.

Overall:

Very pleased, feel like I did when I was younger and looking forward to see how things progress. I have to get the elbow cooperating as right now its really hampering things in the gym and just aches a lot.

Any thoughts on my lab work? My Free T came back high on my second labs, any concerned its too high?

My LH was low as well, TRT Doc said its because the body isn't making it anymore and should be low. He is not a fan of HCG but should that be something I consider and drop the Clomid?

Any questions or feedback, please fire away. This has been a multi-year journey and reading this logs has been invaluable for me to learn.


#2

E2 is way too low. That could be the culprit of your joint pain. How much Anastrozole are you taking?

It’s not often that we see a doctor prescribing TRT with Clomid. Why no hCG?


#3

Anastrazole is 1mg split in half and I take half after each shot so I am taking in 1mg a week.

Clomid is 50mg and its the same, take half a pill the day after a shot.

I asked again about HCG he said it isn’t in the normal protocol and prefers Clomid, granted only 60 days in but my balls still hang the same and are full.

Should I cut the Anastrozole in half or more? Really would like to get the elbow feeling better.

Should I go with HCG and drop the Clomid? My TRT doc will pretty much give me whatever but when I try and have a conversation about things he sticks to the protocol.


#4

Clomid is the day before a shot, not the day after as I typed above.


#5

With clomid, you should be getting decent LH and FSH levels on your labs. That is the point of taking it unless you have gyno which would not happen with your low E2. Should test LH and FSH. If these stay near zero, no need to take clomid and something is wrong with your pituitary and perhaps is should be imaged to see whats going on. You can then try hCG and testes should respond to that. Some can fly on hCG alone, but typically only younger guys.

T clinics do not do diagnostic workups to find out why one has low T. Low T is a symptom of something else.

Cut dose of anastrozole by 1/2. Note that serum levels of anastrozole need to match FT levels. So T dose changes change anastrozole needs. I calculate that you will get E2=25.

Please read the advice for new guys sticky and do not ignore the first paragraph.
We need more info about you.

TRT might be increasing muscle mass/strength. But you need to be training slower to allow connective tissues to catch up. Connective tissues are non-vascular and take a long time to strengthen and heal.

Labs:
TT
FT
E2
LH/FSH [but perhaps not for you in this case]
prolactin !
CBC
fasting cholesterol
fasting glucose
A1C
TSH
fT3
fT4

Last three are thyroid. Check your body temperatures when you first wake up and also mid-afternoon. See the thyroid basics sticky. If temps are good, you can skip fT3, fT4. But TSH can then still be elevated if you do not have a continuous history of using iodized salt.

While T enables fat loss, thyroid levels must also be good.

Your T dose seems way to high. But sadly, typical of T shop Rx practices.

Also see the protocol for injections sticky.

So three stickies to read, that will take time to understand.


#6

You tested about half way between injections?

If so, yes, cut the Adex dosage in half, it should bring your E2 in the 20s, where you want it. Should see pain slowing down after that. Keep the rep ranges higher with lower weight in the meantime.

Cutting Adex in half will also bring down some FT which may leviate some acne flare ups. I think with AI you might be converting some T to exess DHT or at least above your natural set point that your body was used to in your prime. I am having the same issue. Always had clear skin in puberty and now with high FT, I am breaking out. I cut my T from 140mg to 105mg. Little better.

I would stay with Clomid if you plan on having kids soon. Otherwise go to HCG. No need to load your liver more as its numbers are on a higher end now anyways.


#7

I will spend more time reading the stickies and post back additional info as I understand things better.

I did review my labs and I have more info they tested I failed to include first time around:

I am just posting the most recent, if there is value in the 10/31 numbers I can post them.

-age - 38
-height - 6’2"
-waist - 41"
-weight - 260
-describe body and facial hair - fairly thick, I can grow a decent full beard
-describe where you carry fat and how changed - around my waist love handles, always been in this area
-health conditions, symptoms [history] - good health history
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - Never any hair loss drugs
– real dangers! see this http://propeciahelp.com/overvi
-lab results with ranges
-describe diet [some create substantial damage with starvation diets] - Diet is not great, eat a lot of healthy food but eat big portions. Always had a big appetite and still do. I need to do better on this.
-describe training [some ruin there hormones by over training] - Workout out a crossfit gym but I stick to the strongman/strength classes. I do HIIT about 1-2 a week at the most, mainly low rep range, heavy weight.
-testes ache, ever, with a fever? - not that I recall
-how have morning wood and nocturnal erections changed - prior to T, very rarely…now that I have been on TRT for 2 months. Frequently have morning wood.

Here’s the additional labs I didn’t include in my first post:

12/31/14

CBC, Platelet Ct and Fiff
WBC - 4.7 x10E3/uL - Ref Range 3.4-10.8
RBC - 5.19 x10e6/uL - Ref Range 4.14-5.80
Hemoglobin 15.2 g/dL - Ref Range 12.6-17.7
Hematocrit 46.8 % - Ref Range 37.5-51.0
MCV 90 fL - Ref Range 79-97
MCH 29.3 pg - Ref Range 26.6-33.0
MCHC 32.5 g/dL - Ref Range 31.5-35.7
RDW 14.3 % - Ref Range 12.3 - 15.4
Platelets 194 x10E3/uL - Ref Range 150-379
Neutrophils 62 %
Lymps 29 %
Moncytes 8 %
Eos 1 %
Basos 0 %
Neutrophils (Absolute) 2.9 x10E3/uL - Ref Range 1.4-7.0
Lymps (Absolute) 1.4 x10E3/uL - Ref Range 0.7-3.1
Monocytes (Absolute) 0.4 x10E3/uL - Ref Range 0.1-0.9
Eos (Absolute) 0.1 x10E3/uL - Ref Range 0.0-0.4
Baso (Absolute) 0.0 x10E3/uL - Ref Range 0.0-0.2
Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 x10E3/uL - Ref Range 0.0-0.1


#8

[quote]Igs wrote:
You tested about half way between injections?

If so, yes, cut the Adex dosage in half, it should bring your E2 in the 20s, where you want it. Should see pain slowing down after that. Keep the rep ranges higher with lower weight in the meantime.

Cutting Adex in half will also bring down some FT which may leviate some acne flare ups. I think with AI you might be converting some T to exess DHT or at least above your natural set point that your body was used to in your prime. I am having the same issue. Always had clear skin in puberty and now with high FT, I am breaking out. I cut my T from 140mg to 105mg. Little better.

I would stay with Clomid if you plan on having kids soon. Otherwise go to HCG. No need to load your liver more as its numbers are on a higher end now anyways.[/quote]

My last shot was on a Sunday of 100mg and I took Anastrozole on Monday and my labs were pulled on a Thursday so to answer your question in the first line…yes labs were about halfway thru.

Is there a rule of thumb I should use in the future of how long between injections and labs being pulled?


#9

No kids in my future, had a vasectomy 4-5 years back.

Still curious if Clomid or hCG is preferable for me in the future.


#10

Please see all points in my prior post.

Suggest that you inject twice a week. Anastrozole needs to match T levels and that can’t be done when T levels are moving so much across a week.


#11

[quote]Mac_Sledge wrote:
Anastrazole is 1mg split in half and I take half after each shot so I am taking in 1mg a week.

Clomid is 50mg and its the same, take half a pill the day after a shot.

I asked again about HCG he said it isn’t in the normal protocol and prefers Clomid, granted only 60 days in but my balls still hang the same and are full.

Should I cut the Anastrozole in half or more? Really would like to get the elbow feeling better.

Should I go with HCG and drop the Clomid? My TRT doc will pretty much give me whatever but when I try and have a conversation about things he sticks to the protocol. [/quote]

Definitely cut the AI dose in half and retest in ~6 weeks to see where you E2 is. You should also be having the sensitive E2 test done instead of the standard one. The standard test overstates actual values significantly when levels are low.

The standard test is designed for women, and the sensitive test is designed to accurately measure the low estradiol levels found in men.

If Clomid is working for you and you’re not experiencing side effects, no reason to switch it up.


#12

Right now I am taking 50mg Clomid (split in half) the day before my shot. I realize Clomid and Anastrozole don’t reduce E in the same way but should I reduce the amount of it I am taking as well?

Still looking into hCG as an alternative to Clomid.