T Nation

40 Year Old Joining the Club

Hello!

My hat is off to the men who run this forum and all of the thoughtful and informed contributors. I’m in the third week of my TRT and spent the first two feeling guilty, questioning my decision and if it wasnt just “all in my head.” It wasn’t until I started reading through all the testimonials here that I realized what I was dealing with for the past decade isn’t normal or healthy.

I’m 40 years old, 5’8" and 195 pounds with a BF% that seems to be stuck around 20%. I workout hard 3-4 times a week during the winter, and 5-6 during the summer. My diet is good enough, I drink very little and have no recreational drug use. My sleep could be better, but I get about eight hours a night. My job is not very stressful, but my wife is.

I survived testicular cancer at 23, so I’m short an engine and had the other one blasted with two notoriously hard cycles of chemo. I’d enjoy trading cisplatinol war stories with other survivors.

Ever since then I’ve never felt quite “right.” I encountered anxiety and depression problems that were treated at different times with combinations of escitalopram, wellbutrin and abilify. Self-medicating with alcohol at points (lol, why do we ever think this is a good idea?) I also had attention problems that probably carried over from my youth.

About six years back I cut the drinking and turned up the exercise. I was able to drop the anxiety/depression meds, but still have a hard time during the winter. I currently take 30mg vyvanse a day, M-F for work. It has been a godsend for my career.

Having very nearly maximised my healthy living, I would still wake up feeling exhausted. Low libido (and not just because of my wife) and I had forgotten what morning wood is. Vyvanse was no longer driving focus like it had, energy levels and motivation were almost always low. I was resigned to having the “soft” look regardless of how hard I lifted, 100 burpees a day, etc. And most importantly, I was quite irritable even with a life dedicated to daily meditation on being “above it.” Squabbles with my wife would really wind me up.

My current protocol is 200mg test cyp to my thigh once a week, .5mg anastrozole the next day, and 500 IU HCG subQ on days four and six. I’m not clear on the mg in these.

I felt the T within hours of my first injection. An internal warmth and general contentment was the first thing I noticed. Other things I’ve noticed over the last two weeks are morning wood, vivid dreams (increased REM?), waves of high libido subsiding back to “meh,” occasional achy joints and an ability to completely mentally disengage with my wife’s drama.

My tinnitus gets worse for about 48 hours following the T, and vyvanse is not required for focus and drive. In fact, taking it the day after my first shot made me feel weird. By day five or six it seems I’m back to feeling the old way minus anxiety and seasonal depression. I also had some stomach bloat gas issues a couple nights.

However, my intensity in the gym has grown and is there all week long. I have to remind myself to dial it back now. The day after hard workouts I no longer feel like I was hit by a truck. My midsection is thinning out noticeably.

I understand it takes about six weeks to level out and take proper accounting of how I feel. And while the occasional aches and stomach issues are not fun, on the whole I already feel worlds better and would be satisfied if things didnt progress further.

I’m including my blood work, but spoiler is a total T of 238 with the lab range starting at 264. I calculated my free T at 5.8 or so, but doubt I did it correctly.

Is that blood work before or after you started TRT?

The answer you’ll usually get here is to drop the AI and drop the HCG. I don’t know if the HCG piece changes given you’re down a ball but I doubt it does.

I don’t see how anyone could feel good with those levels, or at least almost anyone. I think you’ll feel like a different person once you get things dialed in (which, IMO, probably means going T only and letting things work themselves out e2 wise)

This blood work is from before the TRT. I have no opinion on the AI, but I’d rather stay on HCG as I dont want my remaining testicle to waste away.

I forgot to mention my primary care doctor was not thrilled to hear I started TRT, an experience that seems to be shared by most here.

They must all take a “testosterone is the devil, give them antidepressants instead” course, sponsored by Merck et al

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Toxic masculinity is the greatest threat facing humanity today. Testosterone is the driving force behind the the horrible scourge of locker room talk, daytime pickups and fat girl jokes.

Here’s a picture of me from today. I decided to track body composition.

The AI is probably why your joints hurt. Get rid of it, you don’t need it. Your estradiol was already on the low end and you’ve probably crashed it. And considering your nut wasn’t keeping up with your body’s demands anyway the HCG probably won’t do much good outside of keeping your as fertile as you were. As someone with low-firing nuts (250 TT) my nuts never shrunk getting on TRT…they were already shrunken as yours probably is.

As your body becomes more and more accustomed to the medicine over the next couple months things will probably smooth out but if you are still feeling the dip you may want to consider moving to E3.5D shots of 100mg.

When you get it, put up your new blood work too so we can have a gander.

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Thanks for the thoughtful replies. I should have bloodwork in about four weeks.

It seems the general consensus is to not make changes until a current protocol has a chance to set in. If you were me, would you drop the AI now, or let it ride until after seeing six-week blood results?

Another thing I’ve noticed is that getting to the gym is more crucial than before TRT. I would start to feel anxious and cloudy about 72 hours without exercise before TRT. Now I start to feel it in about 48 hours. However, I now feel incredible after my workouts, totally calm, balanced and powerful.

Drop it now. You want to start with 1 medication at a time. This should be testosterone only for you. This way you can evaluate the effects of the single medication instead of guessing what medication is causing what benefit or side effect.

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I was on Vyvanse during the time my T crashed quickly and soon found no benefit to it anymore. You may in fact have been needing Vyvanse to compensate for low-T.

I also got tinnitus on TRT and is linked to several causes, high hormone levels, iron deficiency and high blood pressure (turbulent blood flow) can cause tinnitus.

This is the wrong way to initiate TRT, throw the body a bunch of compounds and see what happens and try to make sense of everything going on.

Some men report feeling much better after stopping HCG. It should have been added later after you dial in on TRT and add one thing at a time to see how you respond. The fact is most men do not need AI’s and the dosage and injection frequencies should have been adjusted to balance hormones.

Our society is too quick to go to drugs to solves problems instead of manipulating other factors to resolves issues and sometimes end up paying the price for the quick and easy route. The AI’s can wreak havoc on your cardiovascular system.

That’s because you probably can’t handle these large 200mg injections which spike hormones high within 48 hours which is when hormone levels peak. The extra body fat might also spike estrogen high as well. You can inject your doses twice weekly to mitigate these issues.

You could also decrease the dosage (60-80mg twice weekly) a little because it sounds like your hormone levels are too high based on the anxious and cloudy comment. I expect estrogen to be lower if you switch to a twice weekly protocol and if I were you, I would stop the HCG and I would drop the AI as well.

Drop it now…you will feel better in a week. You’re not doing your joints any favors with crashed E2 and heavy lifting either. Several on this board, including myself, injured themselves with E2 crashed from anastrozole and took 6-12 months to heal. Mind you NO ONE gave up the gym so that could lead to quicker healing.

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Alright guys, I’ll drop the AI starting now. This is through a male clinic and I’ll let my doc know what I’m doing and why.

Is there a rule of thumb for how low BF% must be for T -> estrogen conversion to not be a concern? Am I fat enough to worry about high estrogen levels once I drop the AI?

Yes, here is the magic formula (no calculator required).

Ready?

Don’t worry about aromatization.

You’re welcome.

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Technical disaster recording this video but it answers your question:

Thanks for weighing in, Dan. I’ll stop worrying about it.

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It’s going to be different for everyone, you need to tinker with your dosage and injection frequency to figure it out. The daily dosing is the easiest, you increase/decrease the dosage until you feel good.

Welcome to the club. As low as you were, you’re probably going to need 200mg a week to get you where you need to be. The overwhelming majority of guys on injections for TRT take 200mg once a week. Guys who go through their GPs, a urologist or endocrinologist mostly take 200mg once every two weeks. The gym meatheads going underground and the TRT clinic guys are 150mg-200mg once weekly, 90% of them. Most of these guys pay zero attention to E2.

What you’ll see a lot of here are unusual outliers. You’re not one of them, yet.

I’d drop the AI and hCG. Good luck. Oh, look into getting the wife on hormones too.

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This makes the point why gym meatheads on trt take more than they should.

And what does how low your natty testosterone is dictate how much t you need?
Once you are shut down it’s 0 natty

I don’t think so, assuming they are telling the truth, and there is no reason not to do so.

Brother, if you only knew. She might be a big part of my crushed nut levels.

Guys feeling low test symptoms at mid ranges, seem to do fine with lower dosing, probably because their SHBG is higher. Those at the bottom, do not respond as well wit lower dosing. Generally, not always.

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