T Nation

40Y/O New to TRT. Baseline Blood Work. Advice?


I’m new to this and I’m not too excited about giving myself shots, but here I am… I have a few different things going on and hopeful this can help me with a few of them. I got my Test checked because of advice from several friends around my age and a few people at my gym… Turns out it’s low… Great… add that to the list

Age-almost 41
Body Description: 21%body fat, carry fat around waist and face under chin-describe body
Facial Hair-Full & salt&pepper grey now if I don’t shave
Hair on top has started to thin/shed.
Describe where you carry fat and how changed: Pretty much always carried fat around waist and under chin… no fat on arms or legs really.

-health conditions, symptoms [history]
Here we go:
Nasal Polyps, so I have allergy meds & nasal steroids, but don’t take them as much… had a surgery last year and about to have another to correct my septum & clear out polyps again… may try allergy shots.

Degen Disk issue L4/L5… I’m managing it well with exercise, but slow in the mornings and always have to be mindful of how I move… sucks

Doctors prescribe prednisone taper for both issues, but I only take it once or twice per year… makes my knees feel less stable at the end of the treatment, but goes away after a couple weeks…

I was recently diagnosed with diabetes type 2… Mom has it and I used her machine to check and found out I had it too this year : ( I have been taking 500mg of metformin twice daily, but am lazy with the evening dose if I go out drinking which is 3 times per week… I believe I had these uric acid stones because of it… my Mom gets them too… Damn those are painful… I had 3 surgeries last year… 2 for stones and one on my nose for polyps.

Now I checked my Test because I wanted to know and turns out it’s low… So he has put me on:
Test Cyp- 200mg IM once per week… Brand Perrigo from CVS (insurance covered)
HGC- 500iu SQ twice per week… Compounding pharmacy has B12 in it
Anastrozole- 1Mg twice per week… from CVS (insurance covered)

I get about six hours sleep per night and feel well rested… I am generally in a good mood & positive, but energy is a little lower than it used to be… My libido is kind of less, but I do have work related stress that does have an effect… When I have sex I’m usually good for two days before I’m at max hornyness again for some reason unless stressed… I guess it’s the 234 T score… I thought it was just normal to slow down after a while.

My blood pressure is a little more elevated than normal, but it’s possible it’s only when they are taking it that I get a little nervous. I had a bout of panic attacks, but that went away years ago… I don’t take any prescriptions regularly except for the metformin… sometimes potassium citrate to make my urine less acidic or a nasal rinse steroid if necessary.

I have dry scalp and dandruff in my eyebrows regularly for some reason, but it’s not crazy … maybe because of the diabetes?.. It was completely uncontrolled and I used to drink a ton of fruit juices and lemonade… I got eruptive xanthomatosis a few times, but never knew what it was till recently.

I think I may have inflammatory response issues…

I seem to break out if I eat greasy steak or too much chocolate like in kit kats or reeses… dark chocolate doesn’t seem to do that to me.

I drink, but I don’t smoke pot… I used to smoke it from 18-22yrs old… Now it gives me those panic attacks, so I don’t smoke it or anything until I find the perfect one that doesn’t make me feel panic.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever:
No prostate drugs… My hair has been thinning on the top… this started last year… sucks… I started using Nioxin to see if that would help

See Images-lab results with ranges : I drank alcohol the night before and did not fast

-Describe diet:
I eat everything… I do eat healthy, but I also eat bad… I eat frequently and I eat a lot, but I have a normal metabolism and I work out to eat as much : ) … I usually don’t eat a big breakfast… Like half a banana and 25 grams of cinnamon toast crunch protein drink…(Gaspari Nutrition~Precision) Then after workout 25-50grams of the same drink. I get home and take a d3 pill, coq10, a multi or my metformin… I’ll also take a liver detox sometimes & or cinnamon capsules (to help regulate my blood sugar.) I also have little spirulina and chlorella that I’ll take sometimes… and sometimes I’ll make a smoothie with all that in it.

Then I get to work at 12 and eat one of those pre-made salads for two ppl… It has kale & things… and I add cucumbers/avocado…(take 500mg of metformin) I also take some multivitamins Then I get hungry or if someone says they’re going to wendy’s I eat like 2 burgers and some fries between 1pm-3pm… I snack throughout the day till 5pm… Then I usually eat two dinners… one around 5 and another around 10 or 12pm.

I have been eating those “healthy choice: cafe steamers” for dinner lately… and I snack on tortilla & turkey wraps… I eat doritos and make amazing trail mix with dark chocolate covered rasins/cranberries… I put extra almonds, but have a good mix of various nuts in there…

For milk:I only drink organic unsweet almond milk & with my fruit&yogurt cereal… I like seafood, but don’t eat much of it… I eat fried chicken strips 2 to 3 times per week… I eat hard boiled eggs… I don’t really take as many fish oil pills as I probably should for some reason. I don’t drink coffee at all and vary rarely drink sodas or fruit juices…

I drink alcohol probably 3 times a week because I’m recently single… I stay away from beer now, but I drink about 5 glasses of red wine merlot or pinot noir… throughout a 4hr night. Yes even at sports bars… I’m that guy now lol

I usually only smoke when I drink or if stressed, but haven’t had a cig in 3 weeks.

-describe training-
I pretty much workout 6 days per week, but just on the machines and not too hard… I notice that it takes me longer to recover and although I see results… I don’t get stronger like I used to… Seems I always use the same weight for example 250 on the triceps machine.

I do 15min on an elliptical with good range of motion on lvl 13… then chest & back one day… Arms one day… Legs one day… and I’ll take a day off sometimes… maybe after drinking the night before : )

-testes ache, ever, with a fever? Never

How have morning wood and nocturnal erections changed… They have become less frequent, but I thought that was normal with age. I need to get back to rockstar status and yes I would like to have kids and yes I know… I’m 40, so I need to hurry up… I’ll be throwing the football with my kid, just not as far lol

Ok, I think that’s about everything… I’m going to try this treatment and post results… I may start the shots today… I’m a little nervous about it, but what the hell… I know a ton of people do it, so let’s see if this makes me feel better with my back, exercise, recovery, libido, energy, etc…

Doc wanted me to start them all on the same day… then the AI & HCG three days later like Sunday everything, then Wed the AI & HCG…

Now I’m wondering if I should take half a dose of the Test Cyp and just do them all together… Sun & Wed… or whatever is optimal… Maybe I’ll start today Wed… and with 25guage for test shoot IM and 29guage SQ

So I guess my questions are like many… How do I achieve optimal hormonal balance and maintain it : D

Thanks in advance for any suggestions or input : D I’ll let you know how it goes


TRT increases RBC, increased RBC and elevated blood pressure are indications your test dosage is too high, there’s not many who can handle 200mg weekly without some side effects. Your pre-TRT hematocrit looks a little higher than most who have low T, suggest lowering dosage. When I was on 200mg I had the same issues as you do now, RBC, increased heart rate and increased blood pressure that concerned my doctor that decided to start me out 75mg weekly until those values decreased. I’m all for starting out low and going slow, this allows you to monitor the behavior of E2 levels rather than shooting for the moon with a huge 200mg dosage and having to reduce it later for elevated E2, RBC and hematocrit issues.

Sometimes it take several months to a year to dial in your protocol, how long it takes depends on your doctor. Managing hormones is an art form and most endo’s are under qualified. I also noticed you didn’t have SHBG tested, this would help immensely, it would tell us if you’re a hyper excreter meaning how much of your T do you excrete into your urine which is otherwise wasted, if this were the cause you would require shot twice weekly or perhaps EOD for TRT to be effective. Any doctor that fails to run your SHBG is a failing you and doesn’t understand SHBG is the foundation for regulating and activating sex hormones.

That 155 blood glucose level is high even for an non-fasting test. Have you also checked HbA1C? To check for metabolic syndrome and your degree of cardiovascular health you will need to get blood lipids levels from a fasted blood draw.

To stay away from diabetes and to get the most out of your TRT and workouts you may need to clean up your diet and minimize alcohol consumption.

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Ok I am going on week six… and about to call and ask for another blood workup to see where I stand and add some of the other tests.

I was going to move to 100mg every 3.5 days… and I’ve been trying to figure out when to take the AI and HGC…

There are so many conflicting protocols… Some do everything on the same days like Mon & Friday… some say to do the AI with HGC or on the same day as the T… Some say to do it the day after the T?

Some say do the HGC 2 days before and once on the day of the T injection…

I just want feel good & to be steady with a normal high libido lol without screwing by nads up.

For today Wed… I’m just going to do my 200mg T like always and take the AI this evening and do my HGC 50cc shot Friday with the 1mg of AI like normal Till I figure this out… Then maybe start the split dose of 100mg on Mon & Friday… Hopefully by then I figure out when to take the HGC and AI.

For the past 5 weeks I’ve been doing M/W/F injections…

Mon 50cc HCG with 1mg AI
Wed T 200mg
Friday 50cc HCG with 1mg AI

was this a bad protocol? I guess the in theory the HGC was to give little boosts making things a little more steady through the half life of the T to get me to the next dose…

The AI- I have no clue when to take, but that is what I am doing.