T Nation

42 and Just Starting TRT


#1

Hello, as the title states I’m 42 and just starting TRT. I am posting to get some feedback/ advice to get some confirmation that I’m doing the right thing as far as making the decision to start therapy. I will try to keep this succinct, but subjects of this matter require detail as will as history. So here it goes. Growing up I have always been an athlete/ athletic probably more than average. In my early 20’s at college I started lifting/ dieting/ getting into fitness. This lasted pretty consistently until my early 30’s or so. During this time I was always able to gain strength quickly and easily, more so than most of the people I lifted with and did this at a lighter weight ( 5’ 9" 165-170lbs) and lower body fat % (around 10-12%) while almost always trying to be in a calorie deficit. Think I had a 315lb bench at that weight. I would do strength and cardio 6 days a week, hit every muscle group 2x a week.

Always recovered quickly, minimal soreness, and as far as strength went, I never really plateaued, usually would just take a break from lifting before that would happen. As you may imagine I felt unstoppable then and had a constant raging libido as well. My point of all this is I would have to imagine that my natural T levels were always quite high or very good then. Fast forward to mid-later 30’s that were more so than not, marked by complacency with work outs and diet, less active etc. that resulted in weight gain and being less healthy. During this time, I felt less and less like my old self, fatigued, low energy levels, libido diminished. This was most likely due to the condition I was in, but around this time I wondered about T levels and started having it tested. It wasn’t as bad as I had believed it would be. Dr. would only check total T and I was having levels in mid to high 500’s. So occasionally, about every 18mos or so I would have him check with annual blood work and numbers started getting lower. Still within range and he didn’t feel low enough to treat. Then in 2013 I had low test 285 range 300-1080. Dr. was willing to treat, probably wanted me to do gel, but I was trying to have my son so held off. Had my son in 2014 and sometime after that started looking at T levels again because I was still feeling symptomatic and wondered if hormones were a problem. In 2014 had Total T, E2, LH, FSH TSH tested didn’t get free, or bio t levels because the nurse used the wrong type of tube, this seemed to happen occasionally.

Total T - 486 300-890,
E2 - 18 0-54,
FSH - 3.7 1.4-18.1,
LH - 3.1 2-6,
TSH - 1.5 0.40-4.00.

Dr. felt T was high enough didn’t offer to treat. A year later 2015 checked again with annual labs this time got total, free, bio, shbg, albumin, tsh.
Total T - 439 250-1100,
Free T - 99.4 46-224,
Bio T - 217 110-575,
SHBG - 15 10-50,
Albumin - 4.8 3.6-5.1,
TSH - 1.5 .040-4.00.

Once again nothing out of whack enough other than symptoms and I’m still pretty out of shape. In May 2016 I decide enough is enough and it’s time to get back on the horse and get in shape. Cleaned my diet up, starting lifting 3-4 days a week, cardio 3-4 days. Diet consisted of minimal sugar, whole foods, no processed foods, higher proteins, moderate fats, lower carbs. Lost roughly 40lbs of fat in about 4 months. Strength was not horrible, but certainly not like I was used to but was much older so even though that’s a hard pill to swallow, it’s understandable. So I felt better of for a while of course but then around November-December 2016 started feeling symptomatic again, low energy levels, dog tired starting most days in the afternoons, super irritable sometimes and that’s really not like me, less confidence, worse sense of well being, brain fog/ less sharp mentally, and libido never really shot back up after getting back in shape. This was confusing because I had been getting back into some of the best shape of my life.

Went to Dr. in December 2016 checked T again. He only did Total even though I always ask for full T work up. Surprisingly this came back at Total T - 193 300-1100. Dr. said he’d treat this time wanted me to do gel but for all the obvious reasons and my 4yr. old daughter and 2 yr old son I asked for injections. To no surprise he originally wanted to do 100mg T cyp every 3 weeks. I told him why this wasn’t going to be good for me and he reduced it to every 2 weeks with a recheck at 6 weeks. I started IM injects on his schedule for those 6 weeks and like one would expect there were 5-6 good days after a shot, nothing profound, but then 8 pretty bad days. Rechecked bloods after 6 weeks. I asked for a lot more BW but got full T work up and E2.

Total T - 272 250-1100
Free T - 46.9 46-224
Bio T - 102.6 110-575
SHBG - 21 10-50
Albumin - 4.8 3.6-5.1
E2 <5 0-52

These bloods were taken on day 13 about 30 hours before next inject. Dr. saw these and agreed to start weekly doses at 80mg. which I am doing 40mg 2x a week. Since I started doing the shots altogether, even on a horrible schedule, I have noticed a couple positives, and they seem to be increase in libido and way less irritability. I almost actually feel quite calm all the time in a sense. I am hoping to not have to use an AI and am highly considering HCG. although I don’t know when or how much. I would like to see where things are at after 6 weeks of my current regiment but don’t know if that feasible or advisable.

So as I stated in the beginning, with whatever risks are involved in this and it being for life, I just want to make sure I’m going down the right path and not doing something I could regret or that may not have been necessary. I’ve read a lot about this and wonder if some type of restart wouldn’t have been a good idea. I highly appreciate anyone who takes the time to read all this, hope it’s coherent and friendly advice is welcomed. Thank you.


3 Months into TRT. Advice/Discussion on Most Recent Labs
#2

Your doc is an idiot. Hopefully you can groom him/her.

Do labs always half way between injections, time of office visits may be bad.

You probably need 50mg T twice a week. That is the typical standard dose.

Many/most here inject with #29 1/2" 0.5ml insulin syringes. Relion house brand ~$14 per 100 at USA Walmart and SAMS.

Labs:
TT
FT
E2
do not test LH/FSH
CBC
hematocrit
AST/ALT
PSA, you should have a pre-TRT baseline
fasting cholesterol
fasting glucose
AM cortisol - at 8m please, may not need to be routine.

If body temperatures are low:
TSH
fT3
fT4

Please read the stickies found here: About the T Replacement Category

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

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#3

Thanks for the reply KSman. I have read a lot of your posts and am very impressed with your knowledge of the subject. I have a couple questions, do you think TRT may be right/ good for me? Could I be on the right track? So if I am doing injects on Sunday and Wednesday I would want blood work on Monday or Tuesday? I’ve read blood work should be on day of next shot so for me thatd be Wednesday. I agree my Dr. Doesn’t know much about this but with some guidance he is willing just very conservative and lacks some knowledge. I will read up on thyroid and take temps. Will likely not have that blood for another 5 weeks though since I just had it. Finally how soon should I implement HCG. Is it foolish to start after my next bloodwork in 5 weeks or should it be sooner? I’m sure it’s exhausting for you to answer these questions, that most of which are repeats but I appreciate any time and response.