I'm 43, 5'10", and 260lbs obese. I became a father 3 years ago, and since then I've experienced significant loss of libido, ED, and weight gain. I can't have sex without viagra or cialis. About a year ago, I started seeing a personal trainer, doing a mix of weights and cardio, mostly weights, because I meet the trainer MWF for weights, and I'm supposed to do cardio on T and Th (what ends up happening is I just meet the trainer MWF and don't do any cardio!) But I've been pretty good about the training routine MWF for a year, and have been puzzled at the lack of improvement. I mean, there was an initial moderate jump in strength and muscle mass in the first month, but I've been on a plateau ever since. I'm on a low carb type diet, with variable compliance, but end result it's one year later and I gained 10 lbs. Years ago I used to be able to rip off the pounds when I low carbed it, but it's as if it's not working any more. That said, I do feel better now than I did before I started training.
So about a month ago I see a primary care physician, because I haven't seen one in over a decade, and I'm 43 and obese and people are depending on me. He runs a bunch of tests.
I have mild hypertension. For that I'm on a low dose of quinapril (an ACE inhibitor) and I added 200 mg of CoQ10 which is also supposed to help with that.
I'm obese. The doc put me on Victoza, which is FDA approved for Type 2 Diabetes. (I don't have diabetes.) He says it will help me lose weight. It's an off label use, but so far it appears to be working. I lost 8 lbs in a month without trying especially hard, so I'll keep using it as long as it's working.
But this is the TRT forum, right? So I'll get to the meat of the story.
My total testosterone was 173 ng/dL. It was in the mid afternoon when they drew my blood, though, so the doc recommended I repeat it in the early A.M. (Testosterone levels peak in the early morning.)
I repeated it at 8:30 a.m., and it was 191 ng/dL. Still pretty low.
In the meantime I'm tearing up the internet reading everything I can find, experiencing an epiphany, as I had just discovered what ails me. Among other things I discovered the TRT forum on T-Nation. I called my doc and told him I needed Free Testosterone, Estradiol, LH, FSH, and while we're at it let's do the Total Test one more time, because I want to be sure. He says that's fine let's do the labs, but this is beyond my level of expertise and I think you should see a urologist who is the only local doc specializing in testosterone deficiency.
The latest labs with reference intervals(also early A.M.):
TT 199 ng/dL (175-781)
FT 0.69 ng/dL (0.95-4.30)
Estradiol 42.9 pg/mL (20-75)
FSH 1.97 mIu/mL (1.0-12.0)
LH 1.16 mIu/mL (1.24-8.62)
I saw the urologist today. The interesting thing is that he's on TRT himself, using Androgel, which is what he wanted to give me. I showed up hoping to persuade him to prescribe KSMan's recommended triple protocol of twice weekly injected SQ T, SQ Hcg and PO Arimidex. He was an easy going guy and listened to me, but only compromised a little. He's letting me do once weekly subQ T cyp, 100mg. And I think that's because I brought copies of the two abstracts (Greenspan, and Al-Futaisi) that supported subQ injection of T once weekly.
He thinks the Hcg is unnecesary at physiologic doses of T in a man who doesn't plan on having more children, and if I was concerned about preserving fertility, he'd be giving me Clomid and not Hcg. (The disadvantages of Hcg he brought up were cost, and the fact that it had to be injected.) And he says on Androgel himself he hasn't experienced any atrophy of the balls, and only a small fraction of his patients have had an issue with that, and again he prescribes Clomid for that purpose. So I wasn't getting anywhere with Hcg. (Why the bias against Hcg?)
With respect to Arimidex, he's familiar with it's use in this context, but he wasn't so sure my E2 should be considered high. He says we'll consider that later if my E2 levels go up, if I have symptoms related to the E2 or if I don't get the expected results from the TRT.
He drew my blood today for a prolactin level, and instructed me to start the T today (Tuesday), and to get my blood drawn for FT and TT tests on Friday (I guess a peak level), and then again on Tuesday before I inject (the trough level.) He'll discuss those results with me by phone when they come back, and he wants to see me in the office again in 3 months.
So at my Walmart pharmacy I pick up the Test-c. $20 copay. It's the 200mg/mL concentration, in a 10mL bottle. There are no needles in the bag, so I ask for 29 gauge 50IU insulin syringes as recommended elsewhere in this forum. The pharmacist is highly skeptical, because a) I shouldn't be injecting Test subQ, and b) the needle gauge is too fine and it will be too hard to draw up and inject, and I'll probably break the syringe if I try. I'm full of self-doubt, but I decide to trust in the forum, and I insist. He relents and gives me the syringes, with an exasperated look I interpret as "dumbass."
I thought about doing a Youtube video at this point, but talked myself out of it, so you only get the written version.
So I get home, settle into my home office and lock the door so the wife and kids can't bother me. I examine the goods. I briefly entertain backfilling the syringe, as has been suggested by someone on this forum, but decide not to. I pick a spot on my flabby belly and swab it with an alcohol swab. I pop the lid on the test-c, swab the rubber, draw the syringe to .50mL, insert the syringe into the inverted bottle, and slowly inject .50mL of air into the bottle, then draw. It's too easy, I go too fast or something, and somehow air bubbles get into the syringe. Only about .20mL of liquid drew up. So I tap the bubbles to the top, reinject the air, until only liquid remains in the syringe, then draw again as slowly as possible, this time drawing up .50 mL of liquid. I insert the needle into to my fat belly, and it hurts, much worse than I was expecting for a 29g needle (perhaps they're cheap needles?) but once I get through the skin it's not so bad, and the .50 mL is easy to inject. All done. The injection site still hurts, but I see no bruising or anything. I think that perhaps the pain was due to a cheap needle or maybe I had it angled wrong. I remind myself to pay attention to the angle of the cutting point next time.
So there you have it. Mixed bag really, but I'm glad that I got started on T, one way or another. The urologist didn't give me the triple protocol, but I got the sense he was listening (after all he did agree to weekly subQ injections which he's never prescribed before) and might add Arimidex in the future. I think I need some more resources to make a better case for Arimidex and Hcg. There's something about an academic paper that swayed him.
Comments and advice are appreciated.
I'll report back later with more information as this progresses in time.
Thanks KSman, VTBalla, and the rest of you on the forum.