T Nation

45 yo Starting TRT


#1

Like many men here, I'm starting TRT as a continuation of improving my health and quality of life.

My stats:

45 yo
6'0" height
220 lbs
18.5% body fat
Diagnosed with obstructive sleep apnea 3 years ago. Treating successfully with CPAP

I lift moderate weights 3x/week and run HIT sprints (100meters x 10).

I take a multi-vitamin, 1 tablespoon Carlsen Fish Oil, 10,000 IU D3 and 3g l-arginine daily.

My diet is primarily healthy (paleo - organic), I do enjoy sweets though several times/week.

No smoking, drinking alcohol (only drink water) and no drug usage.

No ED symptoms, sexual performance is satisfactory, could always be improved. I awake almost daily with morning erections.

My doc started me with 100mg testosterone cypionate 1x week SC. My two primary complaints were feeling lethargic and inability to lose visceral fat around the abdominal area.

My lab (labcorp) from 3 weeks ago pre-TRT treatment:

RBC 5.31 x10E6/uL 4.14 - 5.80
Glucose, Serum 102 High mg/dL 65 - 99
Cholesterol, Total 196 mg/dL 100 - 199
Triglycerides 49 mg/dL 0 - 149
HDL Cholesterol 56 mg/dL >39
VLDL Cholesterol Cal 10 mg/dL 5 - 40
LDL Cholesterol Calc 130 High mg/dL 0 - 99
Testosterone, Serum 440 ng/dL 348 - 1197
Free Testosterone(Direct) 10.6 pg/mL 6.8 - 21.5
LH 7.7 mIU/mL 1.7 - 8.6
FSH 7.9 mIU/mL 1.5 - 12.4
Prostate Specific Ag, Serum 0.9 ng/mL 0.0 - 4.0
AST (SGOT) 24 IU/L 0 - 40
ALT (SGPT) 34 IU/L 0 - 44

I had a more comprehensive panel (labcorp) done (I get this done twice yearly). The blood was drawn 48 hrs after my first injection and 3 weeks after the prior lab work:

RBC 5.38 4.14-5.80 x10E6/uL
Glucose, Serum 92 65-99 mg/dL
Cholesterol, Total 191 100-199 mg/dL
Triglycerides 59 0-149 mg/dL
HDL Cholesterol 51 >39 mg/dL
VLDL Cholesterol Cal 12 5-40 mg/dL
LDL Cholesterol Calc 128 HIGH 0-99 mg/dL
Testosterone, Serum 611 348-1197 ng/dL
Free Testosterone(Direct) 13.5 6.8-21.5 pg/mL
LH 5.7 1.7-8.6 mIU/mL
FSH 5.9 1.5-12.4 mIU/mL
Prostate Specific Ag, Serum 1.0 0.0-4.0 ng/mL
AST (SGOT) 32 0-40 IU/L
ALT (SGPT) 87 HIGH 0-44 IU/L
Estradiol, Sensitive 16 3-70 pg/mL
TSH 2.230 0.450-4.500 uIU/mL
Hemoglobin A1c 5.8 HIGH 4.8-5.6 %
T4,Free(Direct) 1.13 0.82-1.77 ng/dL 01
DHEA-Sulfate 281.8 71.6-375.4 ug/dL

I've read through the stickies and from the second week on have adjusted the dosage to 50mb 2x week (Sun morning and Wed afternoon SC). I will be ordering the insulin syringes and switching to EOD dosage when they arrive.

I put on 4-5 lbs of water weight and slight bloating since starting treatment. I don't feel any different after 3 weeks (doc said 4-6 weeks for effects to be noticed).

My question is what should I be looking after/to next?

All I noticed was my ALT shot up.

Any feedback is appreciated (especially how to reduce/remove the bloating). Thanks!


Here's the full lab (second one done):

CBC With Differential/Platelet
WBC 5.3 3.4-10.8 x10E3/uL 01
RBC 5.38 4.14-5.80 x10E6/uL 01
Hemoglobin 16.1 12.6-17.7 g/dL 01
Hematocrit 46.5 37.5-51.0 % 01
MCV 86 79-97 fL 01
MCH 29.9 26.6-33.0 pg 01
MCHC 34.6 31.5-35.7 g/dL 01
RDW 13.7 12.3-15.4 % 01
Platelets 149 LOW 150-379 x10E3/uL 01
Neutrophils 56 40-74 % 01
Lymphs 33 14-46 % 01
Monocytes 9 4-12 % 01
Eos 1 0-5 % 01
Basos 1 0-3 % 01
Neutrophils (Absolute) 3.0 1.4-7.0 x10E3/uL 01
Lymphs (Absolute) 1.7 0.7-3.1 x10E3/uL 01
Monocytes(Absolute) 0.5 0.1-0.9 x10E3/uL 01
Eos (Absolute) 0.1 0.0-0.4 x10E3/uL 01
Baso (Absolute) 0.0 0.0-0.2 x10E3/uL 01
Immature Granulocytes 0 0-2 % 01
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL 01
Comp. Metabolic Panel (14)
Glucose, Serum 92 65-99 mg/dL 01
BUN 12 6-24 mg/dL 01
Creatinine, Serum 0.98 0.76-1.27 mg/dL 01
eGFR If NonAfricn Am 93 >59 mL/min/1.73 01
eGFR If Africn Am 107 >59 mL/min/1.73 01
BUN/Creatinine Ratio 12 9-20 01
Sodium, Serum 141 134-144 mmol/L 01
Potassium, Serum 4.6 3.5-5.2 mmol/L 01
Chloride, Serum 101 97-108 mmol/L 01
Carbon Dioxide, Total 27 18-29 mmol/L 01
Calcium, Serum 9.8 8.7-10.2 mg/dL 01
Protein, Total, Serum 7.1 6.0-8.5 g/dL 01
Albumin, Serum 4.6 3.5-5.5 g/dL 01
Globulin, Total 2.5 1.5-4.5 g/dL 01
A/G Ratio 1.8 1.1-2.5 01
Bilirubin, Total 0.6 0.0-1.2 mg/dL 01
Alkaline Phosphatase, S 81 39-117 IU/L 01
AST (SGOT) 32 0-40 IU/L 01
ALT (SGPT) 87 HIGH 0-44 IU/L 01
Urinalysis, Routine
Specific Gravity 1.005 1.005-1.030 01
pH 6.5 5.0-7.5 01
Urine-Color Yellow Yellow 01
Appearance Clear Clear 01
WBC Esterase Negative Negative 01
Protein Negative Negative/Trace 01
Glucose Negative Negative 01
Ketones Negative Negative 01
1 of 3
Occult Blood Negative Negative 01
Bilirubin Negative Negative 01
Urobilinogen,Semi-Qn 0.2 0.0-1.9 mg/dL 01
Nitrite, Urine Negative Negative 01
Microscopic Examination Comment 01
Microscopic not indicated and not performed.
Lipid Panel
Cholesterol, Total 191 100-199 mg/dL 01
Triglycerides 59 0-149 mg/dL 01
HDL Cholesterol 51 >39 mg/dL 01
According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a
negative risk factor for CHD.
VLDL Cholesterol Cal 12 5-40 mg/dL 01
LDL Cholesterol Calc 128 HIGH 0-99 mg/dL 01
Iron and TIBC
Iron Bind.Cap.(TIBC) 284 250-450 ug/dL 01
UIBC 151 150-375 ug/dL 01
Iron, Serum 133 40-155 ug/dL 01
Iron Saturation 47 15-55 % 01
Testosterone,Free and Total
Testosterone, Serum 611 348-1197 ng/dL 01
Comment: Comment 01
Adult male reference interval is based on a population of lean males
up to 40 years old.
Free Testosterone(Direct) 13.5 6.8-21.5 pg/mL 01
TSH
TSH 2.230 0.450-4.500 uIU/mL 01
Hemoglobin A1c
Hemoglobin A1c 5.8 HIGH 4.8-5.6 % 01
.
Increased risk for diabetes: 5.7 - 6.4
Diabetes: >6.4
Glycemic control for adults with diabetes: <7.0
Thyroxine (T4) Free, Direct, S
T4,Free(Direct) 1.13 0.82-1.77 ng/dL 01
DHEA-Sulfate
DHEA-Sulfate 281.8 71.6-375.4 ug/dL 01
Luteinizing Hormone(LH), S
LH 5.7 1.7-8.6 mIU/mL 01
FSH, Serum
FSH 5.9 1.5-12.4 mIU/mL 01
Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 1.0 0.0-4.0 ng/mL 01
Roche ECLIA methodology.
.
According to the American Urological Association, Serum PSA should
decrease and remain at undetectable levels after radical
prostatectomy. The AUA defines biochemical recurrence as an initial
PSA value 0.2 ng/mL or greater followed by a subsequent confirmatory
PSA value 0.2 ng/mL or greater.
Values obtained with different assay methods or kits cannot be used
interchangeably. Results cannot be interpreted as absolute evidence
of the presence or absence of malignant disease.
IGF-1
Insulin-Like Growth Factor I 245 HIGH 75-216 ng/mL 01
C-Reactive Protein, Cardiac
C-Reactive Protein, Cardiac 0.33 0.00-3.00 mg/L 01
Relative Risk for Future Cardiovascular Event
Low <1.00
Average 1.00 - 3.00
High >3.00
Estradiol, Sensitive
Estradiol, Sensitive 16 3-70 pg/mL 01
Male Female
0- 6 yrs. 0 - 15 0 - 15
2 of 3
7-10 yrs. 0 - 15 0 - 70
11-12 yrs. 0 - 40 10 - 300
13-15 yrs. 0 - 45 10 - 300

15 yrs. 3 - 70 See Below
Ovulating Female
Follicular Phase 9 - 175
Luteal Phase 44 - 196
Periovulatory 107 - 281
Oral Contraceptives 0 - 91
Postmenopausal
Treated 42 - 289
Untreated 0 - 19
.
Estradiol results obtained with different
assay methods cannot be used interchangeably.
It is recommended that only one assay method
be used consistently to monitor serial
patient results.
GGT
GGT 26 0-65 IU/L 01
Magnesium, Serum
Magnesium, Serum 1.9 1.6-2.6 mg/dL 01
Insulin
Insulin 16.3 2.6-24.9 uIU/mL 01
Ferritin, Serum
Ferritin, Serum 263 30-400 ng/mL 01
Sex Horm Binding Glob, Serum
Sex Horm Binding Glob, Serum 18.9 16.5-55.9 nmol/L 01


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#2

After re-reading the Thyroid sticky seems like I might need IR. Will start measuring my oral temperature 4x daily and seeing what that has to say.

Will add Cortisol to the next blood work, too.


#3

Will update with my oral body temps tomorrow.


#4

0700 waking temp 96.1F
1000 temp 96.7F
1300 temp 97.1F


#5

If your sex drive and erection quality are good - why do you think you need TRT? Your labs show pretty decent test levels. Is it possible the lethargy and fat issues aren’t from some other cause?


#6

Body temps and TSH does suggests IR if long term intake has been low.

Magnesium: If you get leg cramps, get a good magnesium supplement.

=======
6’0" height
220 lbs
18.5% body fat

What is waist size !?!
Cpap and A1c would be consistent with central body fat.

How is blood pressure?


#7

The decision to go onto TRT was not made lightly. The final decision came after an 8 week effort to handle the fatigue and inability to lose abdominal fat.

I hired a personal trainer and nutritionist. The training consisted of 1 hour sessions 5x week (3 moderate lifting, 2 plyometric). The nutritionist essentially had me on the Zone diet.

After eating clean and working out for 8 weeks, I lost 1.5% body fat and gained 2 lbs of muscle. My trainer/nutritionist was dumbfounded.

After that, I essentially just ate what I wanted and didn’t workout for a month. I didn’t gain any weight and my body fat went up 1%.

At that point, my PCP suggested seeking out a wellness doc to figure out what was off with my biochemistry.

TRT seemed the next logical step. After hours of digging through all the crap on the Internet, I ended up here :slight_smile:


#8

Today’s body temps:

0645 hrs - 96.7F
0900 hrs - 97.0F
1130 hrs - 97.6F
1400 hrs - 98.0F

[quote]KSman wrote:
Body temps and TSH does suggests IR if long term intake has been low.

Magnesium: If you get leg cramps, get a good magnesium supplement.

[/quote]

Thank you for the reply. That’s what I concluded after reading the Thyroid sticky. Lugol’s 5% arrived today and I’m starting with 12.5mg dosage until after the weekend (going OOT and don’t want to be traveling if I have an adverse syptoms).

Oops missed that. Pre-TRT treatment it was 36.5". Now it’s just shy of 39" due to the bloating/water retention from the Test. Last two doses I’ve switched to EOD SQ instead of weekly and started .5mg Adex 2/week today (damn doc wouldn’t prescribe at the start).

Yes, after I started sleep therapy my weight dropped about 25 lbs. I had been eating too much sugar (way too much) due to some familial issues at the time of the last two tests. It’s been handled now and I’m back to eating clean. Losing the excess abdominal fat will bring the A1C back into alignment.

[quote]
How is blood pressure?[/quote]

At the pre-TRT physical, it was 111/75. At the appt today it was 135/85, but it’s always read high at my pcp’s office.

Summary:

Weekly Test to EOD dosing (30 mg EOD)
Starting IR (Lugol’s 5% 12.5mg daily)
Starting generic Adex (.5mg 2x week)
Starting D3 with K2 and Mg supplement (daily)


#9

In addition to the adex, I’ve increased my water intake to 1 gal/day, increased salt usage and cut back 1/2 on hi-glycemic load carbs. Hopefully the water retention will subside soon. I had a blood panel done today pre-adex (total test and e2) but won’t have the results until tomorrow or Monday.


#10

Lab work from 8/21

Testosterone, Serum 610 348-1197 ng/dL
Estradiol 27.6 7.6-42.6 pg/mL

Interesting how the test stayed the same level but E2 almost doubled


#11

??? Weekly Test to EOD dosing (.15mg) ???

With TT=610 with EOD T dosing, you need more T!

With 220 pounds relative to a 160 reference weight, new dose of T would be 222/160 * 100mg per week = 138 mg/week. TT should increase roughly to 840. Many will argue that TT should be in the 900-100 range, so try to get 150mg for T dose.

Your E2 many also increase by 50% and would be too high.

If you can get body temps restored*, with TRT and your improved diet, you should be able to loose weight. Getting E2 into the lower 20’s would be very helpful as well.

  • metabolic rate will increase

#12

[quote]KSman wrote:
??? Weekly Test to EOD dosing (.15mg) ???
[/quote]

I don’t know where .15mg came from (auto-correct on my tablet?), I’ve corrected the prior post to say 30mg/EOD.

The plan now is to continue at 30mg Test EOD, .5 mg Adex EOD and the IR for 2 weeks then have another blood panel to see where I’m at.

Thanks again for the continued feedback.


#13

Met with a new doc today. He’s part of a preferred network and has only 500-600 patients in his practice.

He is very receptive to TRT so his cooperation should make adjusting the dosage and medications painless.


#14

Since my body has accepted the 25 mg/day iodine without issue I’m upping daily to 50 mg/day


#15

“Assuming that 90% of total loss is reflected in measured excreta and that total iodine content of the thyroid gland is 10 mg, geometric mean for total body iodine in these subjects was 14.6 mg (range, 12.1-25.3 mg).”

Hays, M. T. (2001). “Estimation of Total Body Iodine Content in Normal Young Men”. Thyroid 11 (7): 671?675. doi:10.1089/105072501750362745. PMID 11484896


#16

Lab from 08/29/2014

Testosterone, Total: 599 348 - 1197
Free Testosterone: 27.2 6.8 - 21.5
Thyroxine T4: 1.05 0.82 - 1.77
Estradiol: <5.1 7.6 - 42
Triiodothyronine, Free, Serum: 3.4 2.0 - 4.4

Currently taking 15 mg Test EOD and .5 mg Adex E3.5D. E2 is way too low (feel it). The IR seems to be helping the thyroid to function better so I’ll continue the 12.5 mg daily.

To raise the E2, I need to cut the Adex dosage or increase the Test (or combination of both). I’d also like to see the Total Test rise a couple of hundred points. Since the Total Test has stabilized at 600 for the past 3 blood panels, I’m thinking to adjust the Test to 22 mg EOD, along with starting HCG 250 ui EOD and get another blood panel in 15 days.

Thoughts?


#17

You are an over responder to AI just like me. Cut your dose to 1/4 of the current and look see how you feel. Little more test like you suggested probably would do you good.


#18

Thanks for the reply.

To clarify you’re suggesting .25 mg Adex weekly?


#19

Yes, .25mg. It will be difficult to dose unless you can get a compounded AI in small increments. Otherwise, buy a dropper and vodka, count the drops in certain amount of vodka (ex. 5ml), dissolve the AI and dose EOD for more stable levels.


#20

Starting today I’ve increased the Test to 21.5 mg EOD and reduced the Adex to .25 E3.5D. It’s kinda hard cutting the 1 mg pill into 1/4s so I’ll ask the pharmacist if she can fill .5 mg pills.

I’ll pull another panel in 2-3 weeks and see where the no’s are.