T Nation

48 on T Replacement

I’m 48 and have been on T-cyp for 2 mo. Was going to Low T ctr, 160mg 1x/wk. Seem to crash on 5th day. New dr gave me script for T-cyp & AI, currently self inj 2x/wk at 1/3 mL each (not sure how many mg that is).

As of 1/17/13 below:

*H = 6’
*Waist = 44
*250lbs
*Pretty hairy guy. could shave 2 x a day
*Typical male pot belly, upper thighs and butt
*Hi blood psi, constant flush in face, always seem flushed from neck up. Seem to be gaining weight rapidly. last 2 mo put on approx 12lbs.
*Rx = Benicar HCT 40-25mg (take am 6yrs), Amlodipine Besylate 10mg (take pm 6yrs), Omeprazole 20mg (take pm)just started taking AI .25mg 2x/wk. Also take multi vitamins, zinc, D3, B12.
*Past diet–some FF, basically very poor. Currently, juicing and trying to do better.
*Training–Back in 20’s & early 30’s used to train adamantly. Was in very good shape. Mid 30’s to now not much training at all. Just started mountain biking & lifting again 2 wks ago. dropped 6lbs so far.
*No testes ache. However, seems that they are shriveling up quickly…
*Intermittent morning/nocturnal wood. Seem to be more prevalent day of inj.

Will post labs in separate so not so long.

T cyp is probably marked 200mg/ml, but sometimes different. Look.

Have you read the protocol for injections sticky?

Be open minded to other problems other than low T.

http://en.wikipedia.org/wiki/Omeprazole -DO YOU HAVE A HIATAL HERNIA?

Need the labs, include the lab ranges. Need CBC and cholesterol data.

As stated above, i really used to stay in shape. It was quite ez for me in earlier yrs to do so. I really responded well to exercise and lifting. However, over yrs just let myself go.

I’m typical guy with all the usual low t symptoms w/ exception of loss of libido. With T inj’s I always want to chase my wife around the house. She has to beat me off w/ a stick! Below r my labs:

For incase it helps im posting a LabCorp lab I had 8/17/11 (1yr+ before any TRT):

*eGFR = 93 REFERENCE >59
*BUN/Creatinine ratio = 11 REF 9-20
*Sodium serum = 141 REF 135-145
*Potassium, serum = 4.4 REF 3.5-5.2
*Chloride, serum = 101 REF 97-108
*Carbon Dioxide = 27 REF 20-32
*Calcium = 9.6 REF 8.7-10.2
*Protein total = 6.8 REF 6.0-8.5
*Albumin = 4.3 REF 3.5-5.5
*Globulin = 2.5 REF 1.5-4.5
*A/g ratio = 1.7 REF 1.1-2.5
*Bilirubin = 0.4 REF 0.0-1.2
*Alkaline phosphatase = 59 REF 25-150
*AST = 22 REF 0-40
*ALT = 40 REF 0-55
*TTL Cholesterol = 101 REF 100-199
*Triglycerides = 51 REF 0-149
*HDL Cholesterol = 52 REF >39
*VLDL = 10 REF 5-40
*LDL = 39 REF 0-99
*A1c = 5.7 HIGH REF 4.8-5.6
*Testosterone, serum = 348 REF 249-836
*WBC = 8.0 REF 4.0-10.5
*RBC = 5.20 REF 4.10-5.60
*Hemoglobin = 15.9 REF 12.5-17.0
*Hematocrit = 47.8 REF 36.0-50.0
*Monocytes = 1.0 REF 4-13
*Glucose, serum = 97 REF 65-99
*BUN = 12 REF 6-24
*Creatinine = 1.10 REF 0.76-1.27
*TSH = 1.300 REF 0.450-4.500

1st Lab 11/06/12 Low T ctr (before any TRT):
*FastPack TT = 149
*FastPack PSA = .09
**Dr gave me 200mg inj T-cyp on the spot after explaining HPA Axis, etc., etc.
**Also gave blood for complete work up.

1st comprehensive LabCorp Lab drawn approx 2pm on 11/06/12 (before any TRT):
*Glucose = 87 REF 65-99
*BUN = 13 REF 6-24
*Creatinine = 1.12 REF 0.76-1.27
*eGFR = 77 REF >59
*BUN/creatinine ratio = 12 REF 9-20
*Sodium = 141 REF 134-144
*Potassium = 4.3 REF 3.5-5.2
*Chloride = 100 REF 97-108
*CO2 = 25 REF 20-32
*Calcium = 9.6 REF 8.7-10.2
*Protein = 7.1 REF 5.0-8.5
*Albumin = 4.5 REF 3.5-5.5
*Globulin = 2.6 REF 1.5-4.5
*Bilirubin = .05 REF 0.0-1.2
*AST = 42 HIGH REF 0-40
*ALT = 73 HIGH REF 0-44
*TSH = 1.510 REF 0.450-4.500
*LH = 8.1 REF 1.7-8.6
*FSH = 3.2 REF 1.5-12.4
*Prolactin = 7.2 REF 4.0-15.2
*WBC = 10.7 HIGH (was feeling fine, not sure why that was high) REF 4.0-10.5
*RBC = 5.26 REF 4.14-5.80
*Hemoglobin = 16.1 REF 12.6-17.7
*Hematocrit = 46.9 REF 37.5-51.0
*MCV = 89 REF 79-97
*MCH = 30.6 REF 26.6-33.0
*MCHC = 34.3 REF 31.5-35.7
*RDW = 13.6 REF 12.3-15.4
*Platelets = 258 REF 140-415
*Monocytes absolute = 1.3 HIGH REF 0.1-1.0
*Estradiol = 35.2 REF 7.6-42.6
*Free T (direct) = 8.0 (dr says we need to get it up to around 20.0) REF 6.8-21.5

11/27/12 LabCorp Lab (getting 160mg inj 1 x/wk):
*E2 = 46.4 HIGH
*FT = 15.5
*TT = 485

Note–I decided to find a new dr after perusing all KSman’s most excellent info. Paid few hundred bucks for shots at low t ctr. Found dr that would provide script for self injections. Below is 1st labs w/ new dr:

12/16/12 Quest Lab:
*Cholesterol total = 97 LOW LIMITs 125-200
*HDL = 38 LOW LIMITs >OR=40
*Triglycerides = 112 LIMITs <150
*LDL = 37 LIMITs <130
*DHEA sulfate = 50mcg/dl LIMITs 45-345
*Insulin = 9 ulU/mL LIMITs <17
*B12 = 342pg/mL LIMITs 200-1100
*E2 = 42 HIGH LIMITs <OR=39
*PSA = .03 (actually went down since on T) LIMITs <OR=4.0
*Vit D, 25-OH, total = 37 LIMITs 30-100
*A1c = 5.5 (actually went down since on T) LIMITs <5.7
*TT = 762 LIMITs 250-1100
*FT = 164.7 HIGH LIMITs 35.0-155.0

**EDIT: Next Lab will be later this month with results in early Feb. Currently, following KSman’s injection protocol of 50mg 2x per week along with Anastrozle dose of 0.25 day of injection. Feeling better some days, and not so much on other days.

Since i need to lose some weight, should I try to increase T to high normal range??? Will this aid in shedding the pounds, of course along with working out?

—sorry if this is too much info. I did not show everything on the labs. Again, upon perusing KSman’s stickies, doc gave me script for Anastrozole 1mg. He asked that i use pill cutter to qtr the 1mg dose. I take 1/4mg after T inj, so 2 x per week. I’ve been up and i’ve been down. Sometimes a.m. wood and sometimes not. Times have felt utterly fantastic, other times still brain fog, just off, tired, etc. etc…

I would really appreciate any insight from you all. One BIG ???, I think that my testicles are literally going to shrink up and die. Now, i do not plan on having any more kiddos, but am slightly panicked in what’s going to happen with my nuts long-term.

Still perusing and absorbing the stickies. Awesome info for a newb.

KSman i have read the sticky for inj protocol and will talk Dr into changing script to follow your well thought out protocol. Thus far, dr is pretty ez going with whatever i want to do or try.

Dr’s script is for 1/3mL T cyp pin 2x/week. I use a 3mL syringe, actually kinda guessing where 1/3mL is. Going a little over 3 lines.

My goal is to just level out, have consistent wood, generally just feel better, and get back into shape.

Many thanks for providing any insight!

Your total cholesterol is causing a lot of problems. When getting below 160 all cause mortality increases. Low cholesterol is a bad thing. This can cause hormones to be low and low DHEA-S speaks to that. Take 25mg DHEA every day. Total cholesterol around 180 is ideal.

Read the advice for new guys sticky!!!

Are you taking a statin drug?
Do you have any muscle pains or persistent cough?

TRT will make your testes worse, you need hCG as per the protocol.

Your body hair suggests that you were a high T guy once, these lower levels would be worse for you than for guys who never had high T levels.

Your E2 levels with low T indicate a problem clearing E2 from your system. Liver function is the issue. ALT/AST do not indicate a problem. But drugs can cause this and sometimes bad gut flora and a probiotic can help in those cases. Would need to be a good quality product, most products are a joke.

Dump those 3ml syringes and try the insulin syringes suggested and inject SC.

*TT = 762 LIMITs 250-1100 is sort of meaningless when injecting less often and we need to know the lab timing. That TT is not high enough. 1/3ml of what? 200mg/ml? Your FT is good!

E2 is nuts, if taking 120mg/week, we expect that you will need 1.2mg/week anastrozole. You can take .5mg with each injection for now and see how that works. 1/2mg per week is not expected to provide a good result.

Action items, should lower BP and deal with endothelial dysfunction [google that]

  • 25 mg DHEA ED
  • increase cholesterol with diet or but back or eliminate statin drugs !!!
  • high potency B-complex multi vits with trace minerals AND IODINE
  • fish oil caps, nuts, flax seed oil or meal for EFA’s
  • 5000 iu vit-D3 in tiny oil based caps
  • 100mg day CoQ10 Ubiquinol type [not cheap]
  • 1000mg vit-C
  • natural source vit-E
  • post body temps as per the advice for new guys sticky and thyroid basics sticky
  • post history of iodized salt consumption and/or iodine in vitamins
  • list all meds, Rx or OTC and supplements.
  • any digestive problems or heart burn aka reflux?

I vaguely remember approx 10yrs ago going to Endo and he indicating that must be an inherited trait. The Endo did diagnose me to have a NAFL. My father has very low cholesterol as well. I thought that was a good thing… With that said, my father has had a couple of heart attacks and mini stroke. R U saying that this might be attributable to low cholesterol???

So if it is genetic, what can i do to increase it? Eat more cheeseburgers? Should i ask for specific testing for root cause?

Still absorbing all info in the stickies. Its a big bite to swallow for a newb, although very well written and concise.

No statin drugs. No muscle pains or cough.

So do i inject hCG for the rest of my life to keep my testes hanging? Or do i run cycles periodically? I have to ask, what would actually happen to my testes if i didn’t inject hCG? Do they literally die and fall off in 5, 10 yrs? Sorry for the emphasis on my testes, but doc said nothing about losing my testicles. I’m not planning on anymore kiddos, just trying to grasp the fact that TRT and now hCG may be part of the rest of my life.

Periodically throughout the yrs, i have always had slightly elevated AST/ALT. Should this be checked into further? If so, what tests should i ask for?

I suspect that i have had elevated E2 levels for quite some time even before any TRT. I don’t think i have full blown Gyno, but with being overweight have some man boobage going on.

I will start taking a a good probiotic.

I will gladly dump the 3ml syringes and pick up some insulin syringes as suggested in ur protocol.

Pretty sure that the lab timing was 3 days after injection.

U state that TT of 762 is not high enough. Should i move towards 100mg 2 x/week to get higher? To clarify, dr gave script for 1/3 of 1mL 2 X/wk. 0.5mL is = 100mg & 1mL is = 200mg, right? I think i looked that up…

I will also increase anastrozole dosage. If I go to 100mg/wk 2 x per week, is .5mg still enough?

Couple ?'s regarding my action items:

-Endothelial dysfunction–went down several rabbit holes. Seems like cholesterol is the foundation for all of r hormones. Is that right? So how does my low cholesterol play into this?

**One thing to note, i dipped tobacco SKOAL for approx 10-12 yrs. I successfully quit cold turkey just over a 6months ago. I WILL NOT start again. I had a dip in early am to late pm everyday. I’m sure i was severely dehydrated, etc. Just quitting made me feel better…

I will get on all the different items on the list, post my body temps, etc.

Probably in early yrs used iodized salt exclusively. however, now use sea salt. just stated taking vitamins. Most likely have not had much iodine. So how much iodine should i start taking?

My meds r in above post.

approx 6 yrs ago started having severe reflux/heartburn. so started taking Omeprazole 20mg. I have tried to stop taking it several different times. Every time reflux came raging back with a vengeance.

Again, i really appreciate what you r doing for us. It is most helpfull. I’m sure it is quite irritating that we newbs keep asking the same ?'s over and over.

The acid reflux can be from a hiatal hernia. It may be making you overeat by snacking in the evening. The reflux can be interpreted as hunger. The heart burn meds can alter how you absorb nutrients.

See the thyroid basics sticky.

You do not cycle T or hCG, forever

You need to get T Rx dose changed by your doc. 125mg/week would be a good step. But note that hCG can increase T as well, so better to introduce hCG first. Note that when TT increases, anastrozole needs to increase by the same proportion to hold E2 steady.

Note the formula for adjusting anastrozole dose based on an on-anastrozole lab result.

Target E2-22pg/ml, seems to have best fat loss and libido balance.

new_dose = old_dose x (E2 lab result / 22)

The sooner you get a new E2 result while on anastrozole, the better.

Expected anastrozole dose is 1mg/week for every 100mg T per week, adjust from there.

Will check into the hiatal hernia. Makes sense after googling. I most likely have one based on symptoms.

Reading ur thyroid sticky tonight.

**I thought once u were on TRT u never cycle off! Isn’t this for life??? I don’t understand, please explain…

I guess the same for hCG? I’m through with kids, but if i want my package to hang while on TRT, do I not take hCG forever?

What about my low CHOL? I googled and doesn’t sound good to have very low Chol. Do i need to investigate this issue further?

“You do not cycle T or hCG, forever” you do this forever, non stop

Low cholesterol. I guess you can explore eating fatty foods and more red meat. You still need healthy fats.

A hiatal hernia is a mechanical problem. But surgery is not simple or successful. You need to loose fat, it is all about portion control. Put less on your plate and live with it. Intra-abdominal fat and large meals pushes your stomach higher and the lower esophageal area gets bent, the sphincter then cannot keep acid where it belongs. Loosing fat will be easier with a good outcome for your hormone fixes. I know someone who has gone through this and the realization of the situation was empowering.

R there some long-term studies on TRT & hCG? I haven’t seen any. I get why i have to be on T forever. But do i have to stay on hCG every single week? All i’m interested in is the aestetic of my package and keep my balls hanging.

I would like to hear more about losing fat and the person you knew going through the process. Do you have a link? I could use some empowering…

So do i just keep taking Omeprazole. I guess i really don’t have a choice, right if i want to keep the acid at bay. im’ sure it affects my absorption of everything i take orally.

To clarify before i have my dr change my script, do u really think that upping my T to 125mg/wk will get me to where i need to be?

**what dose of iodoral should i get on?.

BTW r u a Dr.? I would really like to hear ur story, do u have a link to share?

You need to keep using Omeprazole until something else improved. The only really good diagnostic for this is an endoscopy under a light general anaesthesia. At your age, makes sense to have a coloscopy while you are on the table. If they show you a nice picture of the problem, the ball is back in your court.

Alcohol makes it worse at it effects the LES function. There are other things that you can avoid.

The subject is not on the internet, but she is my wife. So I know all of the details and struggles. I spent many days researching the surgical procedures, techniques and who does what best where. This really needs to be a last resort. One outcome is that she had to buy new clothes and clothes from years ago not fit.

Loose a lot of fat and your BP and life expectancy will improve. I have no idea how you can loose fat and increase cholesterol at the same time.

Have you been tested for a stomach ulcer and http://en.wikipedia.org/wiki/Helicobacter_pylori?

No reason why cannot have both. But the Helicobacter can be cured and be done with!

Recap:
-125mg 2X/wk, with 2 injections
-0.5mg 2x/wk
-hCG has not come in from mail order Rx yet.

***taking supplements and dosages as you outlined above.

just had labs come in. For some reason TT, FT & E2 are not on them. Will obtain and report. Anyway, here they are:

-Ferritin 11 Low Ref Range (RR) 20-380ng/ml
-TSH 0.92 RR 0.4-4.50
-T4 Free 1.1 RR 0.8-1.8
-T3 Free 3.6 RR 2.3-4.2
-Thyroid Peroxidase <10 RR <35 iu/ml
-DHT 16 RR 16-79
-Pregnenolone 158 RR 13-208

-Cortisol Total 15.6 mcg/dl (took blood test close to 8am) RR (7-9am 4.0-22.0) (3-5pm 3.0-17.0)
-Progesterone <0.5 RR <1.4
-Prolactin 8.7 RR 2.0-18.0
-C-Reactive Protein 0.42 RR <0.80
-Homocysteine 9.8 RR <11.4

I will post TT & E2 once i recieve them. As outlined in your Thyroid sticky my avg waking temp is 97.1 taken over 5 days. Typically stayed in the high 97’s most days. Occasionally hit 98.3 in few afternoons.

I ordered Ioradal bottles at 50 and 12.5. How long should i take the 50 prior to dropping down to 12.5?

Thanks for all replies. Very helpful…

Take 50mg iodine for 14 days, or spread same out if guts get uncomfortable, gut bacteria balance gets shifted. Probiotic later would be good.

Worried: Ferritin 11 Low Ref Range (RR) 20-380ng/ml
That suggests GI bleed, but CBC does not support that idea.
Low ferritin is a problem seen with thyroid problems and often levels of 80 are suggested as needed. Perhaps someone else can add to this.

Omeprazole may be lowering stomach acid enough to interfere with iron absorption. Go to health food store and find an iron supplement that is ready to absorb and not needing acidic conditions to get absorbed. Study WWW for this as well. https://www.google.com/search?q=low+ferritin+Omeprazole

fT4 slightly lowish re mid range 1.3
any new temperature data, if temps improve, ft4 might as well.

-T3 Free 3.6 is strong, if temps not good with that, see discussions re rT3 and adrenal fatigue.

Taking 50mg of iodoral, no gut issues thus far.

Crazy thing about the low ferritin. I really just do not feel anemic. At least i do not think i do… Great find with regard to Omeprazole. I will certainly pick up the ready to absorb iron. I often have wondered if this might have been interfering with absorption. I have tried to drop this in the past to no avail. After day 2 my acid is intolerable. Do you happen to know an alternative?

My temps seem to have actually got worse after 4 days of the 50. My waking temp is 96.8, however mid day have avg 98.3. Late day avg is 98.4.

New labs from 2/11:

-DHEA Sulfate 157 45-345
-E2 30 < OR = 39
-TT 1118 High 250-1100
-FT 290.0 High 35-155
-PSA 0.3 < OR=4.0 It was 0.03

Couple of items, Dr wants me to quit taking anastrozole and begin DIM. Will DIM be as effective?

Thanks for any comments.

“”"
A hiatal hernia is a mechanical problem. But surgery is not simple or successful. You need to loose fat, it is all about portion control. Put less on your plate and live with it. Intra-abdominal fat and large meals pushes your stomach higher and the lower esophageal area gets bent, the sphincter then cannot keep acid where it belongs. Loosing fat will be easier with a good outcome for your hormone fixes. I know someone who has gone through this and the realization of the situation was empowering.

“”"

DIM will not work in this case. You have E2=30 with anastrozole?
You are injecting 250mg/week or 125mg/week?

If your target is E2=22pg/ml, new dose should be 30/22*old_dose[1mg/week]=1.35mg/week
If injecting 125mg/week, expected AI dose would be 1.25mg, so 1.35 would then make sense.

What was lab time re time of injection?

Got it about the hiatal hernia!

I’m injecting 125mg/week.

I will continue to take anastrozole and increase my dosage as outlined. Thanks for helping out with the math.

I’m injecting Tues & Fridays. I skipped my Fri am injection until returning from bloodwork. So Tues was prior injection.

So far i’m down 18lbs. I have been trying to do fasted cardio on my elliptical 3-5 days a week. I’ve built up to 45 min. I have been lifting now for over 1 month, M-W-F. Will start going heavy this week…

My waking temp is now avg 97.9. Mid afternoon temp ave 98.3. Have another week of taking 50mg of iodoral and then will drop down to 12.5mg.

I have been doing some research on using something other than Omeprazole. Thus far, everything else seems to cause issues as well. Do you happen to know of a better solution?

Thanks,
–DJ

KSman I have a protrusion on my stomach only when i’m doing ab work. When i’m relaxed, there is no protrusion. Please look at the picture below. Any ideas, is this a hernia?

No, but are the ab muscle groups attached in the middle or separated? When you lie on your back, tighten your abs and poke in the middle, do not hold your breath. Do you feel a soft gap? While not a hernia, I would have such a thing surgically corrected if is was me. But I have had my share of such issues.

Your belly button does not look normal.

Do I see a bit of gyno?

Yes, feel a soft gap. I can place 4 fingers wide in the space. I have been working out, have lossed almost 35lbs. Is this gap between my abs, due to having been stretched out b’cause of big belly? So my ab muscles will never grow back together with out surgery? I have lossed almost 8" in my waist. I still have a long ways to go. But very motivated to get there.

Should i continue to work abs? Or will this cause further damage or separation?

I’m taking 1.35mg of anastrozole/week. I’m using a pill cutter, so not exact. Will have bloodwork in two weeks to see where E2 is at. Not really sure if its still fat, or some gyno… It might be some of both. I certainly had some man boobs prior to getting on T.

I would see your doc about the ab muscles, he will probably do a referral. This will only get worse, muscle attachments at your sternum are moving! The procedures are not as rare as you might expect, women get this condition from pregnancies. Yes, being fat is a cause or promoter.

When you stand up and relax your abs, you may see that your guts are not been supported properly. Any bulging or roundness creates a situation where your abs want to spread even more. The connective tissue underneath will stretch, allowing the process to proceed. Hopefully that has not herniated. This all has nothing to do with a hiatal hernia which is a opening in the diaphragm that allows the stomach to move up where is should not be. You +35 pounds can cause that too.

NEED TO KNOW WHAT WAS THE SURGERY THAT ALTERED YOUR UMBILICUS!

I have made an inquiry with the clinic that repaired my large incisional hernia and will get back here. I sent your pix.

K. will see doc about the ab muscles. Makes sense…

Have had no surgery anywhere around umbilicus! I assumed my belly button was related to how fat i was.

KSman thanks for taking the time to send my pics. Let me know you need another shot from different angle.

Many Thanks