T Nation

5 Months on TRT, High T but Always Fatigued

I’ve been on TRT now for nearly 5 months. Protocol is 200mg cypionate, 700iu and about .7mg anastrozole. I split this into 2 injections per week.

Here’s my starting numbers from 5 months ago:

Test Serum (ng/dL) (264-916) Test Free (pg/mL) (8.7-25.1) Estradiol (pg/mL) (7.6-42.6) Hemoglobin (g/dl) (13-17.7) Hematrocrit (%) (37.5-51)
468 11.4 13.6 15.5 44.7

Here are my numbers from my last labs 1 month ago:

1215| 32.3| 26.1 |16.6| 48.1

I also had my thyroid checked recently and it was ‘normal’.

Things look good in the labs and I am certainly feeling better in a lot of areas (morning wood, sex drive, erection quality, more strength in the gym, vascularity, not light headed after squats, etc).

But, my biggest issue is I’m still so fatigued during the day. One of the biggest reasons I started TRT was the hope of more energy.

I will admit my diet is not great and I do drink nightly maybe 6-8 ‘drinks’.

My sleep seems fine, I don’t wake up feeling refreshed though.

Just wanted to start this thread and get any advice I can and try to figure out a step forward to figuring this out. I’ve read a few other threads on this and it seems the poster never really figured it out.

Any thoughts, advice or questions are appreciated.

The fact that you are an alcoholic is probably causing you some fatigue and issues. I know I never felt good while poisoning my body daily with drugs and alcohol

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This is definitely not conducive to REM sleep, the restorative kind of sleep where HGH is released, etc.

Shouldn’t even be having 6-8 drinks a week let alone a night. That’s not good. At all. No matter what your justification for it is. Taste, stress, relaxes you, just what you’ve always done, etc. Knock that off.

Thanks Guys, this definitely makes sense. I guess I never really thought of it since it’s just become ‘normal’ for me drinking that much. I do know I have a problem and am trying The Sinclair Method which has been helping lower my intake. I’ll keep going and hopefully the less I drink the more energy I’ll have during the day.

I’ll start there and hopefully eliminating the booze will be the fix.

This is a big variation between doctors on normal thyroid function, the TSH reference ranges are not normal. Recent studies indicate 95% of the healthy population has a TSH between 1-1.5, normal thyroid hormones levels (Free T3) levels need to be mid-range or better, Reverse T3 needs to be <15 ng/d/L, T4 mid-range.

I would bet good money its the anastrazole. Get rid of it.

Low e2 causes fatigue.

With that total test, your e2 should be higher probably.

Interesting. What tests would you recommend I get to check these values? TSH, T3, T4?

I really like the benefits of being on the high side with T so I’d like to continue taking the 200mg/wk.
I think I could probably get away with almost no AI if I was only taking the cypionate since my e2 is naturally low but since my gf and I are planning to start trying to get pregnant towards the end of the year I’m taking the 700iu HCG to keep my fertility going so I think that’s what puts me over the edge on e2 and needing AI.

I’ve been up to 34 pg/ml on e2 on a previous lab and was feeling very emotional and not great so I don’t think I do well with higher e2.

Free T3 (not T3) as the latter is better for diagnosing hyperthyroidism. TSH is a poor marker for thyroid status and is mostly reliable when elevated, seen too many with low TSH and abnormal low Free T3. Most doctors believe TSH between .5-4.5 is normal and you couldn’t possibly be hypothyroid, they would be wrong.

T4 is useful as its the raw stored thyroid hormone which is then converted to Free T4, Free T3 and Reverse T3. There are those with conversion issues where Free T3 will be abnormally low and TSH and Free T4 normal going under the radar of most doctors and then for years being told they are normal.

Most doctors only test TSH and Free T4 as taught to them in medical school. A few hours of reading and you are more informed than in some ways than your doctor regarding proper testing about why a more comprehensive testing is needed.

Thank you! Just so I’m clear, do I want to test (TSH, FREE T3 & FREE T4), or just (Free T3)?

You’re welcome.

TSH, Free T4, Free T3 and Reverse T3 and antibodies should be done for those about to undertake TRT, because if you are having thyroid problems TRT will not work.

If Free T3 was high normal and Reverse T3 high as well, then Reverse T3 will block Free T3 slamming on the metabolic brakes.

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I guess what else I could try is cutting my AI dosage in half and seeing how I feel. If I start getting signs of high E2 and not feeling well I can take the other half and feel better in a few hours.

Dont be surprised if you never figure out why you’re always tired.

Apparently my TRT doc can only get the following via labcorp:

“The three labs that we have the ability to order are the TSH, T(4) and T(3).
They are not free T3 and T4, just the standard T3 Triiodothyronine and T4 Thyroxine.”

Would these be beneficial or a waste of time without the ‘free T’ versions of these labs?

For sure. My Mom has always had lower energy, so maybe it’s a genetic thing and not a lot to do about that.

Discount Labs to the rescue, I ordered my own iron panel days ago and only took a day to get the

Your SHBG is likely midrange or slightly higher based off your Total T and Free T ratios, no need to test now, do it when checking progress.