T Nation

5 Weeks on TRT and Unsure If This Is Normal


#1

I am 46 5”11, 235 lbs and have been in pretty good shape until the last 5 years. I have battled feeling like shit for 4-5 years. Symptoms = No energy, fatigue, muscle weakness, trouble concentrating, anxiety and a feeling of impending doom. I have seen every doctor from Primary, Neurologist, psychologist, endocrinologist ETC and nobody can explain why I feel the way I do. I really thought I was dying and was being misdiagnosed by all the doctors. I read a few articles about TRT and decided I would make an appointment with Men’s Health Boston and a key figure in TRT, (Abraham Mortgentalor). As I filled out the paperwork in his office I felt like they made the questionnaire specifically for me, all the symptoms seemed to hit the nail on the head. My labs were as follows,
Total Test was 368 ng/dL.
Free test .72 ng/dL
LH 3.3
PSA .8
FSH 6.2
Estradiol 32.8
SHBG 27.1
Hematocrit 41.4
I was prescribed 100 MG Testosterone cypionate per week. After reading some articles on TNation I decided to do 2 injections per week to avoid the spikes and lows.

Fast forward 5 weeks. I felt a little better until the past 1-2 weeks. My lab results came back after 5 weeks of TRT. Blood was done by quest diagnostics.
total Test 688 ng/dL range 250-827 (ng/dL)
Free Test 1.89 ng/dL range 0.87-5.47 (ng/dL)
Hemoglobin 13.8 g/dL range 13.2-17.1 (g/dL)
Hematocrit 41.2 range 38.5-50.0 (%)
LH .2 mlU/Ml. Range 1.5-9.3 (mIU/mL
PSA .7 Range < OR = 4.0 (ng/mL
FSH .7 mlU/ml range 1.6-8.0 (mIU/mL)
SHBG 21 nmol/l. Range 10-50 (nmol/L)
Estradiol 46 Pg/ml. Range < OR = 39 (pg/mL)
During my appointment I explained that I felt like I had min/moderate improvement of how I was initially feeling until the last 1-2 weeks. The Doctor asked me if I had any breast tenderness or swelling in which I did. He placed me on 1 MG Arimidex 3 x week and told me he would see me in 3 months. After what I have read, isn’t 1 MG Arimidex 3 x week excessive? Also shouldn’t a repeat of labs happen before 3 months? Any input on my labs and what to ask or do next?


#2

You really need to include lab ranges, every lab has different ranges as it’s not standardized which makes it difficult to know if your labs place you in the ranges. Your hematocrit is way too low pre-TRT, still far too low. My pre-TRT TT numbers were significantly lower than yours and my hematocrit was a few percentage higher, normal ranges are 42% - 54% and you’re still below it. It’s no wonder why you were suffering so much even though your TT numbers weren’t terribly low. Low hematocrit can cause severe anemia can cause fatigue, pale skin, and shortness of breath with exertion. Iron-deficiency anemia: Iron is necessary for the body to make red blood cells. Red blood cells carry oxygen to the body’s tissues, so you’ll need to wait some time for that to happen.

The good news is TRT should increase your red blood cells in the next few months stabilizing several months down the road. As expected your SHBG dropped a bit after starting TRT and is hovering just barely above the point of what’s considered normal, however it would be wise to move possibly to injections EOD. The lower the dosages of T you inject the less suppression on SHBG and the better you should feel since SHBG is responsible for activating and regulating free testosterone, free T is is what matters most, it’s what goes to work for the body. Your TT is locked up in SHBG, SHBG releases small amounts of free T.

Your SHBG was at a perfect level before you started TRT and a lot of guys with low SHBG find that TRT is less effective than those with SHBG in the middle ranges. DO NOT take 1mg of AI 3x weekly or you’ll soon discover a new kind of hell, I’ll let someone with more experience make a suggestions for AI dosing. I’m on 100mg weekly split EOD and do not require an AI at all, imagine had I been place on an AI. You’ll reach a steady state in 4-6 weeks and require 2-3 months to realize if the small adjustment made you feel different. Don’t be one of those guys who’s constantly making changes to his protocol, you’ll never find out what works and what doesn’t.

Your doctor doesn’t seem like a complete moron, but the AI dose is a little insane. What about HCG, it should help you remain fertile and keep your testes from atrophying/pulling up tight.

----> https://naturalbiohealth.com/2015/05/06/shbg-critical-to-your-health/


#3

Forgot to mention, I have no other PMH other than orthopedic surgeries. I currently take 10 mg Piroxicam 1 x day for back pain and 300 mg Neurontin 3 x day for nerve pain. I took propecia for about 10 years for hair loss. Discontinued for the last 4 years and wonder if my symptoms had anything to do with the Propecia.
Also, is injecting test better in evening before bed or in the morning?


#4

I will include lab ranges next time, thank you! Great advise and I appreciate it. I am not so concerned with my fertility as I have 5 year old twins and don’t plan on any more children. My opening post should have included that I have absolutely NO sex drive and erections are on the lame side.
I feel a bit overwhelmed with the numbers and how they relate to testosterone and also how I’m feeling. As far as the Arimadex, should I just get a pill cutter and break it into 1/4 MG q3 days? Also should I ask to repeat labs in a month? Seems like my labs are all messed up.


#5

We see Finasteride users in here all the time, this medication causes a lot of problems and some believe it causes changes in gene expression in relation to DHT which is a derivative of testosterone. DHT is one of the major hormones that regulate libido in men and there’s no cure for Post Finasteride syndrome. The fact that you felt good initially after starting TRT is a good sign! Ordering more labs won’t make you feel better, it’s going to take several months to get dialed in and most take about a year to fully adjust to TRT. Tissues have to be repaired for which some never experience do to the damage Finasteride causes, I’ve heard of some who have made good progress. You pituitary gland likely shut down somewhere in the 1-2 weeks after starting TRT, it saw plenty of T circulating in the blood and shut down. Now you must wait for the medicine to repair tissue, it could take a little more than a year to repair venous leakage, I’ve been on TRT for 7 months and still my erections and libido are not 100%, but getting better all the time. You might ask your doctor for a slight dosage increase on your 6 month follow up appointment. Most guys feel great in the 800 range and you’re not too far off that mark. These pain meds are known to destroy hormones, anticonvulsants can affect libido. I was on an anticonvulsant for 30 years and is responsible for me needing TRT in the first place, the withdraw is what caused my T levels to plummet. They drugs also dampen the nerves in your penus since they calm the nerves by reducing the feeling.


#6

Personally, I’d stick with labs every 6 weeks until things normalize within a high degree of certainty.

I had labs done every 6 weeks for 18 weeks - then they told me to come back in 3 months. After that 18 week period when the Dr. thought he had me dialed in, I started feeling really odd about 4 weeks later (week 22) and insisted on running another lab. Turned out that my T more than DOUBLED to 1500+ and my E2 hit 49.


#7

I agree, but Dr didn’t seem to worried about my E2 which surprised me being soo high. What did you do about your E2 when it hit 49? Curious to know because mine is high and the Dr prescribed 1 MG Arimidex 3 x a week. Systemlord suggested a much lower dose, which seems more in line.


#8

Take 0.5mg anastrozole at time of injecting twice a week.

With E2=X pg/ml later on, adjust anastrozole dose to get near E2=22pgml

New dose = old dose * X/22

To get arbitrary dosing, dissolve 1mg anastrozole per ml in vodka, then dispense by volume or by the drop. A dropper bottle is useful, count drops per ml.

Many have low thyroid function. Do check overall thyroid function via oral body temperatures, see below.


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

  • advice for new guys - need more info about you
  • 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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#9

KSman, Thank you for the response. Forgive me as I am new, but what are stickies?


#10

My E2 being that high made me feel awful. In addition to dropping my T dosage, I am now on 1mg Anastrozole 2x week. I take 1mg with my injection (Tuesday and Friday).

Follow the advice of KSman on the Anastrozole (Take 0.mg anastrozole at time of injecting twice a week.). Some folks are over-reactors and you’d much rather have E2 that is too high than too low. Get labs run again in 6 weeks.


#11

Also, Any preference on injecting morning or night?


#12

I updated lab ranges per your request, if you have a minute would you kindly take a look and see what you think?