T Nation

51, Just Started TRT - So Far So Good

Hey guys, very impressed with the amount of information in this forum. Extremely helpful - thanks!

I’m going to the doc today, and will almost certainly be starting TRT. I got my labs this week, and was surprised at these results (Quest labs in Valencia):

TT: 383 (250-1100)
FT: 39.3 (35-155)

These are not unusual numbers for my age (now 51), but I’m surprised because just 3 years ago I was tested and TT was 926 ! I got it tested at that time because I was starting to have some symptoms of low T, mainly low mental/physical energy level and slightly diminished libido. At the least, I wanted to get a baseline for future reference. After these most recent test results, I’m thinking either the doctor or the lab screwed up the previous test.

Have any of you seen your numbers drop this fast (TT 926 to 383 in 3 years) without a serious health problem causing it?

The charts I’ve viewed show a fairly linear decline starting at about 25, but this would represent a much more dramatic drop-off - unless my T was something like 2000 when I was 30 (which I guess is impossible for natural conditions?). I have stronger symptoms now, but still no sexual dysfunction, which is surprising to me with FT that low.

I’m overall quite healthy, with just the usual aches and pains associated with my age. I work out 4 days a week plus cardio. I don’t and never have used any kind of “training drugs” beyond Creatine. I don’t smoke or drink alcohol or caffeine. Several months ago, I started a very controlled diet suggested by a dietician. It is a fairly well balanced diet targeted to help build lean mass while reducing fat. It is a relatively low fat diet, but not extreme. During the past 10 weeks my body fat has reduced by 3.1% and I’ve added about 6 pounds of lean mass (now at 17.6% [DXA scan] and 180 pounds, 5’11"). But, fat in the mid-section has been stubborn - another potential indicator of low T.

Had my first appointment this afternoon, and doc recommended TRT right away. Seems like a good doc who is aware of the need to monitor and maintain estradiol level with anastrozole. He didn’t feel hCG was necessary for me, though was perfectly happy to prescribe it if I wanted (and would allow me to self-inject it).

He has suggested pellets as opposed to injections. Says many of his patients use them, though he mentioned that he injected himself twice a week rather than using them. He is not open to allowing me to self-inject, at least not right now, because he’d seen a lot of people abuse it and use excessive amounts when allowed to self-inject. I think he might lighten up about that once he gets to know me and realizes I’m not a seeker/abuser.

I notice that most discussion in this forum is about injection. Anyone have good/bad experiences to share about pellets?

My biggest concern with pellets is inconsistent delivery rate during the beginning/end of cycle. In the middle period, seems they’d be ideal with a very constant rate (no roller coaster).

I plan to journal my entire experience with TRT in this thread, giving as much detail as possible. I hope it helps others considering it and wondering about the effects and process.

(I’m pretty new to all this, to preface my statement)

Been reading alot tho. HCG seems to be a long term no-brainer, mainly for its prevention of testicular atrophe. With said atrophe can come a whole host of issues, from minor to severe aches, tight and uncomfortable scrotum, testicular cancer. With long use of trt, and no hcg, you are selfinducing an organ failure, and with that comes consequences.

Again, this is just what I’ve been reading here and there, but it seems the upsides, at least what is known, outweigh the cons.

As far as you total t numbers, at 383 I’m not surprised you have no ED problems. You usually see that with men with much lower T, sub 200 at least from what I’ve been observing in forums.

It’s good you have a doc that will work with you! I’m just started out myself.

30 years old, total t of 344

Been on shots for almost 2 weeks, waiting on hcg, but from what every one says, it too does a ton for energy, mood, overall wellness.

Good luck to you on the journey. I’m sure a more seasoned person will comment soon.

Thanks for the input js. That’s particularly interesting what you said about hCG increasing energy levels (if I understood you correctly). I hadn’t caught that in my reading. That alone might be reason enough to use it, but I agree that it’s a bad idea to knowingly shrivel your nads anyway. I definitely plan to use hCG once I get going.

After more reading, and some first-hand input from a lady friend who had tried pellets (yes, ladies use them for HRT also), I’ve decided they are not the way to go, and will be going for injections to start. She also mentioned that her boyfriend injects T every 2 weeks and has good luck with it, and no apparent “roller coaster” effect. That’s encouraging, because it may only be practical for me to do it once per week at most.

You said you started injections about 2 weeks ago. Are you aware of any effects yet? My doctor suggested that it could take that long or longer before feeling anything. That’s the part of the process that I’m particularly interested in, and plan to detail in this thread as I start my TRT. Good luck with your treatment. Your starting TT level is close to mine, so might be interesting to see if we have the same experience with treatment.

Will be getting my first injection in a couple of days. Had to wait for lab results, else would have gotten it a week ago.

This more complete set of labs included a second set of tests for TT and FT, with significantly different numbers:

First labs taken about 2 weeks ago, at 12:00 noon (didn’t fast before this lab):

TT: 383 (250-1100)
FT: 39.3 (35-155)

Second labs taken a week later, at 10:00 am (fasted before this lab due to other needed tests):

TT: 560 (250-1100)
FT: 91.1 (35-155)
ESTRADIOL: 22 (8-43)

Now I don’t know what to think. The second tests are pretty near normal numbers, which may not really need treatment. Note these tests were done by the same lab (Quest labs in Valencia), and I had no T treatment or any changes to diet or lifestyle during the week between these tests. Would you expect tests results to vary this much without treatment?

I wouldn’t even think about TRT at 560. Maybe the 383 was a bad day. Did he test your LH or FSH?

No, unfortunately didn`t test LH or FSH. I really don’t know what to believe about the different numbers on these labs. I am experiencing some symptoms of low T, and doctor says he expects to see numbers around 1100 during TRT. He’s not a believer in “normal for age”. He believes everyone should try to achieve numbers for a healthy 30 year old.

Don’t fall for the Androgel ads. They’re pushing normal guys into spending $400 per month ($4800 per year). The 383 isn’t good but at 560 you’re probably right at, or a little above the median range for a 51 year old. There are some guys here who have felt much better in the 550 to 600 range than at 900. You need to find what level works best for you, but if you go for 1100 without HCG you’ll have to trade in a perfectly good set of nuts.

The 1100 level is probably a peak level for a 30 year old. The median level for a 25 year old is about 670 - 700. The LH and FSH are important for determining if your nuts are OK, or if your low numbers are from a nut malfunction. Check out the Hormone Panel for Females at privatemdlabs. It’s $50.99 if you use a 15% off coupon code (jk4509sdk) and it measures TT, LH, FSH and E2.

Considering that you were in the 900 range before, you probably would be better off to raise your levels. If the LH is high, you’re probably going to need TRT, but If your LH tests in the low normal or mid range, your nuts are OK. You just need more LH to raise your T levels. HCG alone will do that but if I were you, I’d try low dose Clomid before trading your nuts for TRT. Clomid raises LH and someone in your range might get a nice boost on a low dose of 25 mg every other or every third day.

At that low dosage of Clomid, you won’t be likely to complain about side effects. It’s worth a try. Some guys do great long term at 12.5 mg every other day. Use as little as you can to raise your levels and to get rid of symptoms. If you’re concerned about long term use of Clomid, do a search on Androxal (Enclomiphene). It’s the part of Clomid that raises T without the part that can cause estrogenic side effects that some guys experience. It’s likely to be approved for long term use next year.

Thanks for the info Freddy. You’ve given me a lot to think about. At the very least, I’m convinced I should get FSH/LH tested, and wouldn’t hurt to have another TT test to get an idea of which of the past tests was the anomaly.

I’d read that hCG could increase T without T supplementation, and now I’m wondering if that might be the better path at this stage. I’m definitely not anxious to start an expensive lifelong drug-habit any sooner than necessary (probably inevitable at some point, but maybe I can put it off for a while). On the other hand, the doctor told me that hCG was expensive too, and still means injections.

One more question: Any opinion about whether a single T injection is likely to cause any long-term effects if I were to decide to change course after? In other words, I might let the doctor inject when I see him on Friday, but make a decision when I get the new lab results next week. This doctor tends to be busy, and if I don’t start on Friday, it will probably be at least a couple of weeks before I can get another appointment.

Try hCG monotherapy. Not high doses. If that does not work, go to TRT.

Pellets = $$$ 4 doc

Self injecting and abuse is BS. Tell him that he is talking to one patient at a time.

I considered hCG monotherapy, but ultimately decided on TRT injections - for now.

If that last test was right, my T (560) is slightly higher than normal (450) for my age. However, I do have symptoms that could be attributed to low T. My doctor said yesterday that when a patient presents with symptoms of low T, he will treat them to get to high end of range for a 30 year old, almost without regard for what the starting numbers are (unless they’re extreme, or there’s another explanation for the symptoms). I agree with my doctor that “normal for age” should not be the goal. One of my goals is to feel more youthful, and being “normal for age” will probably not accomplish that.

I found this statement ( http://testosteronewisdom.blogspot.com/2011/10/use-of-hcg-to-increase-testicular-size.html ):

“Some men have asked me why we cannot use HCG solely to make our own testicles produce testosterone without the use of TRT along with it. According to Dr. Crisler, using HCG as sole testosterone replacement option does not bring the same subjective benefit on sexual function as pure testosterone delivery systems do?even when similar serum androgen levels are produced from comparable baseline values.”

It’s possible that my symptoms are not caused by low T (though we don’t yet know of another reason). Since hCG might or might not solve the problem, I decided I wanted to see what effect true direct supplementation would have on the symptoms. I need a definitive answer - even if only for diagnostic purposes. If it is shown to improve the symptoms, then I might try to back-track and try hCG by itself (in any case, if I continue therapy then I will be including hCG).

Given all of this, I got my first injection of 200mg yesterday, 10/18/2013. My second injection of 100mg will be given on 10/29, and then 100mg each week after.

Just before getting my first injection, I got tested for LH/FSH, and got another TT/FT test. Here are partial results (won’t have TT/FT for a few more days):

FSH 2.6 (1.5-12.4)
LH 4.7 (1.7-8.6)

I plan to chronicle my experience with treatment in this thread, and so this is my first entry:

Day 1: Right after my shot, I felt what surely must have been a placebo effect driving home. I had that great feeling of empowerment you get when something in your life has been bothering you, and you finally find a way to be decisively in control of it. We’ll see if that turns out to be true.

Day 2: I can’t say that I feel any change whatsoever, other than that I got an unusually good night’s sleep. In fact poor sleep is one of the symptoms I hope to cure, but last night was probably coincidental (also been getting over a cold which has sapped my energy the past couple of days, so more likely related to that than the shot).

Day 3: Nothing new today, other than my butt is sore from the shot. Feels like I’ve been kicked in the ass by a horse. I’m surprised by this, because the initial shot was essentially painless. Hope it’s not going to feel like this every week (they’ll be 1/2 the size of the first shot). Didn’t stop me from doing my usual Sunday hike though.

Update: Late in the evening, things started to change. There was nothing subtle about it! For no particular reason, I began to feel much more assertive and confident, and suddenly had lots of energy. Was hell on wheels driving, but not in an angry way, just in a very assertive way. I like driving and tend to drive fast anyway, but really had to watch myself. The timing of all of this fresh energy was unfortunate, because it ended up keeping me up 'til about 1:30 (and I have to get up at 7:00 to work out). Still, a GREAT feeling that I hadn’t experience in a long time (if ever).

Day 4: Despite not sleeping well, woke up feeling like a bull! Couldn’t wait to get to the gym. My overall training endurance was low, but I attribute that to poor/minimal sleep. However, my mental energy was still very high, and I bested my previous records by 10lbs - and felt like I could have done more! I had been feeling plateaued in my training lately, so this is a very welcome change. My trainer is aware that I’ve started TRT, and was quite impressed with the obvious result. I understand that the maximum effect of TRT is not expected to be felt until about 4 weeks in, so given how I feel on day 4, I’m almost worried what that might be like. While I still feel very assertive, I don’t feel angry at all. Just very determined - which is a great feeling that I used to have all of the time, but one that’s been missing from my life for years.

Update: This makes three days in a row, where I had an odd set of symptoms that I had previously believed were just part of the process of getting over the cold I had last week. I took Sudafed just a couple of days last week (prior to starting TRT), and my body sometimes has weird reactions to it. Around mid-late afternoon on each of the past three days, I started feeling like absolute crap. Not mentally so much as physically. I had what feels a lot like really bad indigestion but with no acidity. Kind-of a tightness/nausea in the chest area that’s hard to describe. Because I’m really over the cold now, this is starting to seem strange, and I’m wondering if it’s related to TRT. Will watch carefully tomorrow.

vvv Note the post below doesn’t seem to apply to my thread. I think KSman might have clicked a wrong link.

You need to read the advice for new guys sticky and consider the other issues suggested. We need more info about you.

You can check thyroid function via body temperature and evaluate your iodine intake history [important].

Your hematocrit [HTC] was quite high. With TRT, you need to carefully watch that.

You need to self inject 50mg T twice per week. See the protocol for injections sticky [please do not post there]

Labs: - after getting settled on 50mg 2x per week, do labs half way between injections and do not vary that timing

You will probably see total cholesterol come down.

Your ‘decent’ T levels and very low LH/FSH is a problem, should not occur. Please post your labs here that were in my thread so all can be seen.

Take 5000iu vit-D3, find tiny oil based capsules.

^^^ Note the post above doesn’t seem to apply to my thread. I think KSman might have clicked a wrong link.

Day 5: Energy level and mood basically back to pre-TRT levels today. I had some labs done today, and will report the results when they arrive, but suspect my E2 is catching up with the increase in T. Did feel increased energy in the evening after a hard cardio workout. Now wondering if the period of increased energy/mood that I felt in the evening of day 3 was related to the hard cardio workout that I did that day. Maybe the extra adrenalin in my bloodstream from the workout combined with higher T is what caused that effect on both days.

Labs: Got results for lab which was taken on this day. E2 definitely on the rise:

TT: 1380 (250-1100)
FT: 368.5 (35-155)
E2: 50 (8-43)

Day 6: Still feeling like pre-TRT levels today so far.

I’m not an expert … but from my reading, if you start with really historically low levels of T (like I did), it takes a couple weeks for your body to make use of it.

As I understand it, your body needs to produce a shitload of androgen receptors – the little gizmos that drag free T into the nucleas of your cell.

So even if you have lots of T in your blood serum, without the appropriate number of androgen receptors, you’re in a holding pattern.

Speaking from personal experience, my “awakening” followed the standard timeline.

Google time course and TRT - the following is study paid for by Bayer.

Effects on libido, sexual desire, sexual thoughts and satisfaction with sexual life manifest after 3 weeks and plateau at 6 weeks

Changes in erections and ejaculations, sexual performance and satisfaction with erections usually achieved within 3â??6 months

Effects on quality of life evident within 3â??4 weeks and continue to develop for up to 18 months

Effects on depressive mood noted after 3â??6 weeks but may reach a maximum only after 18â??30 weeks

The time course for improvements in lipids varies:

Decreases in total cholesterol and triglycerides appear as quickly as after 4 weeks, but more commonly after 3 months or longer; a maximum may be reached after 12 months

Decreases in low-density lipoprotein (LDL) cholesterol may be slower, occurring after 3â??12 months, with a maximum reached after 24 months

Increases in high-density lipoprotein (HDL) cholesterol may occur after 3â??12 months, with further improvement for 12â??24 months

Effects on glycaemic control become evident after 3â??12 months, although insulin sensitivity may improve within a few days

Changes in fat mass, lean body mass, and muscle strength occur within 12-16 weeks and stabilize at 6-12 months, with marginal further improvements possible over years

Effects on bone mineral density are detectable after 6 months and continue for at least 36 months

Effects on inflammatory factors and endothelial markers noted within 3-12 weeks
Stimulatory effects on erythropoiesis are dose-dependent and apparent at 3 months, peaking at 9-12 months

Prostate-specific antigen (PSA) and prostate volume marginally rise, plateauing at 12 months; further increases may be related to aging rather than testosterone replacement therapy.

Thanks IareChaz. That’s interesting info.

I have noticed comments from various people in this forum indicating noticeable changes in mood and physical or sexual performance beginning within a range of 2 days to 5 weeks after first injection. I also remember one comment from a person using gel that liked the “daily boost” they felt after applying the gel. Some of the observations of very early effects can probably be attributed to placebo effect. I think it has a lot to do with your starting levels (mine were not so low), and with your overall health (I’m fairly lean, and tend to have amplified responses to many drugs). That’s why I’m paying close attention and chronicling my personal experience here. I was actually surprised to feel anything at all within a few days, and if it hadn’t been such a strong “slap in the face” kind of effect, I would have written it off to placebo effect.

Day 7 to day 14: No updates for a while because there have been few changes. Mostly, some periods of increased energy, and definitely noticing a pattern that those periods can be induced by a good cardio workout (I hike a local hill which has 1200’ of elevation change in 1.4mi). Previously, that hike left me depleted. Now it often leaves me feeling more energetic after an hour or so of recovery. Also, some definite increase in libido, but not feeling like a 20 year old. Morning wood most mornings now, which is a definite change because before TRT it happened so rarely that I almost forgot about it. Got my second injection (now only 100mg) on day 12.

[quote]FeistyOldGuy wrote:
^^^ Note the post above doesn’t seem to apply to my thread. I think KSman might have clicked a wrong link.

Day 5: Energy level and mood basically back to pre-TRT levels today. I had some labs done today, and will report the results when they arrive, but suspect my E2 is catching up with the increase in T. Did feel increased energy in the evening after a hard cardio workout. Now wondering if the period of increased energy/mood that I felt in the evening of day 3 was related to the hard cardio workout that I did that day. Maybe the extra adrenalin in my bloodstream from the workout combined with higher T is what caused that effect on both days.

Labs: Got results for lab which was taken on this day. E2 definitely on the rise:

TT: 1380 (250-1100)
FT: 368.5 (35-155)
E2: 50 (8-43)

Day 6: Still feeling like pre-TRT levels today so far.[/quote]

I bet you would feel much better with a lower E2. Time for Arimidex?

Yes, I am thinking that too. I talked to the doctor’s assistant (who gave me the second injection) about it, and she said I would need to talk to the doctor to get it, but there were no appointments available for weeks. We agreed to see what happens after the second injection. So far so good, but if I feel lousy I will get another E2 lab and take it to next visit.