52 Y/O Just Starting Out

Pharma / TRT Testosterone Replacement
1

I’ve been reading through many of the threads and stickys and probably have information overload right. This site is by far the best site I’ve found about the subject.

I’m a 52 year old male, 320 lbs and morbidly obese, never paid that much attention to my health until now as I seem to be going downhill fast compared to others my age. I didnt have a weight problem until my late 30s. I worked in nightclubs…drank alot/smoked alot until around 40 when I became a trucker and on the road for a month at a time. I was very social but have become withdrawn from family and friends yet I do not feel depressed.

I hope to change things around before its too late if not already. I stopped smoking and drinking when I started trucking. I’m currently recovering from hernia surgery and at home. I hope to get as much done while I’m home. My pcp did some test and found I have low testosterone 194 and gave me a prescription for androgel. I went to pick it up today and despite having BCBS the cost was absurdly expensive at walgreens $1252 and so I didnt take it…Called my dr office and they are looking into alternatives and will get back with me.

Here are my lab results. I’m not sure which important for this subject so will list everything.

Testosterone, total 194 (280-800ng/dL)L
FSH 6.2 (1.5-12.4 mIU/mL)
LH 5.8 (1.7-8.6mIU/mL)
Testosterone total & free 21.9 (35.0-155.0pg/mL)
*PSA 0.5 (<=4.0 ng/mL) on the bloodwork sticky thread it said dont do PSA test within 48 hours of ejaculation which I probably did within that time period so I dont know if it might affect the results

WBC 10.0 (4.0-11.0)
RBC 5.28 (4.30-6.00)
Hemoglobin 15.0 (13.0-18.0)
Hematocrit 46.1 (40.0-53.0%)
MCV 87 (78-100)
MCH 28.4 (27.0-34.0)
MCHC 32.5 (31.0-37.0)
Platelet Count 316 (130-450)
RDW(sd) 46.3 (36.0-55.0)
RDW(cv) 14.6 (12.1-18.2)
MPV 11.3 (7.5-14.0)
Segmented Neutrophils 61 (40-85)
Lymphocytes 26 (10-45%)
Monocytes 7 (3-15%)
Eosinophils 5 (0-7%)
Basophils 1 (0-2%)
Absolute Neutrophil 6.1 (1.6-9.3)
Absolute Lymphocyte 2.6 (0.6-5.5)
Absolute Monocyte 0.7 (0.1-1.6)
Absolute Eosinophil 0.5 (0.0-0.7)
Absolute Basophil 0.1 (0.0-0.2)
Immature Granulocytes 0 (0.0-0.1)
Absolute Immature Granulocytes 0.0 (0.0-0.1)
Glucose 95 (65-99) *fasting
Urea Nitrogen (BUN) 9 (8-25)
Creatinine 1.01 (0.60-1.50)
GFR Estimated Non-African American 85 (>=61)
BUN/Creatine Ratio 8.9 (10.0-28.0)
Sodium 140 (135-145)
Potassium 4.3 (3.5-5.2)
Chloride 102 (96-110)
Carbon Dioxide 23 (19-31)
Anion Gap 15 (4-18)
Protein,Total 7.0 (6.0-8.0)
Albumin 4.5 (3.3-4.9)
Globulin 2.5 (2.0-3.7)
Albumin/Globulin Ratio 1.8 (1.0-2.0)
Calcium 9.8 (8.3-10.4)
Alkaline Phosphatase 52 (40-129)
Alanine Aminotransferase 16 (5-60)
Aspartate Aminotransferase 14 (10-50)
Bilirubin, total 0.5 (0.2-1.3)

Cholesterol 237 (<=199)
Triglyceride 237 (<=149)
Cholesterol/HDL Ratio 5.5 (<=4.9)
HDL Cholesterol 43 (>=40)
Non-HDL Cholesterol 194 (<=159)
LDL Cholesterol,Calculated 147 (<=129)
VLDL Cholesterol 47 (<=29)

52 years Old
320 lbs 6’1" with 48" pants size
sedentary (would like to change that but just have no energy or drive to move). I’m always sluggish.
Most fat in in my belly (I look pregnant) with man boobs, i do have evenly thick legs
No RX as of yet, sometimes take mutlivitamin and fish oil
Mostly fast food diet but trying to change…very addicted to Diet Pespi(drink 3-4 liters a day, most of the time my only liquid intake)

moderate body hair, fairly thick head of hair, takes about 4-5 days before I need to shave.
aches-recently been having knee problems and occasional get a migraine tha last for about 20 minutes.
Dont really have morning wood or a sex drive but “take care of business” every morning so that might have something to do with it

My doctor will be getting back in touch with me in the next day or two about the androgel cost problem. Should I start TRT injections or do I need additional test to check for something else. Thank you so much for any feedback. I will be spending alot of time trying to educate myself from this site and will be going though as many threads as possible. I really want to change my health around.
Thank you

2

You need to have at least 2 tests to confirm you hypo gonadal.

If you get the second round of tests with similar LH,FSH, and TT/FT then you would be best served with TRT. Don’t mess with the gels, just get the injections because they are more reliable and cheaper.

You need to get your diet under control. You would lose weight just by eating healthier. You are also more prone to type 2 diabetes and heart attacks with your lipid levels the way they are.

3

You did not get your thyroid tested. Please see the thyroid basics sticky and check your body temperatures and evaluate your long term intake of iodized salt [Post response.]. When you were eating bar food and trucking, you probably were not getting any iodine and would have been iodine deficient. The result would be functional hypothyroidism and weakness and weight gain result from that. Post response.

You have primary hypogonadism [high LH/FSH and low TT, FT].

Do you have any pain or ache in your testes?

Your labs are very clear and self consistent and fit your symptoms. You do not need any repeats.

While estrogens and/or prolactin are not responsible for your primary hypogonadism and obviously are not causing secondary; these things need consideration. You must be testing E2 and I would like to see that tested ASAP. You probably will need anastrozole with your TRT.

Anticipating E2 problems, you would also want to avoid transdermal T because that has the highest T–>E2 potential of all T delivery methods.

Injected T is the least cost method and 100% delivery. Also least E2 potential when injected often. Once a week is not good enough!

hCG will preserve the appearance of your testes. hCG will not do much to contribute T to your TRT.

Back to thyroid: If you have problems with that which is restricting your energy and metabolism, TRT can make you crash as the increased metabolic demands of restored T levels exceed what your body can deliver.

If you have consumed a lot of orange or citrus oil flavored sodas over the years, you could have a lot of bromines in your body that are occupying roles where iodine should be. The only way to displace the bromines would be high dose iodine replenishment, which you might need anyways. Before you start taking iodine, you must be on a multi-vit that contains selenium and other trace elements.

Labs: -now
E2
TSH, fT3, fT4 [not T3, T4]
IGF-1 [determine growth hormone status]
DHEA-S
and monitor HTC with every future lab.

PSA is good. But a DRE is advisable and PSA should be monitored and retested at 6 months.

Based on your weight:
150mg testosterone cypionate per week SELF injected in divided doses at least twice per week.
1mg anastrozole per week in divided doses, see stickies

If you really have gyno, with developed breast tissue, you might be benefited with Nolvadex 20-25mg EOD.

To loose weight:

  • keep E2 in lower 20’s
  • achieve high normal TT, and FT. TT can be 1000-1100
  • thyroid hormones need to be optimal and body temperatures good as per the thyroid basics sticky
  • proper balance diet
  • supplements

When you loose weight, you will be freeing up stored fat soluble toxins in your fat tissues and this may make you feel off at that time.

Supplements:

  • high potency multi-vit with iodine, selenium and other trace elements
  • fish oil, flax seed oil/meal, nuts
  • DHEA probably needed, check DHEA-S labs
  • vitamin C and other anti-oxidants
  • natural source vit-E
  • 5000 iu vit-D3, comes in tiny oil based caps. Start with 25,000 per day for first 5 days.
4

I have made an appointment to see my pcp tomorrow afternoon to get the additional tests done. I was matching up the test names with the lab my doctor uses, Sonora Quest. Is fT3 and fT4 tests the same as Free T3 and Free T4 test as thats what Sonora Quest list as some of the available tests. Until recently none of this was of any interest to me so I’m trying to educate myself , learn the acronyms, and absorb as much information now as I can. The cost of Androgel has turned out to be a blessing in disguise as I no longer wish to use transdermal T and it will give me an opportunity for further testing and research. I do not have any pain or ache in my testes.

While I’m home from the road recovering form surgery, I’m working on improving my diet which I hope will translate to better eating habits while traveling. My aunt was a type 2 diabetic and I know I’m pretty close to heading down that path too along with my lipid levels.

My Iodine is probably dreadfully low. I checked a food list with high iodine levels and really didnt consume much from that list as I dont care for fish or any type of seafood, probably my best intake coming from the occasional steak and baked potato with skin at a truck stop restaurant. I dont have a thermometer so heading out this afternoon to get one and will start tracking my body temperatures and post them. I’ll pick up a high potency multi-vitamin, and vit-d3 as well.

5

If you have thyroid issues, you probably would not absorb transdermal T anyways.

You cannot get enough iodine from food. And there are vast areas of North America where people eating local foods had goiter and cretinism.

The advice for new guys sticky is your best reference for the lingo.

6

Got my requested bloodlab results today and my first shot of 200mg/ml of test cyp. My doctor is starting me out with one shot every 4 weeks but wants new blood tests at the end of 4 weeks and said that we will probably have to go to every 2 weeks injections at that point.
Here are my lab results for the 10/22 test
DHEA-S 141(70-310)
Estradiol 12(8-43)
Estrogen Total 194(130 or less)
IGF-1 188(50-317)
Z-Score Male 0.6(-2.0 - +2.0)
T3 Free 2.8 (2.0-4.8)
T4 Free 1.4 (0.8-1.7)
TSH High Sensitivity 0.96 (0.45-4.50)

My estradiol seems to be in normal range but my total estrogen is high. The doc put me on Anastrozole 1mg tablet per day. Based on what I’m reading that is way too high of a dosage and that I should be taking 1/4 that amount.

7

This is all wrong and your doc really does not have proper approach to this.

What is wrong:

  • your T levels will go way to high, promoting a lot of E2
  • your T levels will crash after one week and E2 will linger and you will not feel good
  • SHBG will increase, so at times your FT will be lower than pre-TRT and you will feel worse
  • anastrozole will only affect E2 and will not have any direct effect on the other estrogens estrONE [E1] and esTRIol [E3]
  • anastrozole dose needs to match your serum bio-T levels which are spiking and crashing, your anastrozole dose will not be enough to manage the T peaks and will be drive E2 dangerously low when T levels crash.
  • you will never have E2 controlled and will never be balanced
  • [injecting once a week has same problems]

Your E1 and E3 are high because you have abnormal metabolization of estrogens. Might be an effect of your % body fat. Can also be from effects of adverse flora in your gut where hormone metabolites in liver bile are reactivated and re-absorbed. Find a good quality probiotic from a health food store that is stored refrigerated and has many different bacteria strains. You will need to take for a while to change your gut flora. That is different from reestablishing flora after a course of antibiotics or a clean out for endoscopic exams. Some supplements can alter the E1, E2, E3 profiles, but I cannot remember any of that.

Alanine Aminotransferase 16 (5-60)
Aspartate Aminotransferase 14 (10-50)

  • no obvious liver issues that would affect estrogens

Tell doc that you want to:

  • self inject 50mg T cyp twice a week
    – use #29 1/2" 0.5ml insulin syringes, $14 per 100 at Walmart/Sam’s, ReLion house brand, no Rx needed in most US States or Canada.
    – inject SC in belly fat or over upper leg, whatever seems more comfortable
    – IM injections are not needed!, above syringe will do IM if you find more comfortable, but legs have to be more lean for that.
    – [some inject T EOD]
  • take 1/2mg anastrozole at time of injection
  • always do lab work 1/2 way between injections, not at random day of visit to doctors office
  • you will have steady T levels
  • anastrozole dose can be steady against steady T levels
  • anastrozole dose can be adjusted to get near E2=22pg/ml using linear calculations [see stickies or ask here later]
  • when fine tunning E2 and anastrozole, you cannot do that cutting 1mg pills, better to make up a solution of pills in vodka and you then have dose increments by the drop. Get a dropper bottle and perhaps 28 drops per ml. Make 1mg/ml. You need to count the drops as that will vary depending on the dropper and the solution [you cannot get the count with water].

TSH is good
fT3=2.8 - should be near 3.4, this is a problem
ft4=1.4 - should be near 1.25

You have enough fT3 but fT3 is lagging. This can be from some mineral deficiencies. See supplements that I suggested earlier. Note the trace elements selenium and iodine!

Low ferritin can also reduce fT4–>fT3.

WHERE ARE YOUR BODY TEMPERATURES? *****************************

WHAT ARE YOU DOING ABOUT IODINE?

Success factors:

  • self inject
  • get near E2=22pg/ml
  • resolve thyroid issues

You need good T and E2 values and good thyroid function to loose weight.

8

I decided to discontinue TRT. My question is: Does anyone know of any issues I may have after just the one dose and how long before my body returns to my pre-trt level.

I had my one injection on 11/5 and while I understand that my doc didnt give me the proper trt regimen,the days following were less than what I had hope for. It was just so-so…but with problems.

Observations and Issues:
After my injection, I felt no noticeable increase in energy or outlook. The only thing I did notice as most other’s have, is morning wood(on it’s own & without any help from me)for the first time in I dont know how long. To me, an increase in libido is not a selling point as I’m a single 52 year old fat guy with no interest in sex, dating, romance, or love and I’m content in keeping it that way. The last thing I need is a high sex drive just to make me frustrated about having no sex life.

My doc prescribed 1mg a day of Anastrozole because my other estrogens were high although my e2 was low. I knew this was a high dose so I started out just doing 1mg every other day. By the second dose of 1mg Anastrozole, I was feeling extremely weak about 5-6 hours after taking it. I felt like I was having heart murmurs and my heart felt like it was being squeezed and pulled down in my chest by an 80lb weight. I stayed in bed all day and this lasted until the next morning. I then decided that maybe the 1 mg eod was high and got a pill splitter and took a .25mg 3 days later and experienced the same thing later in the day with my heart. I took a blood pressure reading and it was around 95/55 with a pulse around 90 (despite being fat, my bp is usually around 130/80 with no meds).

Although most guys seem to benefit from TRT, I dont seem to be one of them and the risks outweigh the slight reward I got. Being a trucker that is only in town once a month(still on medical leave right now though), the thought of trying to “fine-tune” TRT sounds like a nightmare. Unless I have an ailment that is a physical obvious like a wound that needs stitching or my recent umbilical hernia that looked like I was about to give birth to an alien in a sci-fi movie, I’ve never had any faith in doctors. It just creates bills. During my brief TRT, does it shut down my FSH and LH and my body making its own testosterone. How long before I get back to “my” normal?

Thanks for all your help and the advice/education I’ve received.

9

It’s not realistic to “feel” any different after 1 injection. Most guys report that it takes 6-12 weeks to start feeling better…but that’s on a reasonable protocol such as weekly injections. The protocol that your doctor suggested is a recipe for failure.

I can guarantee that the reason you felt so terrible after your injection was the Anastrozole. Your doctor had you on a VERY high dose, especially for somebody who already had low E2 levels. Your E2 crashed.

10

After thinking it over more this afternoon I decided not to “give up” so easily and ordered my own blood tests online for e2 & test and see exactly where I’m at right now midway through the 4 weeks. I completely stopped taking the Anastrozole and will take more info to my doctor at my next appointment in 2 weeks.

I had mentioned to them the protocol that KSman had suggested but will be a little more insistent on weekly injections next time. My morning body temps have been low consistently in the 96.2 range and have been taking a daily with 55mcg selenim and 150 mcg iodine since 10/21. I will increase that with a kelp tabs.

11

150mcg iodine is treading water and will not work as IR.

Most kelp products are not much better.