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6 Months of Ineffective TRT; Latest Labs Posted. What Next?

I have posted a few times, asking general questions and have gotten some advice, some of which i have taken and some of which conflicts with other advice i have been given.
Any way after 6 months on TRT, I am feeling no symptom relief. I will post my initial labs showing how i ended up TRT in the first place. My symptoms were lack of sleep 2-3hrs a night would be a good night, fatigue, poor memory and mental acuity, low libido and ED.
I read all the wonderful things about TRT and was told the same thing by my healthcare provider. I was expecting the clouds to part and the sun to come beaming through, a sense of euphoria, energy and libido of my teenage self. I am still waiting.
When I started my protocol i was started on 100mg/week which i was told was a pretty aggressive starting point but given my low level seemed appropriate (starting level was 86.5ng/dL; when converted from the reported SI units)
After 2 months on that protocol i was upped to 140mg/wk with prescribed AI. after some research on here i split dosage into every 4 days, then later to daily and eliminated AI.
So for the past 6wks have been on 20mg/day of t-cyp plus 15mg DHEA. Sleep might arguably be slightly better but no other positive results. Libido and ED are the most problematic, used to be overcome with Cialis (20mg) but since starting TRT that doesn’t work either.
It has been recommended to increase my dose to something like 30mg/wk, however i don’t have a stockpile of test to do that. I already think i’m going to run short on my current supply as injecting ED leads to more waste. So i will continue to run current protocol until i get my labs done later this month. But what tests should i be requesting? I have asked for TT and free T, since my free T has never been established.
My last labs at the start of January after switching to current protocol for a couple of weeks were:

Compare those to my initial labs that were a little more complete:

let me be the first to reply to my own post to say, this is the bloodwork form that i currently have, im sure my healthcare provider will add to it if requested

Your Free T3 started low. When converted to pg/ml, it calculated to 2.5pg/ml. Normal is 2.4-4.2pg/ml. I would recommend retesting Free T3 as you likely are not making enough Free T3 since starting TRT.

Hypothyroidism and/or adrenal insufficiency will prevent TRT from working. This is why you have no libido and ED. Also, do a 24 Hour Saliva Cortisol test to see your free cortisol levels. Blood test for cortisol is not helpful as it measures bound cortisol. Have you taken antibiotics in the past? How are your bowel movements? If they are loose, mushy or poorly formed you may have intestinal dysbiosis. Bacteria/fungal overgrowth (Candida, etc) will weaken your adrenal function (Cortisol production). TRT makes this problem worse as it suppresses cortisol production as well as the HPTA.

Increase your Vitamin D3 to 10,000IU daily for 3 months and retest. This is a safe dose and can be taken for upwards of a year, probably more. Once you are at the top of the range, you can back off to 5,000IU daily for maintenance.

Anyone with 3.0 nmol/L (86 ng/dL) pre-TRT more than likely has super low SHBG and the high dosing might not be appropriate and if you do have low SHBG, high testosterone is might actually be why you don’t feel any benefits.

This is because everyone is different, I didn’t feel hardly any benefits at high levels, in fact dropping the dosage down worked wonders. Less is more in my case. You’ve only been on the daily protocol for 6 weeks, a little too early to be feeling the full benefits of TRT and the previous protocols were a little aggressive.

I think once you get your SHBG and Free T levels measured, I think things will become more clear because I believe your levels are too high in previous testing if I’m correct about the low SHBG theory.

Or he may need more provided he doesnt feel symptoms relief? I didnt read him saying experiencing side effects so he is not overdosed. On the other hand his hct was quite high before staring, he may be already borderline high there. But still numbers are relative, symptoms should guide us

As a beginning I would drop the dhea on your place. I experimented a few days with dhea lately and it destroyed my libido. Also if you are still taking AI this can be messing how you feel

Check your complete blood panel as well especially the hematocrit

If you don’t have enough SHBG, you can’t play this TRT game, SHBG hands out all the cards, if SHBG is in the single digits, all the testosterone in the world will never be enough and knowing how androgens suppress SHBG, more isn’t always better.

The SHBG transports androgens and estrogen in the blood and regulates their bioavailable fraction and access to target cells. His pre-TRT Total was 86 ng/dL, that would most likely put his SHBG is extremely low.

i had shbg tested once a couple years ago; it was 20.5 (10-70 nmol/L)
this was a couple years ago, and an acting Dr started me on androgel for a few months until my own Dr returned from sabbatical and stopped the treatment, saying i was in range and they were not playing god.

It’s strange how TRT is perceived in western medicine, the very nature of a doctor in to intervene and reverse the natural process of dying, if that’s not playing god, I don’t know what is. God created testosterone, it’s not the devil.

Anyway TRT suppresses SHBG and if it was 20 pre-TRT, surely it’s much lower now. The T creams seem to have no impact on SHBG levels.

Couple things from my experience.
I had to stop DHEA because it tanked my libido.

It took 4 months, an increase to 220mg/week (everyone is different) and some mental work for my ED to go away. In my experience and from what I’ve read of others, this area takes more time than you would think.

Probably converted the DHEA into way too much estradiol. There are many factors that impact libido once TRT is initiated. Most men need a LH analogue (HCG) to convert Cholesterol downstream to other important hormones, Cholesterol>Pregnenolone>Progesterone>DHEA>etc. TRT makes this process diminish, sometimes significantly and it causes loss of libido/ED.
Always best to check thyroid and cortisol as well.

Wow, that’s a new one. I’m not sure if it’s better or worse than the “cocaine makes you feel good too but that isn’t healthy either” line that most of them use.

That’s the stupidest argument I’ve ever heard though. So he thinks it’s fine to use crazy drugs that humans have developed that most definitely are NOT natural but it’s not OK to give a reasonable amount of a hormone we’re all supposed to have anyways?

What about insulin? Is he playing God by giving diabetics insulin too?

I’m not all that confrontational usually but some of these docs need their ass kicked. Then they need their head pulled out of their asses.

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I know this is, but I think we are oversimplifying the effect of SHBG. The science doesnt yet know the whole story around it

The best doctors I know dont base their protocols on SHBG, they dont follow it but follow the symptoms

We know the symptoms of androgen deficiency, we know the symptoms of overdose all else is relative.
As I understand this guy has symptoms of deficiency still, am I right?

Once again, no correlation between these two variables.

Untrue

I feel good on TRT (when I’m using test) I just don’t like the cystic acne, body hair growth etc… my shbg was last tested at NINE

Androgens tend to suppress SHBG regardless of initial concentration… also SHBG is prone too fluctuation, I’ve had tests as high as like 27

@dbossa going to use you as my backup, my ace card in case I’m ganged up on here lol

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I concur

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@systemlord no, just no.

Friend of mine has SHBG of 8. He’s doing very well on TRT. His standard dose is 140mg a week and can trippe his dose with zero I’ll effects.

I know tons of guys with SHBG under 15. Mine hovers around 18-20 which is low-ish.

Crisler uses to reach that SHBG was “the cornerstone of TRT”. We know better now. The same principles apply with high SHBG and low SHBG guys. Low SHBG guys tend to do better with more frequent injections but that’s about it. Dose wise, doesn’t make that much difference.

@unreal24278 is correct here

I tend to disagree with this too, however perhaps I’m an outlier… I can be relatively happy shooting e2w so long as my nadir doesn’t fall below 600 (fat peaks at the start though… you’d be looking at a 2400ng/dl + or so peak!!! So I’d have to shoot like 400mg e2w (I’ve done it before when travelling to great success)

Are you sure about this? This guy has been on TRT for years, 200mg once a week and feels great.

SHBG 3-1

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This guy needs to get his health in order. SHBG of 3 is typically not a good thing. But, yeah, you’ve proven your point with it regardless lol

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thanks guys for all your responses, but this has ended up as a bit of a debate, which would lead me to believe (based on my initial question of which labs i should request) there’s not much point in testing SHBG as i’m injecting daily anyway, just adjust dosing amount.
I will ask for 24hr saliva cortisol as well as thyroid panel in addition to what’s already ordered (FT vs TT, should give somewhat of an indication of what SHBG in anyway, correct?)

Unless it’s induced due to genetic variables… SHBG of 3… just lol

But… genetics can be everything