T Nation

A Lfetime on TRT


i am not natively speaking English so please forgive me for my bad English.

-age 36
-height 185 cm
-weight 77 kg
-permanent primary at 4 years old.
-majority of fat around the middle of the body.
-very watery body fats.
-Gyno between lvl 1 and 2 , not extreme , started at 8 years old.
-started taking T-injections at age 12 then all secondary sex characteristics started to get normal very slowly, and at 19yo i decided by myself to boost T 250mg every week for three months then stopped for three months and repeated once more, i got huge development and good and satisfying results that i guess stopped developing at 22 years old.
-body and facial hair: normal
-health condition is generally normal with laziness most of the time.
-almost permanent tension headache on the left side.
-never took any hair loss drugs or prostate drugs.
-not over training
-normal morning wood and nocturnal erections but reduced when there is no T injections available where i live, it happened several times and restored after resuming T-injection.

the problem:

-as you can see i was not educated at all about taking care of TRT, it was only T-injections 250mg every 4 weeks as doctors recommended.
-my last blood works was 15 years ago.
-now i am generally concerned about the whole thing and want to fix things that must be fixed if any, and really need to fix Gyno and watery look by any mean.
-went to doctor and gave me nebido and letro 1.25mg ED targeting gyno, i have been on this for 1 week now. his plan is 3 months on these.

-blood works with ranges : (8 days a go)

FSH 15.0 mIU/ml range 2.0 - 18.6
LH 8.0 mIU/ml range 1.7 - 11.2
E2 62.8 pg/ml range 10 - 52
Prolactin 11.39 ng/ml range 3.6 - 16.3
TT 14.90 ng/ml range 2.5 - 11
FreeT 33.50 pg/ml range 1 -28.3

my questions please:

-is letro effective in this gyno case?
-is Letro side effects could be easily undone like reduced libido just by reducing dosage?
-what else should i be woried about?
-is hCG essential? i mean is it a must and what are the benefits? and what is the product name (like femara for letro)?
-could i take additional T injections while on nebido if it is not sufficient? i know it defeats the original purpose of stable T of the nebido?
-what can lower prolactin and what if its lowered more than it should?
-what exactly blood works are need other than the above?
-many other questions to follow.

i already learned alot from this forum specially KSman posts.
i extremely appreciate your time and kwnoledge, can’t thank you enough.

Do you have testes now? If not, hCG has zero value. I also assume that your are sterile and then hCG to preserver fertility would not apply. hCG is hCG, brand name is meaningless. Otherwise hCG is only ever needed when LH is low, not your current situation.

You need to explain nebido dose and when your labs were done relative to prior injection.

At time of the lab work, LH/FSH were very high, indicating that your hypothalamus was not detecting T and estrogens and was telling your pituitary to produce LH/FSH, or your pituitary is stuck turned on producing LH/FSH. Do you have a pituitary tumor?

Letro and other competitive aromatase inhibitors [AI] [anastrozole]: These need to match serum T levels. Nebido is long acting and levels change a lot. You would be better off self injecting T twice a week to get steady T levels so your AI can work properly.

Your E2 is clearly too high and you need to get near E2=22pg/ml - 80 pmol/L
I cannot recommend what to do without more info. Your E2 is too high, not low enough to fight gyno.

letro 1.25mg ED is a huge dose. Normally I would say that high LH is causing high T–>E2 production in your testes and a competitive AI cannot work inside the testes. I really need to know what your ‘primary’ really means.

With your TT, FT and E2, your production of LH/FSH should be near zero. Something is very wrong.

Please read the above multiple times until you understand.

Your post was extremely well written!

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.

thanks alot for fast responding KSman

yes one teste was removed the other was undescended on birth and later couldn’t be found, now hCG is understood but is it contribute to fat distribution and watery issue?.

Lab works done after 6 days of last T injection 250mg. Doc said a nebido shot every 3 months.

actually i do not know, seems like i have more important things than gyno to be worried about. would you please advice me more about this. (peripheral vision is ok and vision generally is good)

i totally do not mind do self inject, is this could be done now i mean i just took nebido last week and it should last for 3 months?
i can do another lab work if needed.

is it possible i got inaccurate lab work results? i really nee to understand LH&FSH seems complicated in my case.

i really appreciate you time and efforts, thank you so much.

With no testes, hCG has not function for you. hCG functions as LH and is needed for TRT guys who have LH/FSH–>zero. And as you have lots of LH, no need to replace that.

Your high LH/FSH while on TRT with decent T levels is abnormal pituitary activity.

hCG and LH/FSH should not have any effect on fat. E2 and [other estrogens?] are the major factor.

You need to address issues with your iodine intake and oral body temperatures, see my first post.
You have no need for hCG for two major reasons, plus no need to preserve fertility.

When labs seem impossible/improbably, repeat labs are a good idea before you take any action based on the results. So repeat labs then is same MRI of pituitary/hypothalamus.

It will take time to get rid of nebido. Meanwhile you can get doc on board with a plan. We do not know where T and E2 levels will go with nebido and the lab results on 250mg T injection are not actionable as they do not tell you where you soon will be. I think that E2 management is your most urgent concern, but for reasons stated above, difficult. Get repeat labs TT, FT, E2, LH/FSH then MRI if labs show same improbably results.

Prolactin looks OK. Some meds can increase. Dostinex/cabergoline 0.5mg/week lowers prolactin. Many have low prolactin and some via Dostinex and no adverse effects of low prolactin are known.

We know that there is no testicular T–>E2 that could be driven by high LH. So concerns about Letro or anastrozole not working in that context simply do not exist as a explanation of elevated E2.

Men and women can produce some T and E2 in their adrenal glands, but these levels are very small. But with some odd pituitary activity, other hormones should be screen: AM cortisol at 8AM or 1 hour after waking, IGF-1 to eval GH status, thyroid panel [TSH, fT3, fT4].

honestly i started to panic about this abnormal pituitary activity, would you please suggest proper Lab Work timing and what exactly it should include?

i assume doing:

[ LH, FSH, TT, FT, E2 ] ASAP

then 2 - 4 weeks later do

[ LH, FSH, TT, FT, E2, IGF-1, TSH, fT3, fT4 ]

what do you think?

thanks alot.

If first set of labs shows same pattern, try to get the MRI to see if hypothalamus or pituitary appear abnormal.

Then the expanded set of labs to see if other pituitary hormones are odd. That does not need to wait for MRI results or determination of doing the MRI.

Do not see why the second set of labs repeats the same items that would then be tested for the 3rd time.

Silly question, did prescription for letro get filled with a SERM like Nolvadex or Clomid? At least that might make some sense of the labs…

Letro does not have any direct effects on LH/FSH, SERMs increase LH/FSH and larger doses of SERMs lead to high E2 levels.

headache could be tight muscles in your neck

If it’s your first nebido injection then there won’t be much change to your t levels, if you have been injection something else and have now stopped your level will likely drop as well, Nebido is long acting and it also takes quite some time to get stable, you won’t get the full effect of Nebido until after about 3 or 4 injections

Also, after your first injection you would need a 2nd injection at 6 weeks notice at minimum - this is standard practive

No, i never took anything all my life but T and only a week ago got Letro. i am going to get lab works with the expanded set immediately.

yes you are correct, but i am going to discuss getting back to the regular T injections with my doc.

thank you guys.


sorry i know i am late, had to be out of town for work, now after exactly 30 days on my TRT (nebido shot and letro 1.25mg ED) i have my new labs.

@KSman would you please review my case and take a look here:

FSH 50 mIU/ml range 2.0 - 18.6 (was 15)
LH 19 mIU/ml range 1.7 - 11.2 (was 8)
E2 12 pg/ml range 10 - 52 ( higher than i expected with ED 1.25mg letro )
Prolactin 4.6 ng/ml range 3.6 - 16.3
TT 4.1 ng/ml range 2.5 - 11 ( lower than i expected - nebido peak 30 days )
FT 11.1 pg/ml range 1 - 28.3

fT3 2.34 pg/ml range 2.1 - 3.8
fT4 0.97 ng/dl range 0.8 - 2.0
TSH 0.96 uIU/ml range 0.5 - 8.9

i need to understand is, FSH/LH raised because nebido low T supply? or lowering E2? or what?

thank you very much.

any thoughts sir @KSman ? greatly appreciated