T Nation

About to start TRT


#1

Like many of you, I've been suffering from low T symptoms which have been steadily getting worse over the past 10 years (weight gain, hard to lose fat, moodiness, loss of motivation and declining libido). Last week I decided to do something about it, got my labs, and saw a doc today. I have a few questions but first my labs and other info:

  • LH 2.2 (1.7-8.6)
  • Test (serum) - 450 (348-1197)
  • Test (free) - 8.1 (6.8-21.5)

Got a bunch of other numbers but unfortunately no estradiol (I will request it next time). Early 40s and 220 lbs @ 25% BF. Used to lift a lot but stopped 7 months ago. Last 8 years or so has been incredibly high stress but I've made some changes and my stress levels are much lower now. Also, I was having a few drinks every day for the past year or so. Obviously not a healthy choice.

I started lifting again a few days ago, cleaned up my diet, and stopped with the drinking. I know I have to make a change and I will.

I tried TRT seven years ago with an anti-aging clinic. They put me on HCG which resulted in massively reduced body fat (30 lbs) and increased muscle mass. Cholesterol and blood pressure dropped to healthy ranges. It was great except that my libido dropped to nothing. I suggested an AI but the doc told me to not worry about it so I stopped seeing him (and stopped TRT, too).

Visited a doc today. He put me on Test Cyp 100ml 1x/week, 250 IU HCG 2x/week, and .5 mg 1x/week. From what I'm reading, this seems like a good starting point.

Finally, here are my questions:

  • He prescribed two sets of needles. 1ml 5/16" 30 gauge and 1ml 1" 23 gauge. Which needle do I use with each med?
  • Does the test cyp go intramuscular in the glutes or can I inject in my stomach fat (like HCG - which I've done before).
  • How long should I expect to wait before I notice changes in libido?
  • My labs didn't include any estrogen which seems nuts to me. Should I insist on them next time or can I just dial in the AI by how I feel?

Sorry if these are dumb questions but figured it would be smarter to ask them than just guess.

Thanks


#2

I think you should hold off on trt, I dont think this is your problem.

Yes you're lower but why??

Lh and fsh should be tested along with a shit load of other things bro...

E2 should be tested before you start so you have something to compare to so you know if a raise or decline in T induced or you have another issue exp liver clerance probs.

If I were you I would not do another shot and read all the stickies here starting with the advice for new guys sticky...

Then thyroid basics

To answer you question you can inject T subcutaneous and that info is the the protocol for injections sticky

Alot to be learned here and we focus on helping each other find the root of the problem..

Adrenals and thyroid seem to be big issues as well as GI issues.

All of the glands must work in uniform or it throws others off.. Everything is relative and TRT is sometimes masking a real issue


#3

Thanks for the advice. I have had my labs run three times prior (full labs) over the past 7 years and thyroid was ok each time (maybe a bit on the low side but well within range). They also checked a battery of other things which I won't get into and ruled out any liver or kidney problems.

I have more complete figures from my last lab (2.5 years ago). Symptoms were about the same, maybe a little worse.
* Total test: 440 (250-1100)
* Free test: 76 (35-1100)
* E2 was 19 (13-54)
* DHEA was 126 (110-370)
* FSH 1.6 (1.6-8.0)
* LH 1.3 (1.5-9.3)
* T3 update: 35 (22-35)
* T4, total: 7.1 (4.5-12.0)
* Free T4 index: 2.5 (1.4-3.8)

Tried Nolva and DHEA after these labs. Got a quick bump in libido but it tapered off.

I know this would be a lot easier if they had run a full set of labs but I can't fix that until next time.


#4

Your levels do not constitute trt..

What was

Tsh

Ft3

Ft4

Cortisol

ACTH

Fasting glucose

A1c

Insulin

C peptide

Cholesterol

You are well within range and I started trt with lower numbers then you much lower and still felt horrible..

Something else is going on..

You have T tunnel vision and will come back after starting and tell us u still don't feel right..

Thyroid lab ranges are not right and doctors are not so smart all the time. We actually use the word idiots alot here


#5

I have now stopped trt and looking for answers.. Trying to help you not make the same mistake


#6

Thanks for your reply. I appreciate your opinion and with all due respect, I've done a lot of research into this over the years. I've actually done TRT before (with mixed results). I consider it an informed decision.

My symptoms are gradually increasing and are typical of andropause: weight gain especially in abdomen, moodiness, loss of libido, drop in motivation, high cholesterol, gradually increasing blood pressure despite a reduction in stress. I used to be able to drop weight very quickly. Now it's virtually impossible to lose weight regardless of strict diet and regular exercise. Equipment works but the desire isn't there like it used to be. I'm not depressed and in fact, I'm a very happy and content person.

Two docs have independently diagnosed me with hypogonadism.

Previous treatment resulted in muscle gain, loss of fat, and relief of most symptoms. My first TRT regimen was HCG and armour. Had a short lived increase in libido. I stopped taking the Armour after awhile and it didn't make a lick of difference. However, my T/E ratio dropped during treatment to 14-1. Libido actually got worse. Doc didn't think that mattered so I quit treatment and it improved (although I lost all of the other health benefits). I didn't know about AIs at the time (this was 2005). Shame because that might've fixed me right up.

A few years later I took nolvadex and saw good improvements and weight loss. However, Nolva isn't a good long term solution and I wanted to do it the right way so I discontinued.

As I stated above, they didn't run all of the labs they should've (especially E2 - I will insist on that next time). Here are some other figures though:

Serum cholesterol: 100 (97-108)
Total cholesterol - 241 (100-199) HIGH
Triglycerides 240 (0-149) HIGH <-- this has responded excellently to exercise and TRT in the past
VLDL cholesterol 48 (5-40) HIGH
LDL Cholesterol 146 (0-99) HIGH

CBC with differential/platelet labs are all well within range.

LH is low. Total test is decent but free test is hugging the bottom of the range.

I also showed some mild inflammation of the liver from drinking but nothing serious. Kidneys good. Doc says thyroid is fine (he's a TRT doc). Previously had extensive cardiac testing done through Spectrum Analytics. Decent genetics but I am predisposed to CVD... my body responds very poorly to excess weight and right now I'm 30 lbs over.

It has to be fixed. My BP was super high (167/110) so the doc also put me on BP medication. It's been two days now and my BP has dropped to 118/67. I already feel a big difference, my mood is so much better and I don't feel pressure in my head and chest when I'm working out. Hopefully this will correct itself when the weight comes off.

From your post, I gather that TRT did not work for you and you are unhappy about it. Everyone is different so the fact that I'm not sure that it means anything that your numbers were lower than mine... what does matter is that my free test is so low.


#7

Lol fill your boots...your levels are not even bad and you can increase free T naturally

Go to a trt doc and he will tell you u need trt.


#8

How do you increase free test naturally?


#9

What time were your labs taken?

Where are you from?

Maybe try reading the advice for new guys sticky and editing your first post and add in all info so someone can help you better.. I'm sorry I am kind of on a no trt kick right now and that may be getting the best of me.

I wasn't trying to downplay your situation and I apologize cause after reading my own remarks I feel I may have come across rudely and that is not my intention


#10

LH moves a lot during the day, FSH is steadier and really a better indicator of LH status than LH itself.

Your problem may involve elevated E2 and that in turn can be caused by liver issues, so we want to see AST/ALT.

Do not believe that when your labs are normal that there is nothing to worry about. Docs have blind spots caused by been focused on disease management instead of optimizing your health.

Your old hCG treatments may have failed because dose was too high creating high estrogen levels.


This is standard advice maintained here:
http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/please_help_me_refine_standard_advice

There is a huge amount of knowledge in the stickies. Please study these. Start with the advice for new guys sticky.
http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/prototype_advice_for_new_guys
There is a lot to read there, so read carefully. There are suggestions for things that are root causes of low testosterone [T]. Low T is a symptom, not a root cause itself. But low T itself is a root cause of many of the symptoms one experiences. Note that other things cause the same spectrum of symptoms, so do not have T tunnel vision. Many docs are guilty of that and they only treat the symptom [low T] and do not attempt to find the real problem. If you go to a clinic that specializes in low T, you will get T tunnel vision for sure.

Post info about yourself as suggested in the above sticky. We need labs, almost all of your labs, not just hormones. We also need the lab ranges.

We see a very high number of thyroid issues in the population of guys that show up here. So there is a strong focus on that. Most people are iodine deficient to some degree. Your history of iodine intake from iodized salt and vitamins that list iodine is important. If you become iodine deficient, the RDA [recommended daily allowance] is inadequate for recovery of iodine stores. Please see the thyroid basics sticky for more information.
http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/thryroid_basics
You do not want to suffer from subclinical hypothyroidism or get Rx thyroid meds to treat iodine deficiency.

If you are injecting T or contemplating that, read the protocol for injections sticky.
http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/trt_protocol_for_injections

There are stickies for finding a TRT doc, estradiol [E2] and lab work.

Do not place your history or treatment details in the stickies! That belongs in your thread. Keep all of your posts in your thread so we can have a clear picture of your situation and needs.