T Nation

Advice Please? Is My Dr. Insane?


#1

First time post here, just questioning the sanity of my prescribing physician.

I'm 21 years old and started on a dose of 100 mg/week dual testosterone (50/50) enanthate/cypionate to treat symptoms of fatigue, low libido, and weak erections. I was injecting 100 mg once weekly for about 6 weeks before my next blood work, after the results were in my provider bumped me up to 200 mg split into two injections. For the next several weeks I stayed at this dose of 100 mg Monday and 100 on Thursday.

The next round of blood work came back and I received a call asking if I was still on the test injections and then was again bumped up ANOTHER 120 mg. I am currently on 320 mg/week... 160 mg Monday, 160 mg Thursday with 500 IU HCG/week. I was also on anastrozole but my levels had dropped lower than expected when taking it at 200mg so it was discontinued. After reading about the dosing that most people are on for TRT and how strict some of the docs out there seem to be I'm kind of curious why the hell i'm on such a high dose.

Is it possible to metabolize testosterone in amounts this large to the point some need a crazy high dose? I would like to hear from someone more knowledgable about dosing as I feel my "case" is unique. I have my full lab panel from before I started TRT but am not sure what are necessary to post. I will be glad to post whatever information or if I am in the wrong place to be posting this I would greatly appreciate if someone could point me in the right direction :stuck_out_tongue:

Thanks,

Eml


KSman is Here
#2

We have a few guys here who are hyper-metabolizers of T who need 300mg/week to get to where most guys are on 100mg/week.

In these cases the effective half-life is also shorter, so injecting twice a week may not be sufficient.

You can try 100mg three times a week. That will be 0.5ml of 200mg/ml testosterone.

Do labs 1/2 way between injections to get a measure of your average levels.

Anastrozole needs to match serum T levels. If T was low, anastrozole could take E2 too low.

There are some who are anastrozole over-responders who need to take 1/4th the expected dose.

Please read these stickies:

  • advice for new guys – note first paragraph
  • things that damage your hormones
  • protocol for injections

I don’t think that you doc is insane. You are lucky that he/she is going after T+AI+hCG

Please post your lab work:
TT
FT
E2
LH/FSH - should always be done prior to TRT, all the more for young guys
prolactin
CBC
AST/ALT
TSH, fT3, fT4
DHEA-S

There should always be a focus on finding the cause of low-T for younger guys. Low-T is the symptom.


#3

You should obtain your lab results for total testosterone and SHBG.

SHBG may be low. Since SHBG’s function is to retain testosterone on the bloodstream, low SHBG can cause testosterone to be quickly excreted.

If this is the case, the problem with trying to compensate for low SHBG with high T doses is that high T doses are well-known to suppress SHBG levels. In other words, high T doses may make the problem worse: https://www.ncbi.nlm.nih.gov/pubmed/3160892

You don’t want low SHBG, which is associated with a number of long-term health problems, Here are some other conditions listed in addition to androgen use that could cause low SHBG: https://labtestsonline.org/understanding/analytes/shbg/tab/test#what

Of course you need to see the blood test result first to determine if you do have low SHBG.


#4

Thanks for your response KSman, I will read the stickies you referred me too.

Here is my lab work that was done about 3 months ago prior to ever starting TRT. I have not seen any lab work since but relied on the providers call for test/AI/hCG dosing. I have included the lab results you mentioned being important to post but also included SHBG, albumin, and cholesterol as it was low and I had read something you posted before about its importance.

TT - 583.30
FT - ? No Free T done, Using an online conversion with TT/Albumin/SGHB it comes out to 9.55 ng/dL = 1.64% and bioavailable being 249 ng/dL = 42.6 %
E2 - 24.3
LH - 5.3
FSH - 5.72
prolactin - 6.68
SHBG - 47
DHEA-Sulfate - 133 (low)

Hepatic Function Panel
Albumin - 4.8
AST (SGOT) - 18
ALT (SGPT) - 22

Thyroid
TSH - 2.25
T3 - 1.1
T3 Free - 3.6
T4 - 7.21
Thyroxine (T4) Free - 1.43

Lipid Panel
Total Cholesterol - 116 (low)
Triglycerides - 52
HDL cholesterol - 41
LDL cholesterol - 65
CHOL/HDL Ratio - 2.8
Non-HDL cholesterol - 75

CBC w/ DIFF (sorry if this is excessive, not sure what you’re looking for out of the CBC)
wbc - 5.7
rbc - 5.2
hemoglobin - 15.5 (donated 1 month after trt started)
hematocrit - 47.7
mcv - 91
mch - 30
mchc - 33
platelets - 275
MPV - 10.1
RDW-CV - 14
Neutrophils - 50
Lymphocytes - 39
Monocytes - 6
Eosinophils - 4
Basophils - 1
Neutrophil Count - 2.9
Lymphocyte Count - 2.2
Monocyte Count - 0.3
Eosinophil Count - 0.3
Basophil Count - 0.0

Thanks in advance for checking this out!!

Eml7


#5

Thanks for the response, my total test about 3 months ago was 583.30 and my SHBG from what I was told is higher at 47 nmoles/L.


#6

[quote]Eml7 wrote:
Thanks for the response, my total test about 3 months ago was 583.30 and my SHBG from what I was told is higher at 47 nmoles/L.

[/quote]

At what stage of TRT was that? Before TRT or when you just started? TRT at higher doses lowers SHBG (it changes over the course of a couple of months after a change of dose), so it may well be different now.


#7

Pre TRT lab work suggests this to me.

FSH/LH were not low.

DHEA is low, can reduce DHEA–>T inside the testes. LH/FSH were adequate.
Take 25mg DHEA every day, retest later. Take with oily meals and not with high fiber.

Pregnenolone probably low. Consider 50-100mg. Take with oily meals and not with high fiber.
Taking preg and DHEA at same time will create absorption competition, consider taking at different times. One could be with fish oil.

Your TT was not low.

SHBG could have been reduced with low dose anastrozole which might have reduced SHBG and increased LH/FSH and T.

TSH=2.25 suggests possible iodine deficiency. fT3 and fT4 good, if body temps low, check rT3.

Try to eat more eggs, cheese and other fats to attempt to increase cholesterol.

Low cholesterol may be lowering your cholesterol–>Vit-D3 production.
Take 5,000iu Vit-D3 capsules, small oil based. Take with oily meals and not with high fiber.

Suggest fish oil and other EFA’s [essential fatty acids] from nuts and flax seed meal/oil.


#8

That was before I started TRT all together. I see what you’re saying though, I will be having a more complete panel of labs done soon and will request SHBG if it’s not included. Thanks!


#9

Thanks KSman, I will focus on trying to up my cholesterol(although I do eat a high fat diet) and get DHEA in range. Your help is much appreciated!


#10

[quote]Eml7 wrote:
That was before I started TRT all together. I see what you’re saying though, I will be having a more complete panel of labs done soon and will request SHBG if it’s not included. Thanks![/quote]

You were at 500s in Test Total before TRT? If so, 300mg of Pharm test is alot. I am on 150mg, and dialing it down to 100mg. That is just me though. Just understand man, there is more than TT. As I am having effects, DHT- which you can lose hair on your head, and gain it in abnormal places on the body. Also your free test will also give an inkling to how things are.

However, I want to make sure I read that right, that your levels were normal before trt and then that dose? People can convert things differently. or example, I tend to convert to estrogen. My TT can be so super physiological that it goes over 1500 on 150mg…however, my rbcs are fine, hemoglobin fine…my liver…great. In fact the best blood work I have had in years. Problem? I convert to Estrogen and DHT.

No gyno or anyting. However, that is me. Some at those levels, their RBCs might be higher than normal at above 1500. Also, my body just started like that after years on it. So get blood work, and just pay attention to your body.


#11

Thanks for the response Bitty, I get what you’re saying, however I feel that the total test result is pretty pointless. This is my opinion based on what I have read and seen in results. For example my friend has a total test which is about 200 ng/dL lower than mine, but he also has much lower SHBG and according to http://www.issam.ch/freetesto.htm calculator he has much higher bioavailable and free testosterone compared to me simply because of a lower SHBG. (our Albumin levels were the same at 4.8 g/dL) I have been using 320 mg/week split into two injections on Mon/Thurs and have had no negative side effects at this dose, I also take 500 IU of hCG with Mondays test.