T Nation

Balls [TRT Log]


#1

Hi everyone, thanks in advance for any advice you can give me to help me do this right!


In your case/thread opening post:
-age
-height
-waist
-weight
-describe body and facial hair
-describe where you carry fat and how changed
-health conditions, symptoms [history]
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
-lab results with ranges
-describe diet [some create substantial damage with starvation diets]
-describe training [some ruin there hormones by over training]
-testes ache, ever, with a fever?
-how have morning wood and nocturnal erections changed


Age: 37
Height: 5 foot 10 inches
Waist: 34
Body/Facial Hair: Minimal to average body hair; facial hair grows normal to fairly rapidly (I shave every day though)
Fat Distribution: Less on legs and calves, more on the belly; first thing I notice when I've put on bad weight is that my face/jawline loses definition.
Health Conditions: Long-term (over ten years) anxiety and depression.
Rx & OTC: Citalopram, Neurontin, Clonazepam (tried several different meds/combos over the years; this combo works decently but kills sex drive). No hair-loss drugs ever.

Lab Results and Ranges

IGF-1: 145 (117-307)
T Total: 300 (160-726 ng/L)
SHBG: 51.2 (13-71)
Free T: 44 (47-244)
% Free T: 1.45 (1.5-3.2)
Bioavailable T: 105 (128-430)
Albumin: 4.4 (3.5-4.8)
DHEA-S: 245.0 (80-560)
E2: 29 (0-39.8)
LH: 2.2 (1.5-9.3)
PSA: 0.43 (0.00-4.00)

Diet: Roughly 35% protein, 50% carbs, 15% fat
Training: 6-7 days per week, but very short workouts. 20 minutes of weight lifting followed by 10 minutes of running.
Testes do not ache, although occasionally they hurt (once or twice per month) when I piss.
No morning wood, no spontaneous erections, no erections period without viagra or cialis.


#2

After these lab results, doc put me on 40.5mg T via Androgel.
First week: holy smokes! Spontaneous erections, this is great!
Second week: back to abnormal; no more wood
Third week: doc added 50mg Clomifene per day for a one-week trial; blood work taken at the end of the week and discontinued clomifene but continued Androgel. Subjectively did not notice any difference. Also, starting this week (and continuing), doc added prostate OTC supplement supplying 400mg Saw Palmetto per day

Lab results from one-week trial:
T up to 630
E2: 31
vitamin D (also tested) 40 (range 30-100 ng/ml)


#3

After these results, doc ended Androgel and put me on 100mg per day T via compounding-pharmacy gel; also put me on anastrozole 0.1mg sublingual mon-wed-fri

Been on that for almost one month. Workouts much better, strength is up, anxiety somewhat better, no spontaneous erections though.

Doc now added 10mg DHEA sublingual per day (worth it?) and 125mg T sublingual to be taken on occasion.


#4

Just updating my log with morning temps from the last few days (taken first thing, before getting out of bed)
10/30: 97.7
10/31: 97.6
11/01: 97.6

Should have new blood-test results w/CBC soon.


#5

What is question - btw you were feeling the boost from added test to your natural levels at beginning ( your natural test would turn off and you did not feel boost of 2x test after a while ) your T levels did not seem too bad . I would try to give your natural levels a chance again ( you will need a PCT to restart though ) having to do TRT Forever is not fun if not needed


#6

My reason for TRT is to re-gain libido. If possible, I'd also love to ditch the psych meds, but they've helped me big time. I'm in a bit of a catch-22, because I can re-gain lido by dropping lexapro, but I freak out w/out it, even now (on TRT) I'm a mess if I miss a couple days.

But also, I think 300 total T is pretty damn low for age 37. It shocked me when I found that out. So hopefully it's the root of more than one problem.

Right now, my libido is still weak, but I've no idea what my hormone levels are on my current regimen. On the other hand, I feel way more energetic, motivated, focused, and my workouts and recovery time are way better. Those are all things I did not expect. I honestly didn't realize how poor my energy, motivation, etc. was until now. Maybe these things diminished so slowly over time that I didn't notice, or maybe my hormones have been off for so long that I accepted all of this as normal.

I wanted to start a log because I'm certain that questions will come up, and from reading the stickies, I don't want to be the guy who posts a random question without providing my background.

That said, it would be great to hear from others who were able to either (1) re-gain libido while on an SSRI or (2) even better, bail on an SSRI due to normalizing hormone levels (and thereby re-gain libido). With any luck, I'll be able to get to one of those destinations, and then my experience might help someone else going through the same thing.


#7

I have recently tapered off of benzo use so I know some of where you are coming from. I think trt can help but it isn't a magic bullet at least in my case. I had low t and thought many of my symptoms were from that when in truth I think the benzo was causing most of it. I had also been on SSRIs many times in the past. It wasn't until I finally stopped the benzo that I started having consistent erections again. Ti am finding that in my case things like trt help some but it is crucial to work on the root cause of why you have anxiety and depression. Low t may fan the fire of anxiety but I'm not sure that it is always what starts the fire. There is also many anecdotal and some other reports showing that the benzos and maybe SSRIs too can cause the low t .

So I feel that in many cases you can get off the meds but you better make sure you are working hard on any core issues whether they be mental or hormones or all the above. And take it slow and get familiar with how to get off the meds when the time is right.


#8

TRT will probably never be enough to regain libido or erections while on Lexapro.

If you cannot get off Lexapro, ask your pdoc about either replacing or augmenting it with something like Wellbutrin (or a couple of other possibilities), which can help restore libido.


#9

Unfortunately, I've tried just about everything. Augmenting wellbutrin (even half-dose) makes me agitated as hell, nervous wreck. Buspirone, low to very high dosages, didn't do anything. The only one that worked was a full switch-over to Remeron. I was on that for a few years but could not hold a strenuous job b/c of mass fatigue, I gained a ton of weight on it, and (ironically) it didn't help much with anxiety. We tried a mix of Remeron and wellbutrin but it gave me a weird wired-tired feeling and lots of anxiety.

I'm always looking at new Anti-D's coming out and considering different options.

TRT has been a godsend in ways I didn't expect, I'm still crossing my fingers on the libido issue, but very happy with the changes so far.


#10

Where are you? If you are in a country where you have access to agomelatine or tianeptine, those would be possibilities. They don't affect libido and may even improve it. Moclobemide is another one available outside the U.S. that tends to preserve or improve libido.

For some reason it almost seems to be a requirement for an AD to make you asexual for it to be approved in the U.S. :slight_smile: If in the U.S., augmenting your current regimen of lexapro with a low dose of remeron may feel better than your experience on remeron alone. Augmentation of lexapro with pramipexole is another possibility - pramipexole has been shown to be helpful for SSRI-related sexual dysfunctions. Another possibility is augmenting remeron with a stimulant. I know what you mean about the Wellbutrin - it did the same to me. Another possibility to investigate may be a MAOI. Selegeline is a mild one without the dietary restrictions of the older MAOIs and is widely considered prosexual.


#11

Thanks, I haven't tried agomelatine or tianeptine, I'll look into those. Moclobemide is hard to get in the US but I did get my hands on some several years ago. I had a rough experience with it, but I think I transitioned too quickly from lexapro to it; my doc says my symptoms back then sounded like too much serotonin (not serotonin syndrome but going in that direction). I'd try that one again but yeah, tough to get. My doc might be willing to prescribe if I can get it from Canada or overseas, I'll start searching for that, had forgotten about it. Thx again.


#12

Still tweaking meds to get libido back. Short story there is that I've had a lot of success with a combo of (1) TRT and (2) low-dose buspirone. Still on lexapro, as attempts to cut back or switch have not gone well.

My doc wants to alternate between T-replacement months and HCG months (w/out T-replacement). Seems like a decent idea. After a couple months with bloodwork, I've two questions:

First, for the T-replacement months (which are entirely via transdermal gel) should I be worried about the high DHT number (no hair loss that I've noticed, but the number seems awfully high)?

Second, for the HCG months, I was shocked to see low WBC, but now I see some reference to it on the web: http://anthonycolpo.com/reader-mail/ (?The ability of HCG and its variants to impede white blood cells is critical not only for embryo survival, but helps tumours to grow and spread without being attacked by the patient?s normal immune response to disease. http://www.cancerbacteria.com/trial.html#current?)
Does the purported connection seem like bs? Or if it not, how have people dealt with this?
Labs below, feedback much appreciated

T Gel

T: 787 (348 ? 1197)
DHT: 98 (30-85)
E2: 34.4 (7.6 ? 42.6)
WBC 3.7 (3.4-10.8)

HCG

T: 1110 (348 ? 1197)
DHT: 55 (30-85)
E2: 31.9 (7.6 ? 42.6)
WBC 3.3 (3.4-10.8)


#13

Can anyone explain this? Maybe I'm reading it wrong. Take a look at the chart about 3/4 quarters of the way down the page at the link below. It seems to indicate that, over the course of a quarter year or a full year, 60.75 mg of Androgel per day is more effective than 81 mg per day.

http://www.rxlist.com/androgel-162-drug/clinical-pharmacology.htm


#14

I do not see what you are finding. But you need to know that those dose results represent two different groups of men and it is not unusual to find some significant differences across groups, even when randomized.


#15

Thanks KSman. I was looking at table 5 under Clinical Studies. What you're saying makes sense though, the fellas who took 81 mg were a different group than the guys who took 60.75 mg, so maybe the second group just absorbs it less effectively. I was thinking that maybe the body (or skin) begins to resist absorption over time with higher doses.


#16

Saw Palmetto can cause loss of libido and other sexual problems similar to those caused by finasteride.

Are you saying the Buspar increased your libido?


#17

Thanks Seekonk. Good to know re saw palmetto--I'll bail on that one.
Yes, buspar helps me with libido. Ssris screw with dopamine release, which screws with libido. Low dose buspar helps mitigate that. There are some rat studies supporting the relationship between low dose buspar and dopamine--I'd forward but am on handheld.
It doesn't blast dopamine like wellbutrin, but that one makes me nervous as hell, so buspar is what I'm working with


#18

Anyone know roughly how much of a PSA spike could happen when you have sex the night before a blood test? I haven't gotten my lab results back yet, but I'm realizing I did this, and just want to know the range of what I can expect. Thanks.


#19

Forgive me if this is somewhere in the stickies; I did look there’s just quite a bit to re-read and I’m not sure I ever nailed this down. But if you’ll indulge me: I’m confused about the relationship between Hcg and LH. Does Hcg replicate LH (in which I would expect a drop in the latter), or does it stimulate it (in which I’d expect the opposite). I guess, is there any reason to test for LH other than before beginning HRT? Or is progesterone the only one worth testing to see if the equipment is still working?
Many thanks

Oh, and Ksman, I do see your “-DO NOT routinely test for LH/FSH when on TRT, perhaps once to rule out certain testicular cancers and never again” in the lab sticky, just curious for elaboration or clarification. Again, responses appreciated from anyone with a reasoned opinion.


#20

Cholesterol question:

I’d like to temporarily shave away a chunk of this question just to focus on HRT/TRT issues. I have mildly low overall cholesterol (lipids are great, all else looks good too). I imagine in-range cholesterol is good for lots of things aside from hormone production, but let’s put those to one side for a moment. Here’s my question:

I know cholesterol is tremendously important for hormone production for those not on hormone replacement. I speculate that low levels are of no consequence to those on straight T replacement. But I’m stumped when Hcg enters the picture. Part of me thinks–no, no consequence, because Hcg mimics luteinizing hormone–way down the chain to T production. Then I think, well hang on, cholesterol is building block, and perhaps it’s important to have adequate building blocks all down the line to get the best response from Hcg.

Your thoughts are much appreciated, especially if (probably a long shot), this or close to it has been studied.

On the other issue I shaved off: normal-range cholesterol for other health issues. Feel free to chime in on it if you must, but I will be going over these results and any dietary modifications I should/shouldn’t make with my primary-care physician (who’s a really good doctor, not a quack or even one who feels comfortable advising on male HRT issues).

Thanks!